9/25/15. Pharmacy Quality Measures: Financial Support. Learning Objectives. Speaker Disclosure. Access to Preferred Networks and Clinical Performance
|
|
- Ruth Gaines
- 5 years ago
- Views:
Transcription
1 Pharmacy Quality Measures: Action Steps for Improvement Financial Support Financial support was provided for this activity through an unrestricted grant from Health Mart Systems, Inc. Christine Jacobson Wasatch Pharmacy Care 2 Speaker Disclosure Learning Objectives Christine Jacobson is an owner of a Health Mart pharmacy. The speaker otherwise does not report any actual or potential conflicts of interest in relation to this continuing pharmacy education activity. Off-label use of medications will not be discussed during this presentation. CEI has taken appropriate action for conflict resolution, including external review by a non-conflicted peer reviewer. Pharmacist Learning Objectives Explain why quality performance matters for health plans, pharmacies and patients Recall five key quality measures for pharmacies, performance goals and general action steps for improvement Evaluate your pharmacy s specific performance on the five key quality measures Develop a pharmacy-specific action plan to improve performance on a specific quality measure Technician Learning Objectives Explain why quality performance matters for health plans, pharmacies and patients List five key quality measures for pharmacies Assist the pharmacist in evaluating your pharmacy s specific performance on the five key quality measures 3 4 Personal Learning Objectives Access to Preferred Networks and Clinical Performance Three things you would like to learn today: Preferred networks will continue to grow Continued tradeoff of lower reimbursement rates for access to preferred networks Clinical performance is becoming increasingly important and Star Ratings are a focus area Clinical performance may be the best chance for independent pharmacies to compete 3. 5 Sanger-Katz, M. New York Times. A Health Trade-Off That s Here to Stay: Lower Cost, Limited Choice. July 29, Accessed 08/05/2014. McKinsey & Company. McKinsey Center for U.S. Healthcare Reform. Hospital networks: Updated national view of configurations on the exchanges June Accessed 08/05/
2 Why is Clinical Performance Important? Criteria for pharmacy inclusion in preferred networks Historic Future: Coverage Consumer brand Cost + Clinical performance Operational performance Certification / compliance Who is clinical performance important to? Payers and PBMs Pharmacies Patients Reid RO, Partha D, Howell BL, and Shrank WH. Association Between Medicare Advantage Plan Star Ratings and Enrollment. JAMA. 2013;309(3): Cost and Clinical Quality Criteria for Access to Preferred Networks Sponsor intends to limit the Preferred Network to pharmacies that can provide both the quality level of service and care reflected in the STAR activity and a competitive cost structure for medications Criteria Network scale Generic dispensing rate Marketing investment Competitive rates/open to new benchmarks Openness to clinical performance incentives Positively impact Star ratings Recent RFP example Network Expectation Broad beneficiary access to retail network Achieve industry standard GDR or higher Participate in / contribute towards marketing the plan Willingness to experiment Willingness to enter into pay-forperformance reimbursement model Ability to drive high performance on star ratings 8 Centers for Medicare and Medicaid Services (CMS) Star Ratings Annual rating system to grade Medicare plans 2015 bonus payments, based on 2014 ratings, which were based on data Star Ratings Measures Star Rating Performance Level Poor Below Average Average Above Average Excellent Centers for Medicare & Medicaid Services. Prescription Drug Coverage General Information. PerformanceData.asp. Accessed 08/06/ Star Ratings: What is the Same? 2015 Key Star Rating Measure Goals Four key Part D quality measures for pharmacies to focus on remain the same: Adherence: Proportion of Days Covered (PDC) PDC: Statins Alternative Therapy Use of High-Risk Medications in the Elderly Measure RASA PDC (ACE/ARB PDC) Goal Direction 5-Star Goal % 1 * 2015 Top 20% 2 ** 85% 92.3% PDC: Statins 83% 91 % PDC: Diabetes 81% 90.4% PDC: Oral Diabetes Medications High-Risk Medications in the Elderly 7% 3.3% PDC: Hypertension (Renin-angiotensin system antagonists or RASA) enters for Medicare and Medicaid Services. Part C and D Performance Data Star Ratings Measure List. Accessed 08/05/ *Based on 2015 CMS 5-Star Goals for MA-PD plans, subject to change with each plan year, and in addition, individual payers may set their own goals relative to specific initiatives **Top 20% of retail pharmacies as reflected in EQuIPP (Data Range: October 2014-March 2015). Centers for Medicare and Medicaid Services. Part C and D Performance Data. Trends in Part C & D Star Rating Measure Cut Points. Accessed 5/30/15. Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at (Data Range: 2015). Accessed 05/30/
3 Star Ratings: What Is Changing? Centers for Medicare and Medicaid Services (CMS) has made the following changes: Retired Diabetes Treatment Measure New Full Measure Comprehensive Medication Review New Display Measure Statin Use in Diabetes Quality Measures: Expansion Expansion of quality measures to new populations Accreditation Commercial Health Insurance Exchanges Medicaid Display 2017 Full PQA Quality Connection. PQA Adherence Measure to be included in 2015 Quality Rating System Beta Test Measure Set. August 5, Accessed 08/05/ Adherence: Proportion of Days Covered Quality Measures: Action Steps for Improvement How is PDC calculated? Percentage of Medicare Part D patients 18 years of age or older covered by prescription refill records for the same medication or another in the therapeutic category during the measurement period Only patients with at least 2 fills of the intervention drugs are included What medications are included? Statins Oral Diabetic Medications Renin-angiotensin system (RAS) antagonists Centers for Medicare & Medicaid Services. Medicare 2015 Part C & D Star Rating Technical Notes. Accessed 08/30/ Adherence: Action Steps Adherence: Action Steps Identify non-adherent patients Targeted interventions Run reports Proactive drug utilization review Discuss with patient Leverage behavioral coaching Health Mart. Pharmacy Quality Measures: Improving Performance Playbook. Reviewed by Pharmacy Quality Solutions. Available at: Accessed 08/09/ Based on cause(s) for non-adherence, select the right tool or action: Cause for Non-Adherence Do not know why I need to take the medication Forget to order refills Forget to take each day Inconvenience of multiple medications and multiple trips to pharmacy Intolerable side effects Cost Solution Disease-state medication counseling using motivational interviewing approach Use electronic refill reminders Dose reminders, or if multiple meds, compliance packaging Medication synchronizations Therapeutic interchange/prescriber collaboration Therapeutic interchange, formulary review, patient assistance programs 18 3
4 9/25/15 High-Risk Medications (HRM) in the Elderly High-Risk Medications (HRM) in the Elderly: Action Steps How is it calculated? Patient identification Percentage of patients 65 years of age or older who received two or more fills of a prescription for a high risk medication during measurement period Prospective is key! Discuss with patient Prescriber communication What medications are included? Specific list of high risk medications in the elderly (subset of Beers Criteria) Example included below, full list included as Appendix Evidence: Beers Criteria Update Centers for Medicare & Medicaid Services. Medicare 2015 Part C & D Star Rating Technical Notes. Accessed 08/30/14. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc Available at: Accessed 08/07/ The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc Available at: Accessed 08/07/ Key Takeaways on Impacting the Measures Diabetes treatment Adherence High-risk medications Retired: Shift focus to other measures and CMR completion Personalizing the solution and consistent follow-up Prevention of fill or refill is key Health Mart. Pharmacy Quality Measures: Improving Performance Playbook. Reviewed by Pharmacy Quality Solutions. Available at: Accessed 08/09/14. EQuIPP : Evaluating Pharmacy Performance 21 Who has EQuIPP access to see their pharmacy specific performance? EQuIPP: Store Selection of Goal Set Getting Started: Select CMS Threshold (5-Star Goals) Taking Performance to the Next Level: Select Top 20% 23 Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at
5 EQuIPP: Pharmacy Performance Report Trend Line Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 25 Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 26 Pharmacy-Specific Performance Goal and Gap Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 27 Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 28 Versus Others Analyze Performance Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 29 Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at
6 Analyze Performance Pharmacy Performance Improvement Example Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at 31 Sample Pharmacy Performance Report Action Steps What? Patient identification How? Within workflow Outside of workflow Completing targeted interventions Pharmacy management system reporting Vendor solutions Resources Measure-specific HRM list Patient target lists Action Steps Action Steps What? Discussion of potential risks with patient How? Leveraging behavioral coaching techniques Open ended questions Resources Coaching guides Behavioral coaching education What? Prescriber communication How? Consider leveraging a prescriber fax template 3-day follow-up call Special outreach to select prescribers office Resources Review evidence-based guidelines Fax templates 6
7 Sample Pharmacy Performance Improvement Quality Performance Action Planning Evaluating Your Pharmacy Performance Take Action Exercise Write in your pharmacy s performance scores Consider Which measures is your pharmacy doing well in? Which measures is your pharmacy below goal on? How many patients would you have to impact to get to goal on those measures? Consider pharmacy specifics that may be impacting your numbers Circle the measure(s) that your pharmacy would like to improve on Select an initial action step(s) CE Claim Credit Instructions Questions? CE can be redeemed with The Collaborative Education Institute (CEI) at Follow the instruction sheet and enter the unique code provided for this specific program and date Redeem your CE as soon as possible but no longer than 60 days from today CPE Access Codes: (Case sensitive) Pharmacists Technicians c2n8c t3jzp 42 7
8 9/25/15 THE HEALTH MART STRATEGY We re leveling the playing field so you can grow your business. Health Mart is the largest network of independent pharmacies in the nation. We re strong, yet flexible, and we re here to fuel your success. HEALTH MART CALL TO ACTION THE HEALTH MART DIFFERENCE Gain Access to Preferred Networks Bring Patients to Your Store Expand Your Services for More Revenue BUILT ON THE STRENGTH OF McKESSON Count on Reliable Distribution ROAD TO IMPROVED PHARMACY PERFORMANCE: KEY RESOURCES* YOUR PHARMACY S PERFORMANCE ADHERENCE SOLUTIONS TOOLBOX PROMOTIONAL TOOLBOX CO-PILOT Pharmacy Quality Measures: Driving Improved Pharmacy Performance Playbook (with case studies) Health Mart University: CE courses on quality measures, health coaching, MTM, Med Sync, disease state-specific, and more EQuIPP Enrollment How to Read Your EQuIPP Dashboard Guide Health Mart MRA Program (AccessHealth ) Adherence Performance Solution (McKesson Pharmacy Systems & Automation) Behavioral Coaching: Pharmacy Intervention Program Medication Synchronization Medication Therapy Management Refill and Pill Reminders: Your Pharmacy OnlineSM Health Mart Marketing Hub Health Mart Exclusive Partnership: Pharmacy Development Services (PDS) SyncRx and SyncRx + HEALTH MART EXCLUSIVE Physician Outreach Program Improve Your Bottom Line Boost Your Efficiency Plan for Your Future HEALTH MART: TOP 20% PHARMACIES ACTION PLANNING AND EDUCATION TOOLBOX HEALTH MART EXCLUSIVE Optimize Your Generics HEALTH MART EXCLUSIVE * For additional resources and education please visit Health Mart Operations Manual & Health Mart University Health Mart Named Pharmacy Innovator of the Year by Chain Drug Review! HEALTH MART: TOP 20% + PHARMACIES WITHIN 5% 47 8
9 9/25/15 Early Bird Registration Open Now! Register by March 20 and Save $100! ACTION STEPS 1 2 Monitor your pharmacy s specific performance with EQuIPP Enroll if you haven t already included in Health Mart and AccessHealth memberships! Check your Pharmacy Performance Report monthly Utilize your Quality Improvement Action Plan to begin taking action in the next 30 days Visit to learn about discounted pricing, our schedule of events, and to register for the show! Complete available Medication Therapy Management Case 3 Learn, Collaborate and Network Mirixa: or Outcomes: or QUESTIONS? Contact your Retail Sales Manager or HealthMartOperations@McKesson.com 9
Medicare Star Ratings and the Shift to Quality- Based Payment Models. David Nau, RPh, PhD, FAPhA PQS President
Medicare Star Ratings and the Shift to Quality- Based Payment Models David Nau, RPh, PhD, FAPhA PQS President The shift to Value-Driven Healthcare The U.S. health care system is rapidly moving to value-based
More informationHow Independent Pharmacies Can Use Medicare Star Ratings to Improve Their Businesses
How Independent Pharmacies Can Use Medicare Star Ratings to Improve Their Businesses We are in a new, changing healthcare environment that is affecting every stakeholder in the market hospitals, doctors,
More informationPHARMACY QUALITY MEASURES: Improving Performance Playbook
PHARMACY QUALITY MEASURES: Improving Performance Playbook Table of Contents How to Use This Resource 4 Why Performance Measures Matter to Your Pharmacy 5 The Medicare Star Ratings System 5 For More Information
More informationPATIENT-IMPACT SCORECARD
UNDERSTANDING THE GSC PATIENT-IMPACT SCORECARD What is the GSC Patient-Impact Scorecard? The GSC Patient-Impact Scorecard shows pharmacy performance scores for GSC patients during the period indicated.
More information116th Annual Convention
116th Annual Convention Date: Tuesday, October 21, 2014 Time: 8:30 am 10:00 am Location: Austin Convention Center, Room 17AB, Level 4 Title: Activity Type: Speaker: Medicare Part D Star Ratings What They
More informationUSING MTM TO IMPROVE STAR RATINGS : CASE STUDIES
USING MTM TO IMPROVE STAR RATINGS : CASE STUDIES Sept 13, 2015 Amanda Applegate, PharmD, BCACP Disclosures Nothing to disclose Learning Objectives Describe how MTM can improve star ratings Discuss strategies
More informationUnderstanding Your Patient Care Opportunity Report (PCOR)
Understanding Your Patient Care Opportunity Report (PCOR) Use your January/February 208 PCOR to help improve performance on Medicare Part D Clinical Star Ratings measures. Your January/February 208 Patient
More information2015 Annual Convention
2015 Annual Convention Date: Tuesday, October 13, 2015 Time: 8:00 am 9:30 am Location: Gaylord National Harbor Resort and Convention Center, National Harbor 2 Title: Activity Type: Speaker: Benefit from
More informationLegislative & Regulatory Update Brad Young, RxPlus Government Affairs
Legislative & Regulatory Update 2018 Brad Young, RxPlus Government Affairs Disclosures Brad Young reports no actual or potential conflicts of interest associated with this presentation. 2 Learning Objectives
More informationPolling Question # 3. DISCLOSURE STATEMENT Pharmacy Immunizations How to Stay Competitive and in Compliance LEARNING OBJECTIVES
DISCLOSURE STATEMENT Pharmacy Immunizations How to Stay Competitive and in Compliance R. JEFFREY HEDGES President & CEO I, Jeff Hedges, disclose that I am employed as a consultant at R.J. Hedges & Associates.
More informationNote: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis.
COMMUNITY PHARMACY V1.1 MANDATORY S Note: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis. # NAME DESCRIPTION NUMERATOR DENOMINATOR
More informationCost-Effective Process to Improve Drug Adherence for Medicare 5-Star
Cost-Effective Process to Improve Drug Adherence for Medicare 5-Star HEALTH ALLIANCE PLAN Presented by Vanita K. Pindolia, Pharm.D. VP, Ambulatory Clinical Pharmacy Programs_PCM Medicare 5-Star Rating
More informationInnovative Opportunities for Pharmacists in the Evolving World of Healthcare
Innovative Opportunities for Pharmacists in the Evolving World of Healthcare Christina Pornprasert, PharmD Population Health Clinical Pharmacist Hartford Healthcare Integrated Care Partners Assistant Clinical
More informationTHE GROWTH OF SPECIALTY PHARMACY
UnitedHealth Center for Health Reform & Modernization THE GROWTH OF SPECIALTY PHARMACY Current trends and future opportunities Issue Brief April 2014 Summary Innovative specialty drugs are providing important
More informationThe Value of Walgreens
The Value of Walgreens How Walgreens improves employer health plans through access, quality and lower costs Why millions of patients choose Walgreens And your options to move forward with Walgreens Walgreens
More informationDrug Therapy Management
Measures At A Glance Updated: 11/01/2018 2018 Page 1 of 9 Mandatory Measures (10) Note: Mandatory measures are those measures that are a requirement of accreditation and must be reported to on an annual
More informationPBMs: Impact on Cost and Quality of Pharmaceutical Care in the U.S.
Speaker Brian K. Solow, MD, FAAFP Optum Life Sciences Irvine, CA, USA PBMs: Impact on Cost and Quality of Pharmaceutical Care in the U.S. Brian K. Solow, MD, FAAFP Chief Medical Officer, Optum Life Sciences
More information2017 URAC PHARMACY BENEFIT MANAGEMENT PERFORMANCE MEASUREMENT: AGGREGATE SUMMARY PERFORMANCE REPORT
2017 URAC PHARMACY BENEFIT MANAGEMENT PERFORMANCE MEASUREMENT: AGGREGATE SUMMARY PERFORMANCE REPORT December 2017 Table of Contents Executive Summary... 1 Pharmacy Benefit Management Organization Characteristics...
More informationStatement Of. The National Association of Chain Drug Stores. For. U.S. House of Representatives Committee on the Budget.
Statement Of The National Association of Chain Drug Stores For U.S. House of Representatives Committee on the Budget Hearing on: 2:00 p.m. 210 Cannon House Office Building National Association of Chain
More informationNote: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis.
Note: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis. DESCRIPTION NUMERATOR DENOMINATOR DM2012-12 Portion of Days Covered
More informationRxVACCINATE: A National Education and Practice Support Initiative to Increase Pharmacist Administered Pneumococcal Vaccinations.
RxVACCINATE: A National Education and Practice Support Initiative to Increase Pharmacist Administered Pneumococcal Vaccinations. Pfizer Grant 45130: LOI Pneumococcal Disease Prevention Grant ID: 45130
More informationRethink. Adherence. David D. Pope, PharmD, CDE Editor-in-Chief, CreativePharmacist.com Brands
Rethink. Adherence. David D. Pope, PharmD, CDE Editor-in-Chief, CreativePharmacist.com Brands Objectives Identify patient barriers to medication adherence. Describe the clinical and economic impact of
More informationMEASURE STEWARD Pharmacy Quality Alliance (PQA) D ATA SOURCE Enrollment; U R A C DOMAIN Engagement & Experience of Care
MANDATORY S Note: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis. DM2012-12 DTM2015-01 Portion of Days Covered (PDC) Adherence
More information3/17/2017. Innovative Opportunities for Pharmacists in the Evolving World of Healthcare. Elderly represent about of our emergency medical services:
Innovative Opportunities for Pharmacists in the Evolving World of Healthcare Christina Pornprasert, PharmD Population Health Clinical Pharmacist Hartford Healthcare Integrated Care Partners Addolorata
More informationPHARMACY BENEFITS MANAGER SELECTION FAQ FOR PRODUCERS
PHARMACY BENEFITS MANAGER SELECTION FAQ FOR PRODUCERS For Producer Audience Only - Please Do Not Distribute Regence has selected Prime Therapeutics as the Pharmacy benefits manager for its health plans.
More informationMail Service Pharmacy
Mail Service s At A Glance Disclaimer: reserves the right to update its measures and measure sets to maintain measure relevancy and to remedy any unintended consequences that may arise during implementation.
More informationStatement Of. The National Association of Chain Drug Stores. For. U.S. Senate Committee on Finance. Hearing on:
Statement Of The National Association of Chain Drug Stores For U.S. Senate Committee on Finance Hearing on: 10:00 a.m. National Association of Chain Drug Stores (NACDS) 1776 Wilson Blvd., Suite 200 Arlington,
More informationVaccine Starter Kit Program FAQs
Vaccine Starter Kit Program FAQs Program How does this program help Health Mart pharmacies provide vaccines for their customers? McKesson has designed a comprehensive program specifically for Health Mart
More informationJefferies Healthcare Conference. June 2016
Jefferies Healthcare Conference June 2016 Today s Speakers John Figueroa Chief Executive Officer Vic Breed Chief Financial Officer Joined Genoa in July 2014 Previously served the dual roles of CEO of Apria
More informationMedication Therapy Management Solution
Medication Therapy Management Solution A Medicaid Case Report It s often challenging to include evidencebased clinical programs that offer financial benefits. However, pharmacotherapy is central to the
More informationPharmacy Benefit Management
Benefit Management Measures At A Glance Updated: 10/8/2015 Page 1 of 7 Benefit Management Mandatory Measures (6) Note: Mandatory measures are those measures that are a requirement of accreditation and
More informationPayment Innovation and Health Center Dental Programs: Case Studies from Three States
Payment Innovation and Health Center Dental Programs: Case Studies from Three States January 2018 CONTENTS California-2 Iowa-3 Implementation-2 Clinical Practice Implications-2 Implementation-4 Clinical
More informationHow Mail-Servi. Prepared for
How Mail-Servi ice Pharmacies Will Save $46.6 Billion Over the Next Decade and the Cost of Proposed Restrictions Prepared for February 2012 Table of Contents I. Executive Summary... 3 Major Findings on
More informationA COMPREHENSIVE APPROACH TO MANAGING DIABETES
A COMPREHENSIVE APPROACH TO MANAGING DIABETES Programs and services to help individuals avoid costly complications and improve outcomes 2 0 1 8 ENTER Supporting each member with targeted guidance and services.
More informationMedication Therapy Management: Improving Health and Saving Money
Medication Therapy Management: Improving Health and Saving Money Ed Staffa, RPh Vice President, Pharmacy Mirixa Corporation estaffa@mirixa.com July 23, 2008 MTM At A Glance The U.S. health care system
More informationSTARS SYSTEM 5 CATEGORIES
TMG STARS 2018 1 2 STARS Program Implemented in 2008 by CMS. Tool to inform beneficiaries of quality of various health plans 5-star rating system Used to adjust payments to health plans (bonus to plans
More informationStatement Of. The National Association of Chain Drug Stores. For. U.S. Senate Finance Committee. Hearing on:
Statement Of The National Association of Chain Drug Stores For U.S. Senate Finance Committee Hearing on: 10:30 a.m. 215 Dirksen Senate Office Building National Association of Chain Drug Stores (NACDS)
More informationJanuary 16, Dear Administrator Verma:
Ms. Seema Verma Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMMI New Direction P.O. Box 8011 Baltimore, MD 21244-1850 Re: (CMS-4182-P) Medicare
More informationIntroducing ValueOptions Clinical Care Alerts
Introducing ValueOptions Clinical Care Alerts January 2013 Agenda What are Clinical Care Alerts? How does it work? What are the benefits? Questions and Answers 2 The Issue of Poor Medication Adherence
More informationPREVENTATIVE COMMUNITY PHARMACY DIABETES MANAGEMENT PROGRAMS BROOKE HUDSPETH, PHARMD, CDE, MLDE KROGER DIABETES CARE
PREVENTATIVE COMMUNITY PHARMACY DIABETES MANAGEMENT PROGRAMS BROOKE HUDSPETH, PHARMD, CDE, MLDE KROGER DIABETES CARE DISCLOSURE STATEMENT Brooke Hudspeth is employed by The Kroger Co. No other conflicts
More informationQuality Metrics & Immunizations
Optimizing Patients' Health by Improving the Quality of Medication Use Quality Metrics & Immunizations Hannah Fish, PharmD, CPHQ Discussion Objectives 1. Describe the types and distribution of quality
More informationSubmitted to the House Energy and Commerce Committee. Federal Efforts to Combat the Opioid Crisis
STATEMENT FOR THE RECORD Submitted to the House Energy and Commerce Committee Federal Efforts to Combat the Opioid Crisis October 25, 2017 America s Health Insurance Plans 601 Pennsylvania Avenue, NW Suite
More informationPanel Discussion: Orals Adherence & Challenges Friday, April 28 th, 2017
Panel Discussion: Orals Adherence & Challenges Friday, April 28 th, 2017 1 2017 Community Oncology Alliance Panel Discussion: Orals Adherence & Challenges Ray Bailey, RPh, Director of Pharmacy Florida
More informationHow to Conduct an Effective Medication Therapy Management Session in the Community Pharmacy
How to Conduct an Effective Medication Therapy Management Session in the Community Pharmacy Presented by: Dale Christensen, University of North Carolina Susmita Chavala, Humana Ed Staffa, Community MTM
More information6/18/2015. Disclosure. Objectives. Star Ratings. Understand the current climate of healthcare reform
Star Ratings John A. Galdo, Pharm.D., BCPS, CGP (Jake) Assistant Professor of Pharmacy Practice Community Practice Residency Director jgaldo@samford.edu Disclosure I do not have (nor does any immediate
More informationChanges to the Eighth Edition
Pharmacy Practice and the Law, Eighth Edition Includes Navigate 2 Advantage Access By Richard R. Abood, BS Pharm, JD-Professor Emeritus Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences,
More information2017 PGIP Fact Sheet Electronic Prescribing of Controlled Substances (EPCS)
2017 PGIP Fact Sheet Electronic Prescribing of Controlled Substances (EPCS) Overview Value Partnerships, in conjunction with the Blue Cross Pharmacy team, has created the Electronic Prescribing of Controlled
More informationAnthem Colorado and the Colorado QuitLine
Anthem Colorado and the Colorado QuitLine Building on the Successes of Our Public-Private Partnership Cissy (Elizabeth) Kraft, MD MHS FAAFP January 14, 2014 Topics for Discussion Colorado Tobacco Use Fast
More informationMonthly Campaign Webinar. May 19, 2016
Monthly Campaign Webinar May 19, 2016 WEBINAR REMINDERS Webinar will be recorded today and available the week of May 23 rd Together2Goal.org Website (Improve Patient Outcomes Webinars) Email distribution
More informationPHARMACY Section 9. Overview. Preferred Drug List. Additions and Exceptions to the Preferred Drug List
Overview The management of outpatient prescription drugs is an integral part of the medical management program to improve the health and well-being of our members. Prescriber and member involvement is
More informationRe: Docket No. FDA-2009-N-0294 Regulation of Tobacco Products; Request for Comments
VIA Electronic Submission to http://www.regulations.gov September 29, 2009 Division of Dockets Management (HFA-305) Food and Drug Administration 5630 Fishers Lane, rm. 1061 Rockville, MD 20852 Re: Docket
More informationHEADED FOR HEDIS AND REACHING FOR THE STARS: THE PHARMACIST S ROLE IN POPULATION HEALTH MANAGEMENT
HEADED FOR HEDIS AND REACHING FOR THE STARS: THE PHARMACIST S ROLE IN POPULATION HEALTH MANAGEMENT Desola Davis, PharmD, BCPS, BCACP Dalia Zall, PharmD 1 Copyright 2017 Kaiser Foundation Health Plan, Inc.
More informationMedicaid in South Carolina. South Carolina Medicaid in /19/2018. > FY 2017 Appropriation: $7.2 billion > Full benefit Membership: 1.
Medicaid in South Carolina > FY 2017 Appropriation: $7.2 billion > Full benefit Membership: 1.04 million South Carolina Medicaid in 2018 Bryan Amick SC Chapter, American Academy of Pediatrics 2018 CATCH
More informationA Step-by-Step Guide for Rubicon Pharmacists Delivering the RubiReview Program (SMAP)
A Step-by-Step Guide for Rubicon Pharmacists Delivering the RubiReview Program (SMAP) May 2014 RubiReview Program Overview... 3 Overview... 3 Adherence Packaging (RubiPaks)... 4 Eligibility... 4 Financial
More information16 th Annual IHA Stakeholders Meeting Session 2C
16 th Annual IHA Stakeholders Meeting Session 2C September 19, 2017 Hilton Los Angeles Airport Thank you to our Content Partner: Medication Adherence AppleCare Pharmacy Programs Confidential and proprietary.
More informationTools for Targeting High Risk Patients in Your Practice. Statement of Disclosure
Tools for Targeting High Risk Patients in Your Practice Joseph Vande Griend, PharmD, BCPS, CGP Assistant Professor, University of Colorado Departments of Clinical Pharmacy and Family Medicine Skaggs School
More informationHow pharmacy and retail health can support health and wellness. Nancy Gagliano Chief Medical Officer, MC September, 2014
How pharmacy and retail health can support health and wellness Nancy Gagliano Chief Medical Officer, MC September, 2014 2 An important decision for public health Current Health Care Challenges The State
More informationMember-centered cancer care In Georgia
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Member-centered cancer care In Georgia Ira Klein, MD, MBA, FACP GASCO Annual Meeting September 5, 2015 > One
More informationSuccess NCPA Digest-IN-BRIEF sponsored by cardinal health
Success 2008 NCPA Digest-IN-BRIEF sponsored by cardinal health [October 2008] Dear Reader: This year s publication of the NCPA Digest, sponsored by Cardinal Health is an important and timely resource as
More informationMedicare STRIDE SM Physician Quality Program 2019 Program Overview
Medicare STRIDE SM Quality Program 2019 Program Overview Health Services- Managed by Network Medical Management 2019 Program 1 Medicare Advantage Quality Program Program Overview The Plan will support
More informationCapital Health Plan CMS Star Ratings Strategies for Improvement
Capital Health Plan CMS Star Ratings Strategies for Improvement ESTRELLITA REDMON, MD, MBA MEDICAL DIRECTOR The Ultimate Goal Outline Current 5 Star Plans CHP History Importance of Ratings Part C and Part
More informationCONVERSATION STARTERS: ENGAGING YOUR PATIENTS AT PICK UP JULY 12, :00 2:30 PM
CONVERSATION STARTERS: ENGAGING YOUR PATIENTS AT PICK UP JULY 12, 2017 1:00 2:30 PM ACPE UAN: 0107-9999-17-097-L04-P 0.15 CEU/1.5 hr Activity Type: Knowledge-Based Learning Objectives for Pharmacists:
More informationChairwoman Bono Mack, Vice-Chairwoman Blackburn, Ranking Member Butterfield and
United States House of Representatives Committee on Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade Hearing on Chairwoman Bono Mack, Vice-Chairwoman Blackburn, Ranking Member Butterfield
More informationComprehensive support for your patients on MYALEPT
Comprehensive support for your patients on MYALEPT Insurance and financial assistance options (see page 3) Fulfillment support (see page 6) Co-pay assistance a,b (see page 4) Your patient Injection training
More informationComplex just became comfortable.
Complex just became comfortable. DENTRIX ENTERPRISE Work Well With Others To serve your community, your clinic must work well with others other providers, other clinics, other organizations. To be effective,
More informationBob Davis, PharmD, FAPhA Professor and Chair, KPIC South Carolina Primary Health Care Association September 19, 2015
Bob Davis, PharmD, FAPhA Professor and Chair, KPIC davisb@kennedycenter.sc.edu South Carolina Primary Health Care Association September 19, 2015 Myrtle Beach, SC Kennedy Pharmacy Innovation Center Foundation
More informationMiami-Dade County Prepaid Dental Health Plan Demonstration: Less Value for State Dollars
Miami-Dade County Prepaid Dental Health Plan Demonstration: Less Value for State Dollars Analysis commissioned by The Collins Center for Public Policy / Community Voices Miami AUGUST 2006 Author: Burton
More informationPQS Summary of Pharmacy/ Medication-Related Updates in the CY 2020 Final Call Letter
Managing Performance Information in a Quality Driven World PQS Summary of Pharmacy/ Medication-Related Updates in the CY 2020 Final Call Letter REGULATORY UPDATE PQS Summary of Pharmacy/ Medication-Related
More informationEvaluation of Specialty Pharmacy in an Integrated Health-System
Evaluation of Specialty Pharmacy in an Integrated Health-System Emma Chermely, PharmD, BCACP Alyssa McCann, PharmD, BCACP *The presenters have no conflicts of interest to disclose. Objectives Introduce
More informationInsight ONCOLOGY. Drug Class. Background, new developments, key strategies INTRODUCTION. Incidence of cancer types per year
Drug Class Insight ONCOLOGY Background, new developments, key strategies INTRODUCTION Over 1.6 million Americans will be diagnosed in 2014 1 Total annual costs for cancer: $216 billion, including $87 billion
More informationTeam-Based Decision Support in Diabetes Outcomes and Costs
Team-Based Decision Support in Diabetes Outcomes and Costs Session 89, 8:30 a.m. February 13, 2019 Gary Ozanich, Ph.D. - College of Informatics, Northern Kentucky University 1 Conflict of Interest Gary
More informationSTRIDE SM Quality Program 2017 Program Overview
STRIDE SM Quality Program 2017 Program Overview Health Services 2017 Program 1 Quality Program Program Overview The Plan will support the efforts of the LCU and LCU Participating Providers in managing
More informationMedicaid s Role in Combating the Opioid Crisis
1 Medicaid s Role in Combating the Opioid Crisis September 23, 2016 Deborah Bachrach Partner Manatt Health Assessing Innovations in Medicaid 1 Medicaid Started as Adjunct to Welfare Programs 2 Eligibility
More informationA&M Care Prescription Drug Program Express Scripts Holding Company. All Rights Reserved.
A&M Care 2018 2019 Prescription Drug Program 1 Prescription Drug Benefits Annual Deductible Out of Pocket Maximum Access Options Retail 30 Day Supply: Refills allowed as prescribed. (Good option for new
More information2017 Drug Trends Series
2017 Drug Trends Series Part 1 Evaluating the traditional view Retail and mail-order prescriptions Published April 2018 1 2017 Drug Trends Series Traditional View First Script A year of important progress
More informationThe Maine Lung Cancer Coalition. Working Together to Reduce Lung Cancer in Maine
The Maine Lung Cancer Coalition Working Together to Reduce Lung Cancer in Maine funding Maine Lung Cancer Coalition (MLCC) Webinar Insurance Coverage For Low Dose CT Lung Screenings with Barbara Wiggin,
More informationMail Order Is Not For Everyone!
Mail Order Is Not For Everyone! Face to face patient counseling by pharmacists can have a powerful impact on long term health care costs and quality. So, the way health plan sponsors promote mail and generics
More information2125 Rayburn House Office Building 2125 Rayburn House Office Building Washington, DC Washington, DC 20515
The Honorable Greg Walden Chairman Ranking Member 2125 Rayburn House Office Building 2125 Rayburn House Office Building Washington, DC 20515 Washington, DC 20515 Chairman Ranking Member Subcommittee on
More informationMarket Distortions from the 340B Drug Pricing Program
Market Distortions from the 340B Drug Pricing Program Adam J. Fein, Ph.D. www.drugchannels.net @DrugChannels The opinions and views expressed in this presentation are those of the author and may not reflect
More informationHealth Care Reform Update and Advocacy Priorities
Health Care Reform Update and Advocacy Priorities Robert Greenwald Clinical Professor of Law Director, Center for Health Law and Policy Innovation of Harvard Law School October 2012 PRESENTATION OUTLINE
More informationAWARD DESCRIPTION AND APPLICATION PACKAGE
AWARD DESCRIPTION AND APPLICATION PACKAGE Award Description Recipient: a graduating student from a Canadian School of Pharmacy Purpose: The purpose of this award is to recognize a graduating student who
More informationPopulation Health Management Design: Optimizing the Outcomes for Special Populations 21th Annual ASHP Conference for Pharmacy Leaders
Learning objectives Define population health and its impact on pharmacy leaders. Population Health Management Design: Optimizing the Outcomes for Special Populations Meghan D. Swarthout, PharmD, MBA, BCPS
More informationContinuing Education. An integral member of the healthcare team Utilize creative technology Intentional in marketing
Upon successful completion of this article, the pharmacist (or pharmacy technician) should be able to: Describe the key points of the clinical community pharmacist Define the prevalence of the major chronic
More information36th Annual J.P. Morgan Healthcare Conference. Kevin Conroy, Chairman and CEO January 9, 2018
36th Annual J.P. Morgan Healthcare Conference Kevin Conroy, Chairman and CEO January 9, 2018 1 Safe harbor statement This presentation contains forward-looking statements within the meaning of Section
More informationDental Payment Innovation:
Dental Payment Innovation: Best Practices of Health Center Dental Clinics in Three States Irene V. Hilton, DDS, MPH, FACD Lyubov Slashcheva, DDS, FABSCD July 16, 2018 Objectives Understand the environment
More informationValue of Hospice Benefit to Medicaid Programs
One Pennsylvania Plaza, 38 th Floor New York, NY 10119 Tel 212-279-7166 Fax 212-629-5657 www.milliman.com Value of Hospice Benefit May 2, 2003 Milliman USA, Inc. New York, NY Kate Fitch, RN, MEd, MA Bruce
More informationInsurance Providers Reduce Diabetes Risk Through CDC Program
Insurance Providers Reduce Diabetes Risk Through CDC Program ISSUE BRIEF JULY 2018 KEY TAKEAWAYS 86 million Americans 1 in 3 adults have pre-diabetes. Studies show that losing 5 to 7 percent of body weight
More informationAmerican Joint Replacement Registry s Orthopaedic Quality Resource Center a CMS approved Qualified Clinical Data Registry (QCDR)
American Joint Replacement Registry s Orthopaedic Quality Resource Center a CMS approved Qualified Clinical Data Registry (QCDR) American Joint Replacement Registry s Orthopaedic Quality Resource Center
More informationIssues for Part D Compliance
HCCA- MEDICARE PRESCRIPTION DRUG PART D COMPLIANCE CONFERENCE Issues for Part D Compliance Craig Miner, RPh, JD Division of Drug Plan Policy Babette S. Edgar, Pharm.D., MBA Division of Finance and Operations
More informationPatient-Centered Oncology Payment: Payment Reform to Support Higher Quality, More Affordable Cancer Care (PCOP)
Patient-Centered Oncology Payment: Payment Reform to Support Higher Quality, More Affordable Cancer Care (PCOP) May 2015 Summary Overview The American Society of Clinical Oncology (ASCO) has devoted considerable
More informationJuly 30, VIA TO
July 30, 2012 VIA EMAIL TO DMEPOS@cms.hhs.gov Elliot Klein Centers for Medicare and Medicaid Services 7500 Security Boulevard Mail Stop C5-03-17 Baltimore, MD 21244-1850 RE: Inherent Reasonableness of
More informationTips for Evolving Medicaid Pharmacy Benefits Management (PBM) Programs. June 5, 2015
Tips for Evolving Medicaid Pharmacy Benefits Management (PBM) Programs 1 June 5, 2015 Introductions Mark Steck Pharm.D Independent Consultant, MAXIMUS John J.P. Crouse Vice President, MAXIMUS Market Lead
More informationMary Ann Hodorowicz RDN, MBA, CDE, CEC (Certified
Mary Ann Hodorowicz RDN, MBA, CDE, CEC (Certified Endocrinology Coder) Mary Ann Hodorowicz, RDN, MBA, CDE, CEC, is a licensed registered dietitian and certified diabetes educator and earned her MBA with
More informationuniversity client training program
COURSE OFFERINGS university client training program Dear Valued Client, Since our inception in 1997, TSI Healthcare has followed a guiding principle that support and training do not end after implementation.
More informationCARD/MAIL/PRE-APPROVAL/PREFERRED RIDER FOR PRESCRIPTION DRUG [INSURANCE] [Policy]holder: Group Policy No: Effective Date:
RIDER FOR PRESCRIPTION DRUG [INSURANCE] [Policy]holder: Group Policy No: Effective Date: CARD/MAIL/PRE-APPROVAL/PREFERRED The Prescription Drug Coverage under this Rider [replaces] [supplements] the Prescription
More information- Description, Objectives, Operational Framework
2 1. CNCD - Overview (significance, causes, burden) 2. CDAP - Description, Objectives, Operational Framework 3. Research Findings of Study on CDAP - Research Objectives and Methodology - Limitations and
More informationPatient-Centered Measurement: Innovation Challenge Series
Patient-Centered Measurement: Innovation Challenge Series Learning Collaborative 2018 Webinar Thursday, March 1, 2018 1 Hala Durrah, MTA Patient Family Engagement Consultant, Speaker & Advocate 3 2017-18
More informationOncology Management at HAP. John Calabria, DO, Medical Director
Oncology Management at HAP John Calabria, DO, Medical Director Agenda Rising Cost of Health Care Ways of Managing Oncology Cost Pathways Update Where do we go from here? The Cost of Cancer Source: National
More informationWe see health care. differently. Comprehensive data Novel insights Transformative actions Lasting value
We see health care differently Comprehensive data Novel insights Transformative actions Lasting value 24 Hours of Optum data: Creating a more complete health picture We capture: Largest EHR dataset 90
More informationDr. Sandeep Bhattacharya, Chief Innovation & Strategy Officer, Merck & Co., Inc. / MSD Asia Pacific
Dr. Sandeep Bhattacharya, Chief Innovation & Strategy Officer, Merck & Co., Inc. / MSD Asia Pacific Disclaimer: The opinions expressed in this presentation are the personal opinions of the speaker & do
More information