How pharmacy and retail health can support health and wellness. Nancy Gagliano Chief Medical Officer, MC September, 2014

Transcription

1 How pharmacy and retail health can support health and wellness Nancy Gagliano Chief Medical Officer, MC September, 2014

2 2 An important decision for public health

3 Current Health Care Challenges The State of health and wellness is changing in America due to several factors: Increased prevalence of chronic disease Aging population Obesity epidemic Health insurance reform Primary care shortage Cost Quality Access Employer focus on prevention & wellness 3

4 The US Faces a Shortage of More than 90,000 Doctors by 2020 Shortage = 91,500 Source: AAMC center for Workforce Studies, June 2010 Analysis * Total includes primary care, surgical and medical specialties

5 Positioned to Support Physicians and Health Systems RETAIL HEALTH Acute Minor Illness Reduce Emergency Room Provide Access and increase PCP capacity Wellness Vaccinations Smoking Cessation Weight Loss Chronic Care Support Disease Screening, Monitoring and early intervention PHARMACY Adherence First Fill Counseling Refill Reminders Provider information Chronic Disease Support Pharmacy Advisor Gaps in Care Screening and Monitoring Services Vaccinations

6 Current Health System Affiliations

7 Percent Persistent (%) Only Half of Patients Adhere to Evidence-Based Drugs Prescribed by Physicians* Consistently observed for multiple diseases and drugs Percent of patients who were adherent 6 months after initiation: Oral Antidiabetics: 66% ARBs: 63% Statins: 56% After a heart attack, patients still only adhered to half of the essential medications they were prescribed** Oral antidiabetic ARB Statin Months following initiation *Source: Yeaw J, Benner J, et al. J Manage Care Pharm 2009;(9): **Source: Choudhry, Shrank. NEJM 2011

8 Better Pharmacy Care: Investing in Adherence Improves Outcomes Productivity Savings Medical Savings Additional Rx Spend Medical and Productivity Savings (PMPY) Lipid Lowering Net Savings: $2,710 Diabetes Net Savings: $5,227 $1,470 Hypertension Net Savings: $5,247 $1,339 $1,451 $1,860 $4,413 $4,337 Annual Pharmacy Investment per Adherent Member $601 $656 $429 Sources: Roebuck MC, Liberman JN, Gemmill-Toyama M, Brennan TA. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Affairs. 2011;30(1): Carls GS, Roebuck MC, Brennan TA, Slezak JA, Matlin OS, Gibson TB. Impact of medication adherence on worker productivity: an instrumental variables analysis in five chronic diseases. Joem

9 Retail Pharmacies Opportunities COMPREHENSIVE INTERVENTIONS TO SUPPORT ADHERENCE RETAIL CHAIN PERFORMANCE* Our core adherence interventions include: New Script Pickup First Fill Counseling Refill Reminder 80 CVS Top 3 Competitors Medication Possession Ratio (%) Adherence Outreach Additional focus on generic substitution can improve adherence by 7%* 230+ million interventions have helped drive adherence results *Source: CVS Caremark Quarterly Adherence Report. In press: Annals of Internal Medicine 2014

10 Pharmacy Advisor Counseling: Focused on Improving Chronic Medication Management TARGETS 10 COMMON CHRONIC CONDITIONS Asthma Breast Cancer CHF COPD Coronary Artery Disease Depression Diabetes Dyslipidemia Hypertension Osteoporosis 3 KEY COMPONENTS Proactive outreach triggered by key events in medication therapy in particular gaps in care and failure of adherence Pharmacists provide one-on-one counseling by phone and faceto-face Responsive, clinical telephonic outbound support for all targeted patients Focus, access and expertise to support chronic disease management

11 Groundbreaking Advances in Adherence Achieved with Pharmacy Advisor Counseling NON-ADHERENT MEMBERS WITH DIABETES WHO MOVED TO OPTIMAL ADHERENCE 1* 55.9% 56.9% 52.7% 48.7% 46.5% 46.7% 43.5% 38.8% ORAL ANTIDIABETICS ACE INHIBITORS ARBS LIPID-LOWERING MEDICATIONS PHARMACY ADVISOR COUNSELING CONTROL *2012, Statistically significant. P-value < Pharmacy Advisor and control group populations are matched and include other adherence programs implemented by clients. 1. CVS Caremark Enterprise Analytics; Evaluating the Impact of Pharmacy Advisor on Adherence and Gaps in Care, 2013.

12 Closing Gaps in Care 2 Next fill flagged 1. Pharmacy Advisor Engine identifies diabetic patient without an ACEI or an ARB 3 Prompts pharmacist counseling at pick-up Pharmacy Advisor Counseling 7 Ongoing monitoring and follow-up 6 Pharmacist counsels member on first fill 5 Pharmacist discusses gap in care with doctor 4 Pharmacist counsels member on gap in care; average five minutes

13 MinuteClinic Provides Access to High Quality Care at a Lower Cost 900+ full time clinics in 29 states with over 20M visits to date 50% of patient visits occur after 5pm or during weekends THE FIRST AND LARGEST RETAIL HEALTH CARE PROVIDER TO BE ACCREDITED BY THE JOINT COMMISSION Up to 80% savings over higher costs of care 85% of patients use third party coverage 50% of patients indicate no PCP Walk-in care, 7 days per week including evenings 92% overall patient satisfaction 1 Largest employer of Nurse Practitioners Over 2,300 NPs 1. Press Ganey Satisfaction Survey Results, 2012.

14 MinuteClinic Suite of Services Extended to Enable Better Population Management EXPANDING ACCESS TO LOWER-COST, HIGH-QUALITY HEALTH SERVICES ACUTE CARE Practitioners treat and prescribe medications, when appropriate, for common illnesses and minor injuries Allows physicians to continue providing high-quality care for more complex patient needs CHRONIC CONDITION MONITORING for after-hours care Helps patients effectively manage conditions Supports clinical quality improvement initiatives and closes gaps in care Convenient monitoring services include patient education and counseling SERVICES TO COMPLEMENT HEALTH MANAGEMENT STRATEGIES PREVENTIVE Easily accessible for chronic disease screenings, vaccinations, etc. Complete Health Review*: for year old population to obtain data for health status assessment and risk adjustment WELLNESS Determine health conditions/issues through screenings Evidence-based smoking cessation and weight loss programs Identify patients without PCP and provide resource list Source: An Annals of Internal Medicine study compared costs and quality of care for common illnesses: Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses, Annals of Internal Medicine, August, N = 2,100 care episodes (700 of each) compared across venues. *Complete Health Reviews. Not available in all areas. Requires 90-day implementation

15 Minute Clinic Delivers High Quality Care QUALITY OF CARE FOR 3 COMMON ACUTE CONDITIONS AMONG 75,886 EPISODES OF CARE, 20,153 WERE ELIGIBLE FOR AT LEAST ONE QUALITY MEASURE. Percent Success by Index Condition 75.8% 63.2% 58.3% 55.7% 53.9% 51.2% 47.8% Total Percent Success 71.9% 51.9% Minute Clinic Ambulatory Visit Emergency Department 49.4% 23.0% 21.3% Otitis Media Pharyngitis Urinary Tract Infection 15

16 MinuteClinic Generates Significant Cost Savings COMPARING COSTS AT POINTS OF CARE FOR THREE COMMON ILLNESSES 1 80% of adults visit the ER due to lack of access to other providers 2 MinuteClinic costs are less than other settings by 40% to 80% 1. Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses, Annals of Internal Medicine, August, N = 2,100 care episodes (700 of each) compared across venues. 2. Emergency Room Use Among Adults Aged 18-64: Early Release of Estimates From National Health Interview Survey, January-June 2011, CDC,

17 MinuteClinic Aligns Wellness & Chronic Care Services to Support the Medical Home Wellness/Monitoring Chronic Conditions MinuteClinic Support Chronic Disease Wellness Programs Identify modifiable risks through Biometric Screening Program Focus on smoking, weight, exercise, stress reduction Education, Behavioral Coaching, and prescriptions where appropriate to help patients reduce risks Worsening Health Status Goals for MinuteClinic Wellness & Chronic Care Services: Help patients reduce modifiable risks prior to developing more serious health problems Help patients identify and manage chronic disease in the early stages prior to serious complications developing Support primary care medical home through referral of patients and co-management with PCPs Reduce overall health costs through early identification and treatment Close gaps to support continuity of care as measured by HEDIS & STAR

18 MinuteClinic Weight Management Program

19 Smoking Cessation Program at MinuteClinic Readiness Assessment: Complete assessment and customized plan together with patient Medication Support: If appropriate prescribe Chantix, Zyban, NRT Education: Give the customer the program brochure, Quit Card, and customized plan Coaching: Provide ongoing in-person coaching, including follow up visits as appropriate 3-8 visits

20 Support for Chronic Condition Care Provide convenient access to routine tests, results and education for those diagnosed with diabetes, high cholesterol, high blood pressure or asthma. Complements the primary care provider Supports health management and improves adherence to standards of care Currently Performed at MinuteClinic, most could be performed by pharmacist b

21 Example of Regulatory Challenges ANP REGULATIONS VARY GREATLY STATE TO STATE NP to Physician Collaboration Ratio TN VA SC FL No Ratio Change from 4 to 1 to 6 to 1 (FTE) 3 to 1 (FTE) 4 to 1 (simultaneous) Physician Supervision onsite requirements VA AL LA Recently removed Onsite required Considering adding Other GA KY Limited Prescriptive Authority Chronic Care Restrictions 21