HEADED FOR HEDIS AND REACHING FOR THE STARS: THE PHARMACIST S ROLE IN POPULATION HEALTH MANAGEMENT

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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.

Desola K Davis, PharmD, BCPS, BCACP Desola (Kalejaiye) Davis, PharmD, BCPS, BCACP is a Clinical Pharmacy Specialist in Drug Utilization at Kaiser Permanente Georgia, where she also completed her PGY-1 managed care and PGY-2 ambulatory care residency training. She serves primarily as the pharmacy member of the pulmonology team, and as a member of regional and interregional respiratory committees. She also manages drug use trends for gastroenterology/hepatology, infectious diseases, and urology specialties. Dr. Davis leads the research training program for the pharmacy residents at Kaiser. Professionally, she is the Secretary for the Georgia Affiliate chapter of AMCP, and a member of the AMCP Joint Research Committee. Desola Davis, PharmD has no conflicts of interest to declare. 2

Dalia L. Zall, PharmD Dalia Zall, PharmD, is the Clinical Pharmacy Specialist (CPS) for Medication Adherence at Kaiser Permanente in Atlanta, Georgia (KPGA). She earned her Bachelor of Science in Food Science and Human Nutrition from the University of Florida and her Doctor of Pharmacy degree from the University of South Florida College of Pharmacy. She completed her PGY-1 Managed Care Residency at KPGA from 2015-2016 and transitioned into her CPS role in July 2016. She is part of the Drug Use Management team and works closely with a team of pharmacy assistants to identify and resolve barriers to adherence in the Medicare population. Additionally, she serves as the KPGA pharmacy adherence expert on both local and inter-regional quality oversight groups. Her interests include patient safety and quality, project management, and performance improvement. Dalia Zall, PharmD has no conflicts of interest to declare. 3

Accreditation Statement The Institute for Wellness and Education, Inc., is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Participants of the session who complete the evaluation and provide accurate NABP e-profile information will have their credit for 1.5 contact hours (0.15 CEU) submitted to CPE Monitor within 60 days of the event. Please know that if accurate e-profile information is not provided within 60 days of the event, credit cannot be claimed after that time. ACPE program numbers are: 0459-0000-18-005-L04-P & 0459-0000-18-005-L04-T Initial release date is 3/3/2018. 4

Agenda Describe select HEDIS and CMS Star performance quality measures in relation to clinical patient outcomes Discuss pharmacy-driven clinical strategies aimed to improve HEDIS and CMS Star measures in an integrated healthcare delivery system Apply learnings from clinical interventions and recommendations for widespread implementation in the future 5

Health Effectiveness Data And Information Set (HEDIS) Data tool used by 90% of health plans to measure performance on important dimensions of care and service Maintained by National Committee for Quality Assurance (NCQA) Health plans Employers Consultants/ Consumers Apples-toapples comparison Plan options for employees Plan coverage purchases 6 http://www.ncqa.org/hedis-quality-measurement/what-is-hedis

How are HEDIS Measures Created? Measure Proposed Field Tests Conducted Measure Approved Measurement Advisory Panel Technical subgroups created Draft and present initial measure recommendations Technical Subgroups Develop field specifications and testing protocols Field testing and analysis Revisions to measure Presentation to CPM and open for public comment CPM reviews public comment/ votes to adopt measure Measure added to HEDIS set Technical Advisory Panel methodological assessment CPM: Committee on Performance Measurement 7 HEDIS Measure Development Process. http://www.ncqa.org/tabid/414/default.aspx

How are HEDIS Measures Created? Measure Proposed Field Tests Conducted Measure Approved Measurement Advisory Panel Technical subgroups created Draft and present initial measure recommendations Technical Subgroups Develop field specifications and testing protocols Field testing and analysis Revisions to measure Presentation to CPM and open for public comment CPM reviews public comment/ votes to adopt measure Measure added to HEDIS set Technical Advisory Panel methodological assessment CPM: Committee on Performance Measurement 8 HEDIS Measure Development Process. http://www.ncqa.org/tabid/414/default.aspx

How are HEDIS Measures Created? Measure Proposed Field Tests Conducted Measure Approved Measurement Advisory Panel Technical subgroups created Draft and present initial measure recommendations Technical Subgroups Develop field specifications and testing protocols Field testing and analysis Revisions to measure Presentation to CPM and open for public comment CPM reviews public comment/ votes to adopt measure Measure added to HEDIS set Technical Advisory Panel methodological assessment At least a year to adopt a new measure! CPM: Committee on Performance Measurement 9 HEDIS Measure Development Process. http://www.ncqa.org/tabid/414/default.aspx

Examples of HEDIS Measures Currently 94 measures across 7 domains of care Effectiveness of Care Asthma Medication Ratio Potentially Harmful Drug-Disease Interactions in the Elderly (DDE) Comprehensive Diabetes Care Access/Availability of Care Experience of Care Utilization and Risk Adjusted Utilization Relative Resource Use Health Plan Descriptive Information Measures Collected Using Electronic Clinical Data Systems 10 http://www.ncqa.org/hedis-quality-measurement/what-is-hedis

Kaiser Permanente Georgia (KPGA) Not for profit integrated healthcare delivery system 26 Outpatient Medical Offices Clinical Pharmacy Services Ambulatory Care Drug Utilization Medication Adherence Chronic Kidney Disease Gastroenterology/Hepatology Geriatrics/Palliative Care Heart Failure Infectious Disease and others! 11

12 ASTHMA MEDICATION RATIO (AMR)

Asthma Medication Ratio (AMR) Use of daily controller medications reduces risk of acute exacerbations, emergency room visits, and hospitalizations AMR= number of controller medications (# canisters)/number of controller medications + number of reliever medications AMR 0.5 indicates adequate asthma control Measures quality of asthma care received by their members with persistent/chronic asthma 13 https://www.network-health.org/providers/news-and-updates/provider-update/membercare/what-is-an-asthma- Medication-Ratio-.aspx

HEDIS AMR Measure Proportion of members age 5 to 64 years old identified as having persistent asthma and had an AMR 0.5 during the measurement year Plan performance ranked into 25 th, 50 th, 75 th, and 90 th percentiles Continuously enrolled during measurement year and previous year No more than gap of 45 days Medicaid: No more than gap of 30 days 2018 changes Removed Medicare reporting Removed Commercial reporting for 65 85 age group 14 National Committee for Quality Assurance (NCQA). HEDIS 2018: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2017. various p. National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

HEDIS AMR Measure Denominator At least one ED visit At least one acute inpatient encounter At least four outpatient visits or observation visits with any diagnosis of asthma and at least two dispensing events At least four asthma medication dispensing events Numerator Members who have an AMR 0.5 during the measurement year Exclusions 15 Emphysema COPD Obstructive Chronic Bronchitis Cystic Fibrosis Acute Respiratory Failure

16 ALBUTEROL OPTIMIZATION PROJECT

Albuterol Optimization Project Goal: Influence prescribing patterns to reduce overutilization of asthma reliever medications Target population Met HEDIS criteria for persistent asthma AMR < 0.5 Current albuterol prescription order with 2 canisters remaining for refill Intervention between October and December 2016 17

Albuterol Optimization Project: Methods Identify Population Persistent asthma AMR < 0.5 Age > 22 Exclusion Review Respiratory comorbidities 1 albuterol canister on file Pend Albuterol Order Albuterol #18 gm; 0 refills Sig: 2 puffs q4h prn Contact provider if canister runs out before 3 months Route to Prescriber Approved: Pharm.D. sends letter from prescriber to patient Not Approved: No further action 18

Albuterol Optimization Project: Results 0.7 Average Asthma Medication Ratio (AMR) 0.6 0.5 0.4 0.3 0.2 0.1 0 0.22 Before Intervention (Oct 2016) 0.5 After Intervention (Feb 2018) Goal AMR 0.5 Change in Asthma Control 19

Albuterol Optimization Project: Results 12 Average Number of Canisters 10 8 6 4 2 9.6 5.4 0 Before Intervention (Oct 2016) After Intervention (Feb 2018) Change in AMR Group Distribution Change in Annual Albuterol Canister Utilization 20

Albuterol Optimization Project: Takeaways and Future Directions Decrease in utilization of reliever medications with incidental increase in controller medication utilization Increase in average AMR due to change in refill behavior Efficient use of pharmacist resource to implement initiative Expand to nurses or other healthcare staff with access to electronic medical record Identify overutilizers using pharmacy claims Contact provider via fax, phone, or electronically Send patient targeted messages 21

TIPS & BEST PRACTICES Patient Case JR is a 54 year old patient diagnosed with intermittent asthma. In 2016, he had two asthma exacerbations. One leading to an emergency room visit and the other leading to a hospitalization. Maintenance medication: Advair Diskus 250/50 mcg filled on 2/28/2017 (1 unit), 6/1/2017 (1 unit) Reliever medication: Ventolin filled on 2/28/2017 (3 units), 6/1/2017 (1 unit), 8/30/2017 (2 units), 10/30/2017 (2 units) Does he meet criteria for inclusion in AMR metric? 22

TIPS & BEST PRACTICES HEDIS AMR Measure Denominator At least one ED visit At least one acute inpatient encounter At least four outpatient visits or observation visits with any diagnosis of asthma and at least two dispensing events At least four asthma medication dispensing events Numerator Members who have an AMR 0.5 during the measurement year Exclusions 23 Emphysema COPD Obstructive Chronic Bronchitis Cystic Fibrosis Acute Respiratory Failure

TIPS & BEST PRACTICES Does JR Meet Inclusion Criteria? Denominator At least one ED visit At least one acute inpatient encounter At least four outpatient visits or observation visits with any diagnosis of asthma and at least two dispensing events At least four asthma medication dispensing events Numerator Members who have an AMR 0.5 during the measurement year Exclusions 24 Emphysema COPD Obstructive Chronic Bronchitis Cystic Fibrosis Acute Respiratory Failure

TIPS & BEST PRACTICES What is JR s AMR? JR is a 54 year old patient diagnosed with intermittent asthma. In 2016, he had two asthma exacerbations. One leading to an emergency room visit and the other leading to a hospitalization. Maintenance medication: Advair Diskus 250/50 mcg filled on 2/28/2017 (1 unit), 6/1/2017 (1 unit) Reliever medication: Ventolin filled on 2/28/2017 (3 units), 6/1/2017 (1 unit), 8/30/2017 (2 units), 10/30/2017 (2 units) AMR= (1+1) /(1+1) + (3+1+2+2) = 2/10 =0.2 25

26 COMPREHENSIVE DIABETES CARE (CDC)

Comprehensive Diabetes Care (CDC) Members 18 75 years of age who received care for diabetes (type 1 and type 2) and had each of the following Hemoglobin A1c (HbA1c) testing HbA1c Poor Control (> 9%) HbA1c Control (< 8%) HbA1c Control (< 7%) for age 18-64 Retinal eye exam performed Medical attention for nephropathy Blood pressure control (< 140/90 mmhg) 27

HEDIS CDC Measure (A1c < 8%) Denominator 18 75 years as of Dec 31 of the measurement year Encounter data: At least two outpatient visits, observation visits, ED visits, or nonacute inpatient encounters At least one acute inpatient encounter Pharmacy claims data: Dispensed insulin or hypoglycemic/antihyperglycemics Numerator Compliant if most recent HbA1c is < 8% 28

29 PROACTIVE PANEL MANAGEMENT (PPM) MEETINGS

PPM Meetings Goals: Population care management Identify patient barriers and potential solutions Develop team based treatment plans Optimize member care, improve clinical performance and staff efficiency Monthly meetings between panel manager (pharmacist or nurse) and primary care provider Contact patients with tailored recommendations to improve quality of care 30

The Diabetes Panel Management Team Complete Care Panel Management focuses on outreach, treatment planning, and follow-up. PCP Patient Panel Manager Panel Support Coordinator Each PCP has either a Clinical Pharmacist or RN Panel Manager, whose role is to improve diabetes control. The Panel Support Coordinator is a non clinical resource primarily utilized for outreach. 31

PPM Meetings: Methods Identify Population HbA1c 8% Type 2 DM 18 years old Exclusion Review Insulin pump Prescription for Humulin R U-500 Pregnant PPM Meeting Identify interventions for 10 patients Review PCP HbA1c control rate Academic detailing Panel Manager/Support Staff Follow Up Medication adjustment Reminders for lab, SMBG Appointments 32

PPM Meetings: Results A1c Control Rates for Members with Diabetes at KPGA PMMM 33

PPM Meetings: Takeaways and Future Directions Interdisciplinary collaboration led to positive patient outcomes Addition of panel support coordinators increased program capacity Support for patients in between physician office visits Can expand to include other disease states like hypertension Changes in membership pose a barrier to continued care 34

What diabetes care services have you implemented to improve HEDIS A1c < 8%? 35

CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) STAR RATINGS STRATEGIES 36

CMS Star Ratings Overview Rating is displayed as 1 to 5 stars to assist Medicare beneficiaries in plan selection High performing plans: Quality bonus payments 5-Star plans can also market year-round and beneficiaries can join these plans at any time via a special enrollment period 2018 Star Ratings: 48 Part C and D measures Stars are calculated for each measure, domain, summary, and overall There is a 2 year lag in data for the Star Ratings 2018 year of service determines 2020 CMS Star Ratings https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin/downloads/2018-star-ratings-user-call-slides.pdf 37

Definitions Performance year/ measurement year/ year of service = year the work was done Ratings year = year the ratings were released (2 year lag from performance year) 38

Overview of Select Quality Organizations Centers for Medicare and Medicaid Services (CMS) CMS Star Ratings Pharmacy Quality Alliance (PQA) Measure concept development, specifications, and endorsement 39

CMS Measure Lifecycle 40 https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/mms/measure-development-by-phase.html

CMS Medicare Plan Comparison Tool 41 Medicare.gov

Selected 2019 Star Ratings (2017 performance year) 42 h"ps://www.cms.gov/medicare/health- Plans/MedicareAdvtgSpecRateStats/Downloads/Advance2019Part2.pdf

Selected Full and Display Measures 2019 Proposed Changes (2017 measurement year) Ratings Year 2018 2019 Proposed Changes Full Measure Statin Use in Persons with Diabetes (single weighted; projected to be triple weighted by 2020) Display Use of opioids from Multiple Providers or at High Dosage in Persons without Cancer Antipsychotic Use in Persons with Dementia (APD) Statin Use in Persons with Diabetes (SUPD) Use of opioids from Multiple Providers or at High Dosage in Persons without Cancer Antipsychotic Use in Persons with Dementia (APD) 43

44 CMS: Adherence Measures

Proportion of Days Covered (PDC) CMS contracts with Acumen, LLC for the analyses of Medicare data to generate the rates for the medication measures PDC is the PQA-recommended methodology for estimation of medication adherence for patients using chronic medications PDC > 80% = Adherent PDC = # of days covered by the prescription fills during the denominator period # of days between first fill and the end of the measurement period 45

Adherence Performance Measure Calculations Considered an Intermediate Outcome Measure (weighted x3) for 3 drug classes Total weight of 9 in the CMS Star Ratings Select Diabetes, RAS, and Statin medications Percentage of patients taking medications in a particular drug class that are considered adherent (PDC >80% for the individual) >2 claims for a medication within the same therapeutic drug class during the measurement year Example: ü 100 members fill a statin medication at least twice during the measurement year è Denominator = 100 ü 83 of the 100 members have a PDC > 80% è Numerator = 83 ü 83/100= 83% è Statin Adherence Performance Measure = 83% 46

CMS Adherence Measure: Diabetes Denominator Members with at least two prescription claims for a non-insulin diabetes medication during the measurement year Beneficiaries are only included in the measure calculation if the first fill of their medication occurs at least 91 days before the end of the enrollment period. Numerator Members with at least two prescription claims for a non-insulin diabetes medication who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the mediation during the measurement year. Exclusions End-stage renal disease (ESRD); Hospice Claim for insulin 47

CMS Adherence Measure: Renin Angiotensin System (RAS) Antagonist Denominator Members with at least two prescription claims for a RAS medication during the measurement year Beneficiaries are only included in the measure calculation if the first fill of their medication occurs at least 91 days before the end of the enrollment period. Numerator Members with at least two prescription claims for a RAS medication who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the mediation during the measurement year. Exclusions ESRD; Hospice Claim for sacubitril/valsartan 48

CMS Adherence Measure: Statins Denominator Members with at least two prescription claims for a statin medication during the measurement year Beneficiaries are only included in the measure calculation if the first fill of their medication occurs at least 91 days before the end of the enrollment period. Numerator Members with at least two prescription claims for a statin medication who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the mediation during the measurement year. Exclusions Hospice 49

Is AM adherent to her diabetes medication? AM is a 74 year old female prescribed only metformin to manage her diabetes. In January 2017, she filled her first two prescriptions through Kaiser Permanente pharmacy, then discovered she could receive it for free from an outside pharmacy, and filled all subsequent prescriptions through them. AM fills all of her prescriptions on time every 3 months and takes her medications on a daily basis. Will AM be considered adherent for the 2017 performance year? 50

Is AM adherent to her diabetes medication? AM is a 74 year old female prescribed only metformin to manage her diabetes. In January 2017, she filled her first two prescriptions through Kaiser Permanente pharmacy, then discovered she could receive it for free from an outside pharmacy, and filled all subsequent prescriptions through them. AM fills all of her prescriptions on time every 3 months and takes her medications on a daily basis. Will AM be considered adherent for the 2017 performance year? AM had > 2 prescription claims for a diabetes medication in 2017, therefore she will be included in the denominator of the diabetes measure If the outside pharmacy is not adjudicating the claims for metformin through the insurance provider, AM will be considered NON-adherent for the 2017 performance year, even though she is filling her medications on time. Claims must be captured through the insurance provider to count. 51

https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin/downloads/2018-cut-point-trend-2017_12_14.pdf 52

https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin/downloads/2018-cut-point-trend-2017_12_14.pdf 53

https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin/downloads/2018-cut-point-trend-2017_12_14.pdf 54

SUPD Performance Measure Calculations Measure: Percentage of members between 40 and 75 years of age who received at least two diabetes medication fills AND also received a statin medication during the measurement period Projected to be weighted 1 star for the 2019 Ratings (2017 performance year), and then 3 stars thereafter Example: ü 100 members have at least 2 fills for a diabetes medication during the measurement yearà Denominator = 100 ü 78 of the 100 members filled a statin at least once during the measurement yearà Numerator = 78 ü 78/100 = 78% à SUPD Performance Measure = 78% https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/downloads/advance2019part2.pdf 55

CMS Adherence Measure: Statin Use in Persons with Diabetes (SUPD) Denominator Members 40-75 years of age with at least two prescription claims for a diabetes medication during the measurement year Numerator Members 40-75 years of age with at least two prescription claims for a diabetes medication AND a claim for a statin medication during the measurement year Exclusions Hospice 56

57 CMS: Adherence and SUPD Strategies

Strategies to Improve Adherence Measures Population based interventions: Low cost share including $0 Optimize 90-day supply utilization Optimize mail order utilization Refill reminder calls for patients at risk for becoming non-adherent Medication reconciliation for PDC < 80% Deprescribe unnecessary therapies Two-way text messaging Additional strategies: Include Medication Therapy Management (MTM) eligibility, response model and/or predictive analytics Physician Report Cards Engage other specialties such as nursing 58

Data Analytics Data analysts key in identifying high priority patients for intervention as well as reporting productivity and outcomes Medication Adherence Outreach Lists PDC and critical refill due dates PDC <80% and inconsistent refill dates ½ tab or QOD identification Lab values and diagnosis codes to further prioritize outreach Response model and/or predictive analytics Statin Use in Persons with Diabetes Outreach Lists Diagnoses, lab values, prescribing physician specialty, statin history, allergy/intolerance history Productivity and Outcomes reporting Excel and/or Tableau using data from claims history and/or electronic health record 59

What strategies have you implemented to improve your organizations performance? 60

61 CMS: Adherence and SUPD Strategies at KPGA

KPGA Background ~30,000 Medicare Patients ~75% qualify for $0 cost-share on most generic medications when a 90-day supply is ordered via mail order 1 Manager, Drug Use Management Medication Adherence Team Medicare 1 Clinical Pharmacy Specialist, Medication Adherence 6 Pharmacy Assistants, Medication Adherence 1 Manager, Ambulatory Care (not exclusive to Medicare) 13 Ambulatory Care Pharmacists Diabetes management for A1c >8% Medication Therapy Management (MTM) 62

63 KPGA Adherence Trends: Performance Years 2014-2017

KPGA Medication Adherence Journey Q3 2016 Clinical Pharmacy Specialist, Medication Adherence (1) Q3 2016 Update default prescription order lists to include 90-day supplies + 3 refills on adherence medications Q3 2016 Pharmacy Support Center starts documenting refill reminder calls in electronic health record Q4 2016 Update default statin sigs to state to reduce risk of heart attack/stroke vs for cholesterol and implement standing order for 90-day supplies 64

KPGA Medication Adherence Journey Q4 2016 Decision to hire pharmacy assistants versus additional clinical pharmacy specialist Q1 2017 Pharmacy Assistants, Medication Adherence (3) Q2 2017 Pharmacy Assistant training and workflow refinement Q4 2017 Pharmacy Assistants, Medication Adherence (6) Q1 2018 Medication Sig Update project 65

KPGA Medication Adherence Team Pharmacy Assistants/Technicians Adherence PharmD Outbound calls to at risk population Address encounters escalated by assistants Review chart for claims remediation opportunities Remind patients to refill medications when due Educate patient on cost-savings opportunities and 90-day utilization/mail order Adherence counseling Clinical assessment of patient and medication optimization opportunities Identify and correct medication reconciliation opportunities Collaborate with physician to make recommendations to optimize therapy Screen for and document barriers to adherence Triage complex patients to physician support staff to schedule office visit Taking differently than prescribed 66 How long taking differently than prescribed Why taking differently than prescribed Escalate patients eligible for PharmD intervention to Adherence PharmD ~5% of at risk population identified for PharmD intervention

Adherence: Optimize 90-day Utilization and Decision Support Tools Q1-Q4 of performance year Identified that regardless of prescription benefit and pharmacy location, patients on <90 day supplies had 58% adherence rates vs patients on 90-day supplies with 85% adherence rates Department medication preference lists and SmartSets updated to default the dispense quantity and refills to a 90-day supply with up to 3 refills for statins, RAS, and oral diabetes medication orders Standing order for pharmacy to change <90 day to 90-day supplies for select statins, RAS, and oral diabetes medications Update default statin sigs to state to reduce risk of heart attack/stroke vs for cholesterol October 2016 February 2018: + 17% change from baseline 67

Adherence In Progress: Update Medication Directions on Sig of Prescription Focus during Q1 of performance year PDC <80% and due for an upcoming refill PDC 60% and less è likely have been taking 1/2 tab for 1 year or more PDC >60% è likely recently started taking 1/2 tab Pharmacy assistants contact patient to inquire how patient is taking medication Escalate to PharmD if patient reported directions do not match current order or other medication concerns reported (~16%) PharmD addresses barriers to adherence and makes recommendations to MD to support adherence January 23, 2018 February 15, 2018: 28% of PharmD interventions have resulted in sig update 68

69

Statin Use in Persons with Diabetes (SUPD) Q42016 Identified Medicare patients 40 to 75 years of age with at least 1 diabetes medication fill and no statin prescription Clinical Pharmacy Specialists clinically reviewed chart to determine statin eligibility and route recommendations to primary care provider If approved, attempted to contact patient via phone to inform/counsel; summary letter sent Results: 42% of patients identified were initiated and filled a statin medication during the 2016 performance year Learnings: 35-50 minutes per patient, need for more advanced data analytics prior to distributing patient list Q42017 Updates Improved data analytics Primary and secondary non-adherence, ESRD, palliative care/hospice, allergy/intolerance, prescriber specialty, diabetes diagnosis Improved productivity Naïve patients: If approved, letter sent; if not filled within ~8 weeks, pharmacy assistant contacted patient Results: 43% of patients identified were initiated and filled a statin medication during the 2017 performance year Learnings: Less time spent per patient due to letter ahead of phone call and pharmacy assistant involvement; for primacy non-adherence, may consider pharmacy assistants calling ahead of pharmacist; remove patients with >2 statin allergies/ declines statins 70

Tracking Productivity, Outcomes, and Opportunities Electronic Health Record Excel, Access Database, Tableau Weekly meetings to address feedback and opportunities Pharmacy Assistant Outcomes: PharmD Outcomes: 71

Adherence: Potential Opportunities for Future Directions Lovastatin conversions/statin conversion standing order Deprescribing initiatives Partner with Medication Therapy Management (MTM) pharmacists to manage patients at risk for non-adherence Patient rewards program Auto refill and medication synchronization Proactive outreach Two-way texting Expansion of initiatives to commercial population 72

What resources could your organization implement to improve adherence and/or SUPD performance? 73

HEADED FOR HEDIS AND REACHING FOR THE STARS: THE PHARMACIST S ROLE IN POPULATION HEALTH MANAGEMENT Desola Davis, PharmD, BCPS, BCACP Dalia Zall, PharmD 74 Copyright 2017 Kaiser Foundation Health Plan, Inc.