Community Pharmacies:
Leveraging Access & Data to Impact Health
Care Quality and Value
Today’s Health Care Decisions are DATA
DRIVENPharmacy CANNOT be
Excluded from the EQUATION
LeveragingAccessData
GOALS• Explain how pharmacy quality is defined in today’s health care system
and Identify key strategies for improving patient care that also positively impacts other health care stakeholders.
• Describe barriers and benefits of direct to payer engagement through clinically integrated pharmacy provider networks
OBJECTIVES (Pharmacist & Technician)
• Explain how pharmacy quality is defined in the healthcare system• Identify key strategies in improving patient care that also positively
impact other healthcare stakeholders• Describe barriers and benefits of direct to payer engagement through
clinically integrated pharmacy provider networks.
Disclosures:TrippLogan,PharmD
TrippLogan,PharmDdoesnothave(nordoesanyimmediatefamilymemberhave)actualorpotentialconflictofinterest,withinthelasttwelvemonths,avestedinterestinoraffiliationwithanycorporateorganizationofferingfinancialsupportorgrantmonies forthiscontinuingeducationactivity,oranyaffiliationwithanorganizationwhosephilosophycouldpotentiallybiasthispresentation.
Affiliations:
NCPA Innovation Center Board Member; CPESN USA National Luminary; Partner, MedHere Today Consulting; Partner, ESPhA; Vice President, Logan & Seiler Inc. (L&S Pharmacy / Medical Arts Pharmacy)
TrippLogan,PharmDCOMMUNITY PHARMACIST / PHARMACY OWNER• 2nd generation multi-pharmacy owner -
Southeast Missouri• Strong focus on appropriate medication use • Quality focused pharmacy practices• Residency program, care coordination, disease
state management, diabetes support group, medication use monitoring, MTM, compliance packaging, TOC, etc.
SERVICE ORGANIZATIONS• Pharmacy Quality Alliance (PQA) Board
Liaison• NCPA Innovation Center Board Member• CPESN USA National Luminary• CPESN Missouri Lead Luminary • Local Department of Health Board of Directors
PHARMACY QUALITY CONSULTANT / PARTNERMedHere Today is a healthcare quality and performance consulting firm created to help healthcare stakeholders expand and grow their quality and value based initiatives by leveraging community pharmacy.
AdherenceData
AdherenceMonitoring:2011IncreaseinADDITIONALprogram-drivenRx
volume
100 29*
2900Numberofpatientsenrolledinprogram
AdditionalRxsperpatientannually
*ArmstrongT.,ImpactoftheMedHereTodayProgramonPersistenceandAdherence,ADescriptiveReport;Pfizer,May2011.
AllRxsARE NOT CreatedEqual
AllRxsARE NOT CreatedEqual
Fill vs Claim
RxFillvsRxClaim
LessonsLearned1. Prescriptionvolumecanbesignificantlyincreased
withadherencemonitoring2. Enhancedpatientengagementresultsinincreases
inadherencemetrics3. Prescriptionvolumeincentivesareoftenpositively
perceivedbypharmacies4. Adherencemonitoringhasmanyfinancialand
patientcarebenefitstothepharmacy
MedicationSafetyData
HighRiskMedicationintheElderly
https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin/downloads/2014-trends-in-part-c-and-d-star-rating-measure-cut-points.Pdfhttps://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin/downloads/2017-trends-in-part-c-and-d-star-rating-measure-cut-points.Pdf
HighRiskMedicationintheElderly
HighRiskMedicationintheElderly
“ThePatientwasexaminedbyme(face-to-face).Myprofessionaljudgementisaswritten.Toobadyourcomputercan’tseethepatient.:”
HighRiskMedicationintheElderly
HighRiskMedicationintheElderly
HighRiskMedicationintheElderly
Do HRM metric improvements
positively reflect better patient outcomes?
Opioids
Pharmacy 1 Pharmacy 2
Opioids
Pharmacy 1 Pharmacy 2
Opioids
Pharmacy 1 Pharmacy 2Cash Prescriptions Cash Prescriptions
https://www.optum.com/about/news/optumrx-risk-management-program-leads-to-better-outcomes.html
https://cvshealth.com/newsroom/press-releases/cvs-health-fighting-national-opioid-abuse-epidemic-with-enterprise-initiativeshttps://expressscriptsholdingco.gcs-web.com/news-releases/news-release-details/safer-opioid-prescribing-express-scripts-significantly-reduces
https://cvshealth.com/newsroom/press-releases/cvs-health-fighting-national-opioid-abuse-epidemic-with-enterprise-initiativeshttps://expressscriptsholdingco.gcs-web.com/news-releases/news-release-details/safer-opioid-prescribing-express-scripts-significantly-reduces
Do opioid metric improvements positively
reflect better patient outcomes?
LessonsLearned1. Claims based metrics don’t always tell the whole
story2. History may be telling us something with the
opioid epidemic3. Strategies need to be developed to fill these
measurement gaps4. There are opportunities to improve the way
pharmacies are being measured
PharmacyInterventionStrategies
ClaimsBased PatientBasedFillreminders CopayassistanceMedsync Medicationaccess
Fillgapsincare TransitionofcareMedicationsafety Healthliteracy/social
CMR CarecoordinationPackaging TransportationDayssupply EducationDIRreduction Empathy
“Thereismorevalueinhittingthemeasure'sstarrebatelevel,thanafocusonthemedicalcostreduction”
-MedicarePartDPlanExecutive,August2017
PayerStrategies
Direct&IndirectRemuneration(DIR)Data
It’s Not Just About Star RatingsTherealityofwhatiscoming...
…orwhatmayalreadybehere…
ACE-I Prescribed and TakenSingle =
Home Run = BP < 140/90
Patient Hospitalization AvoidedGrand Slam =
Slide compliments of: Troy Trygstad [email protected] & Joe Moose [email protected]
PresentationtoCMSQ2-2016
HighQualityPharmacyProviders
HighRisk/ChronicallyillMedicareMember
PatientAttribution
MedicarePartDHealthPlan
HighQuality
PharmacyProvider
PresentationtoCMSQ2-2016
HighQualityPharmacyProviders
HighRisk/ChronicallyillMedicareMember
PatientAttribution
HigherDIRFees
HighQuality
PharmacyProvider
PresentationtoCMSQ2-2016
WhatHighQualityPharmacyProvidersSee
PresentationtoCMSQ2-2016
WhatHighQualityPharmacyProvidersFeel
PresentationtoCMSQ2-2016
WhatisaDIRfee?DIRisanyformofpriceconcession,receivedeitherbythePartDsponsororbyanintermediarycontractingorganization(aPharmacyBenefitsManager,orPBM,forinstance)withwhichthesponsorhascontracted,fromanysource(includingmanufacturers,pharmacies,enrollees,oranyotherpersonorentity)thatservestodecreasethecostsincurredunderthePartDplanbythePartDsponsor,eitherdirectlyorindirectly.Thus,DIRincludesdiscounts,chargebacks,rebates,cashdiscounts,freegoodscontingentonapurchaseagreement,up-frontpayments,coupons,goodsinkind,freeorreduced-priceservices,grants,legaljudgmentamounts,settlementamountsfromlawsuitsorotherlegalaction,andotherpriceconcessionsorsimilarbenefits.*
*Final Medicare Part D DIR Reporting Requirements for 2015; Centers for Medicare & Medicaid Services memorandum; May 31, 2016
PresentationtoCMSQ2-2016
WhatisaDIRfee?DIRisanyformofpriceconcession,receivedeitherbythePartDsponsororbyanintermediarycontractingorganization(aPharmacyBenefitsManager,orPBM,forinstance)withwhichthesponsorhascontracted,fromanysource(includingmanufacturers,pharmacies,enrollees,oranyotherpersonorentity)thatservestodecreasethecostsincurredunderthePartDplanbythePartDsponsor,eitherdirectlyorindirectly.Thus,DIRincludesdiscounts,chargebacks,rebates,cashdiscounts,freegoodscontingentonapurchaseagreement,up-frontpayments,coupons,goodsinkind,freeorreduced-priceservices,grants,legaljudgmentamounts,settlementamountsfromlawsuitsorotherlegalaction,andotherpriceconcessionsorsimilarbenefits.*
*Final Medicare Part D DIR Reporting Requirements for 2015; Centers for Medicare & Medicaid Services memorandum; May 31, 2016
Shouldn’tthegoalbetodecreasethecostsincurredundertheMedicareProgramand
toMedicareMembers?
PresentationtoCMSQ2-2016
OutcomesData&PharmacyNetworks
ClinicallyIntegratedNetworkofProviders
1.CMS Innovation Center Grant & National Expansion of Concept
1.NC Pharmacy Providers Partner with Family Practice CIN
Family Practice Providers in North Carolina Prove CIN Savings
1.FTC Exemption for Clinically Integrated Network (CIN) Creation
1.Federal Trade Commission Barriers to Collaboration (ANTI-TRUST)
1.Begins as Providers Striving to DO MORE Together
Patient Access
Benefits of Providing Medication Use Support Integrated with Primary Care
A2010performanceanalysisofCommunityCareofNorthCarolinaprimarycarepracticeswithintegratedcommunity-basedpharmacysupports
What is an Enhanced Pharmacy Service?
According to the Community Pharmacy Enhanced Service Pharmacy Network* (CPESN), an Enhanced Pharmacy Service is a service that:
“…transcends conventional outpatient pharmacy contract obligations.”*
Network Minimum Service Sets Like:§ Comprehensive Medication Reviews§ Medication Synchronization Program
§ Immunization Screening§ Medication Reconciliation
§ Personal Medication Record *https://www.cpesn.com/
What is an Enhanced Pharmacy Service?
According to the Community Pharmacy Enhanced Service Pharmacy Network* (CPESN), an Enhanced Pharmacy Service is a service that:
“…transcends conventional outpatient pharmacy contract obligations.”*
Network Minimum Service Sets Like:§ Comprehensive Medication Reviews§ Medication Synchronization Program
§ Immunization Screening§ Medication Reconciliation
§ Personal Medication Record *https://www.cpesn.com/
Opportunities are LOCAL
WhoaretheMarketDisruptors?
•Frustrated Employers•Clinically Integrated Networks of Providers
•Patient Engagement Technology Vendors•Healthcare Cost Transparency Advocates•Patients With a Voice!
Thank You!!Tripp Logan, PharmD