Health SharePharmacy Workgroup Experience

Jim SlaterFacilitator

Workgroup Pharmacist Participants• Janice Hogue…Adventist Health

• Jim Slater, Dean Haxby…CareOregon

• Sandy AndersonCentral City Concern

• TBDClackamas County (Mental Health Services)

• Steve Logan, Nancy Louie Lee…Kaiser Foundation Health Plan of the Northwest

• Kathy Stoner, Cory Huot…Legacy Health System

• Carol Richmond, Michele Koder…Multnomah County

• Yen Pham, Amy Szczukowski…Oregon Health & Science University

• Priyesh Patel…• Steve Stoner…• Helen Noonan-Harnsberger/Greg Dietzman…• Terri Bianco…

Providence Health & ServicesHospital

Health PlanMedical Group

Specialty Pharmacy

• Brian Dotter…Tuality Healthcare

• TBDWashington County (Mental Health Services)

Shared Expectations & Questions

• What are you hoping to accomplish with collaboration?

• What questions do you have about the HSO?• What questions do you have about working

together as a workgroup?• What do you think would make a great

collaborative relationship?

Scope

• Collaborative workgroup of pharmacy staff from each HSO partner

• Goal is to demonstrate the power of collaboration using collective resources of the collaborative participants

• Indentify 3-5 cost-saving drug-therapy initiatives with savings measurable in 6-12 months

Possible Traits of a Successful Initiative

• Clear evidence or experience suggesting good chance of cost-savings (direct/indirect [high correlation])

• “Shovel Ready” – Can be implemented in 3 months• Collaborative partners can provide sufficient staff resource

allocation to be successful• Members and/or Providers likely are positively impacted

(Triple Aim) – Tangible experience for the better• Project can work in more than one setting/facility• More than one HSO partner participates together

– Even better to work across the system (Plan + Hospital + Clinic/Medical Group)

Some Cost-Saving Drug Utilization Levers That Can Be Pulled – Others?

• Improving PCP and office staff productivity– Formulary & prior-authorization standardization & unification– EMR best practice – formulary communication & individualized drug therapy plan

documentation and updating (EPIC and other platforms)

• Ensuring success of drug treatment care plans for high-acuity individuals– Concurrent review/collaboration – hospitalization– Medication reconciliation/transition-of-care post-discharge drug treatment plan F/U

(Handovers) Clinic ↔ Hospital ↔ Clinic– Monthly coordinated fills (Adherence packing, dispensing appointments, clinical

pharmacist monitoring/updates of drug therapy care plan)

• Pro-active steps to protect at-risk members– Hepatitis C (readiness –to – treat, progress/refill monitoring)– Safe Opiate Use (standardizaton: dose ceilings & quantity limits, tapering protocols,

instruments: D.I.R.E Score, applying prioritized list coverage/PA criteria)– Guideline Note 1 & 12 – best practice oncology & palliative care– Mental heath access issues ( PCP education on appropriate antipsychotic drug therapy &

pearls, limiting off label/poor evidence use)

Project Idea Brainstorming

• Open Discussion– What projects would lend themselves towards a 6-

12 month cost-saving (Triple Aim) objective?

Internal & External Communication

• Goal: Inspire/achieve orderly & effective team collaboration within the CCO and within the tri-county– How should we proceed with inside and outside

interest to join the work?– What are key opportunities to consider in how we

communicate our work?– What other groups of pharmacist should we consider

to keep in the loop and what is the right juncture?

Project Implementation Ideas

• One page sponsor report created for each project to report up to HSO

• At least co-leads for each project (creates continuity and back-up to keep it moving)

• Roll-up dashboard to track progress for each project – regular reporting (monthly)

• LEAN/A3 API methodology encouraged to refine work on each project towards success

Timeline/Strategy(2012 – 2013)

• 3Q2012– Form pharmacy workgroup and identify projects,

• 4Q2012– Form sub-workgroups, interpret scope into actionable steps

• 1Q2013– Monitor projects, CQI/Lean along the way, monthly progress reports

• 2Q2013– Presentations to collaborative of success/learning’s– Start working on next year objectives

TCMC Pharmacy Work GroupDraft Sponsor Report

Date Updated:

Scope:

Goals:

Success Defined:

Milestones:

Barriers/Concerns:

Key Learning's:

Next Steps/Timeline:

Key Stakeholders (KS),:

Oversight Owner(s):

Implementation Owner(s):

Project Title:

*Report Change **Process Change

VSMs and A3s for Project Management

Current State VSM Future State VSM

Future State PlanNew Current State VSM

PDSA

Project Implementation Brainstorming

• Open Discussion– What project resources can we collectively

contribute?– What training would help project teams be

successful?– What infrastructure do we need to secure

pathway towards project success?

Establish Pharmacy Director Workgroup with representation

form each CCO Board Partner

Orient workgroup to known CCO facts and workgroup goal

Gather key questions and

expectations from workgroup participants

Agree on initial projects for first

year. Define initial scope

Create sub workgroups with CCO partner staff for each project

Subgroups meet monthly and

interpret scope to create actionable

steps

Report out progress or clarification

needs to pharmacy director workgroup

Pharmacy Workgroup Steps

1 2 3

Conduct Ease & Impact exercise to

help identify project ideas

Report to HSO CMO workgroup progress

4 5 6

7 8 9

Medication Reconciliation Process Mapping Workshop 12-17-2012

Thank You!