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Medication Safety LAN Event –Campaign for Meds Management Phase 2 Kick-off: Impact of a Hospital-to-Community Pharmacist Med Management Intervention

Thursday, May 25, 20173:00 – 4:30 PM ET

Welcome and Reminders

Risa Hayes, CPCQIN NCC

Event Lead

Rachel Digmann, Pharm D, BCPS

QIN NCCChat Manager

• Please be prepared for sharing and open discussion

• Slides and a recording from today’s session can be found on: http://qioprogram.org/medication-safety-lan-event-may-2017

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Agenda

• Continuing Education Details • Speaker Presentations

– Risa Hayes, QIN NCC– Karen Pellegrin, University of Hawaii Hilo

• Facilitated Discussion• Wrap-up

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Things to Think About

Will you commit to being… • Attentive• Active participant• Actionable

Show your commitment by clicking the green checkmark!

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Now Offering Continuing Education Credit

Continuing education credit is available for:• Physicians & Physician Assistants• Registered Nurses & Nurse Practitioners• Dietitians• Pharmacists & Pharmacy Technicians• Certificate of Attendance

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Instructions for Obtaining CE

• Attend the entire event• Complete the evaluation that will pop up at the

conclusion of the event• There is a separate evaluation required for CE that will

load in your browser following completion of the general evaluation

• Once you submit your CE evaluation, you will be provided with a certificate to retain for your records

• For technical assistance, please email Nikki Racelis(nikki.racelis@qinncc.hcqis.org)

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CE Information

Physicians:This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants:NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.

Pharmacists:AKH Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.AKH Inc., Advancing Knowledge in Healthcare approves this knowledge-based activity for 1.5 contact hours (0.15 CEUs). UAN 0077-9999-17-031-L04-P; UAN 0077-9999-17-031-L04-T. Initial

Release Date: 5/25/17

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CE Information, Continued

Registered Nurses:AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.This activity is awarded 1.5 contact hours.

Nurse Practitioners:AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider Number: 030803.This program is accredited for 1.5 contact hours which include 0 hours of pharmacology. Program ID #21718-4

This program was planned in accordance with AANP CE Standards and Policies.

Dietitians:AKH Inc., Advancing Knowledge in Healthcare is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 1.5 continuing professional education units (CPEUs) for completion of this program/material. CDR Accredited Provider #AN008. The focus of this activity is rated Level 2. Learners may submit evaluations of program/materials quality to the CDR at www.cdrnet.org.

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Disclosure of Financial Relationships & Commercial Support

• The planners and faculty do not have any relevant financial relationships to disclose.

• AKH Inc., CRW & Associates, and Telligen do not have any relevant financial relationships to disclose.

• No commercial support was received for this activity.

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Disclosure of Financial Relationships & Commercial Support

DisclosuresIt is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use and Investigational Product This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant's misunderstanding of the content.

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Method of Participation

• You must participate in the entire activity to receive credit.

• A statement of credit will be available upon completion of an online evaluation/claimed credit form.

• The link to the online evaluation will be provided after completion of the activity.

• If you have questions about this CME/CE activity, please contact AKH Inc. at service@akhcme.com.

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Who is on the call today?

• Academic Faculty• Government agency (CMS,

CMMI, CDC, etc.)• Home Health Agency• Hospital• Nursing Home/LTC/SNF• Patient, Family, or Caregiver• Patient or Family

Representative

• Pharmacist: Clinic• Pharmacist: Community• Pharmacist: Hospital• Pharmacist: LTC• Prescriber/Practitioner• QIN-QIO staff• Other (please specify in the

comments field)

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Session Goals

By the end of today’s call you will be able to…

• Understand the value of the Pharm2Pharm (hospitalpharmacy to community pharmacy medicationmanagement) to patients, providers, and health systems.

• Identify at least two Pharm2Pharm training and utilizationresources.

• Apply the Pharm2Pharm model of care to alternativehigh-risk populations.

Centers for Medicare & Medicaid Services

Anita Thomas, PharmDMedication Safety Lead

Mission & Vision for CMM Phase 2

• CMM Team Mission: Increase awareness of and access to patient-centered medication management resources to improve thehealth and safety of people with Medicare who are at high risk foradverse drug events (those using medications that are consideredhigh-risk medications (HRMs): opioids, diabetes medications,and/or anticoagulant medications).

• Our Motivating Vision: This campaign aims to elevate andpromote the practice of patient-centered medicationmanagement and use of patient-centered tools, especially in theHRM population, in order to transcend traditional medicationmanagement, advance patient-centered shared decision makingmodels, and emphasize the patient voice in healthcare.

How will we do this?

• Focus: Patient voice and patient needs – specific to HRMs. We willfocus on resources that are patient-centered and/or promote shareddecision-making.

• Organizing and Action: We seek to partner with individuals andorganizations – patients, family members, caregivers, providers, andothers who share our vision. The only way to reach our goals is withyour commitment, help, and active participation.

• National Resource Center Website: Tools, resources and stories willcontinually be made available to on the CMM Website. Participantswill also be able to connect with each other via the website.

• Education, Awareness, and Innovation: We will continue to hostquarterly Medication Safety Learning and Action Network (LAN) eventsto showcase innovative and effective interventions, tools, resources,and techniques for safe and patient-centered medicationmanagement.

How you can get involved

• Share your story: How has/is medication safety impacted yourlife/work? What would you like others to know?

• Share your tools: Do you have a tool, system or trustedresource that works for you? What have you put in place toenable shared decision-making? Share an innovation orpromising practice with us.

• Pledge: Join this campaign. Share a story or resource; promotethe campaign to others; utilize the resources, and incorporateshared-decision making models into your practice. Attend QrtlyLAN events

• Mastermind Groups: Are you interested in creating, modifying,or testing a HRM specific resource or being part of aworkgroup?

2017 Aims

• Collect or create at least three distinct resources forpatients/families/caregivers (1 per HRM drug class)

• Collect or create at least three distinct patient-centeredresources for providers (1 per HRM drug class)

• Receive at least 50 pledges to participate• Collect at least three stories from the patient/family

perspective

Campaign for Meds Management

Phase 2 Campaign Timeline

Cap

acit

y B

uilt

2017

Phase 2 Kickoff

PEAK 1:1) Launch CMM Phase 2

Website by May 20172) Launch CMM Pledge

Page by May 20173) At least 1 story by Jul

2017

PEAK 2:1) 3 new tools by Sep 20172) 20 pledges by Sep 20173) 2 new partners by Sep 2017

PEAK 3:1) 3 new partners by Oct

20172) 5 new tools by Nov ‘173) 30 pledges by Nov ‘17

PEAK 4:1) 6 tools by Jan 20182) 50 pledges by Jan

20183) 3 patient stories by

Jan 2018

Elevate and promote the practice of patient-centered medication management, especially in the HRM.

PDSA: Reflection & Adjustment

I would like to Pledge to join the Campaign for Meds Management (CMM)

• Yes, let’s do it!• I need more information• Not at this time

Facilitated Discussion

Chat in your questions and comments.

Press *1 on your telephone key pad to enter the teleconference queue.

University of Hawaii at Hilo

Karen Pellegrin, PhD, MBAFaculty/Director

Karen Pellegrin, PhD, MBA karen3@hawaii.eduDaniel K. Inouye College of Pharmacy Center for Rural Health Science University of Hawaii at Hilo

THE VISION OF PHARM-2-PHARM

Leverage underutilized pharmacist expertise across the continuum of care to achieve the three-part aim of the CMS Innovation Center: • Better care• Better health• Lower total costs

“Pharm2Pharm” = “Hospital Pharmacist to Community Pharmacist” care transition and coordination model focused on medications

Pellegrin KL. Pharm2Pharm: Leveraging medication expertise across the continuum of care. Hawaii Journal of Medicine & Public Health 2015;74(7):248-252

*Adapted from: Pharmaceutical Care Practice – The Patient Centered Approach, Cipolle, Morley, and Strand, 3rd Edition, McGraw Hill, 2012

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*

ENROLLMENT CRITERIASee details in Standard Operating Procedures

1: Patient is on 15 or more medications

2: Patient is on 10 or more medications AND at least one of those is high risk (i.e., narrow therapeutic index and/or commonly implicated in medication-related hospitalizations)

3: Current acute care episode is due to a drug therapy problem

4: Two or more previous acute care visits (ER, hospitalization, or observation stay) for uncontrolled chronic condition within past 3 months OR any previous hospitalization for uncontrolled chronic condition within past 12 months

5: Newly diagnosed Acute Coronary Syndrome, Atrial Fibrillation, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and/or Diabetes AND being discharged on a new home medication regimen for the condition(s)

6: Age less than 65 with all 5 of the following OR age 65 or older with at least 4 of the following

- Use of 1 or more medication with narrow therapeutic index

- Use of 1 or more medication commonly implicated in medication-related hospitalizations

- Five or more medications

- Three or more chronic conditions

- Any ED use or non-elective hospitalization/observation stay within past 12 months

DEFINITIONS

Narrow Therapeutic Index (NTI) drugs are defined as those with less than a 2-fold difference between median lethal dose and median effective dose1

Drugs commonly implicated in medication-related hospitalizations: Warfarin, oral antiplatelet agents, insulins, oral hypoglycemic agents, digoxin, opioid analgesics2

Drug therapy problems: Indication (i.e., untreated indication or unnecessary medication), effectiveness (i.e., dose too low or more effective alternative available), safety (i.e., adverse drug reaction or dose too high), adherence (i.e., patient non-compliant)3

Chronic condition is defined as a condition that lasts a year or more and requires ongoing medical attention and/or limits activities of daily living.4

1 http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part3.pdf2 Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365:2001-12.3 Pharmaceutical Care Practice – The Patient Centered Approach, Cipolle, Morley, and Strand, 3rd Edition, McGraw Hill, 20124 http://www.hhs.gov/ash/initiatives/mcc/#_edn3

PHARM-2-PHARM MEDICATION PROCESSES*

*Adapted from: Pharmaceutical Care Practice – The Patient Centered Approach, Cipolle, Morley, and Strand, 3rd Edition, McGraw Hill, 2012

MODEL IMPLEMENTATION

Launched sequentially in all 4 counties in Hawaii:

Maui - Q1 2013

Kauai - Q2 2013

Hawaii - Q3 2013

Honolulu (only at 2 of 7 hospitals) – Q2 & Q3 2014

> 2,500 patients enrolled by Hospital Consulting Pharmacists and handed off to Community Consulting Pharmacists

ProceduresTools/templatesTraining

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TRAINING NOW AVAILABLE ONLINEhttp://pharmacy.uhh.hawaii.edu/ce/irdtp.php

HEALTH INFORMATION TECHNOLOGY IMPLEMENTEDBY HAWAII HEALTH INFORMATION EXCHANGE

Secure messaging: Care transition documents sent from the Hospital Consulting Pharmacist to the Community Consulting Pharmacist via HHIE’s secure messaging system

http://files.hawaii.gov/dbedt/census/acs/Report/Data-Report-Non-English-Speaking-Profile-Hawaii.pdf

18.5% of Hawaii’s population reports speaking English “not well” or “not at all.”

% of care transition documents sent from Hospital to Community Pharmacist via HHIE

Virtual translation service: Available to Community Consulting Pharmacists 24/7, allowing non-English speaking patients to be enrolled

Lab access: Consulting Pharmacists have immediate e-access to patient labs via HHIE community health record

HCS med rec: Consulting Pharmacists use to: - check fill history- document reconciled medication list- document drug therapy problems

KEY OUTCOME MEASUREKey measure: population rates of medication-related hospitalization (biggest opportunity is 65+ age

group; 62% of Pharm2Pharm patients are age 65+), using ICD codes

*WHY?:

0.9%

0.0%

1.0%

2.0%

3.0%

4.0%

6.0%

7.0%

8.0%

0-17

3.4%

6.8%

5.0%

18-64 65+AGE GROUP

in Hawaii, 2010*% of hospitalizations that are "medication-related" per ICD code

*Pellegrin KL, Miyamura J, Taniguchi R, Ciarleglio AE, Barbato A, Holuby RS. Using ICD codes to track medication-related hospitalizations of older adults. Journal of the American Geriatrics Society (JAGS); 2016, Vol. 64(3), 651-653.

*This project was supported by a grant from the U.S. Department of Agriculture, National Institute of Food and Agriculture (NIFA) Rural Health and Safety Education Competitive Grants Program (USDA-CSREES-RHSE-002255), Medication Safety Education for Elderly in Rural Areas (award #: 2009-46100-06032). The content is solely the responsibility of the authors and does not necessarily represent the official views of the USDA.

“MEDICATION-RELATED” ICD-9 CODES

357.6 (neuropathy due to drugs)

692.3 (contact dermatitis due to drugs and medicines in contact with skin)

693.0 (dermatitis due to drugs or medicines taken internally)

960.0-964.9, 965.02-969.5, 969.8-979.9 (poisoning by drugs, medicinal and biological substances, including overdose of these substances and wrong substances given or taken in error)

E850.1-E858.9 (accidental poisoning by drugs, medicinal substances, and biologicals, including accidental overdose, wrong dose given or taken in error, and drug taken inadvertently)

E930.0-E934.9, E935.1-E949.9 (drugs, medicinal substances, and biologicals causing adverse effects in therapeutic use, including correct drug properly administered in therapeutic or prophylactic dosage as the cause of any adverse reaction including Allergic or hypersensitivity reactions)

COST SAVINGS DUE TO PHARM2PHARM / ROIPredicted medication-related admission rates 2014-Q4:

A. - Comparison group rate per 1,000 admissions 72.14

B. - Intervention group rate per 1,000 admissions 45.83

C. - Difference between comparison group and intervention group rates (A-B) 26.31

D. Actual number of admissions among those age 65 or older at intervention hospitals 2014 14,966

E. Predicted number of avoided medication-related admissions per year among those age 65 or older

associated with the intervention (C x (D / 1,000))393.75

F. Average cost of a medication-related hospitalization for a patient age 65 or older across intervention

hospitals in 2014 based on Medicare cost-to-charge ratio$16,830.02

G. Estimated annual cost of avoided medication-related admissions among those age 65 and older

associated with the intervention (E x F)$6,626,913

H. Actual annual cost of pharmacist services to deliver the intervention $1,820,454

Estimated return on investment in pharmacist services ((G – H) / H) 264%

Pellegrin, Krenk, Jolson-Oakes, Ciarleglio, Lynn, McInnis, Bairos, Gomez, Benitez-McCrary, Hanlon, Miyamura. Reductions in Medication‐Related Hospitalizations in Older Adults with Medication

Management by Hospital and Community Pharmacists: A Quasi‐Experimental Study Journal of the American Geriatrics Society, 7 OCT 2016 DOI: 10.1111/jgs.14518

ACKNOWLEDGEMENT OF FEDERAL FUNDING

The project described is supported by Funding Opportunity Number CMS-1C1-12-0001 from Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation.

Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

Pharm2Pharm Testimonial

https://www.youtube.com/watch?v=zIjRkXj_48s

Facilitated Discussion

Chat in your questions and comments.

Press *1 on your telephone key pad to enter the teleconference queue.

Preview of CMM Website

• Pull up Pharm2Pharm resources

Facilitated Discussion

Chat in your questions and comments.

Press *1 on your telephone key pad to enter the teleconference queue.

Individual Reflection

What are your key takeaways?

Did you hear any tactics that you could apply to your efforts around medication management?

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Call to Action

• Review the supplemental resources.• Visit the CMM website for resources and updates• Consider pledging to join the CMM

(see poll question next)• Complete the post-event assessment upon exiting WebEx:

https://www.surveymonkey.com/r/PXH53RN

I would like to Pledge to join the Campaign for Meds Management (CMM)

• Yes, let’s do it!• I need more information• Not at this time

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Call For Future Topics

• We want to hear from you!• Do you have a need or desire to hear about a certain topic?• Submit your ideas in chat or email us at:

QINNCC@area-d.hcqis.org

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Save the Date!

• Join us for the next Medication Safety LAN Event!– Wednesday, July 12, 2017– 3:00 - 4:30 PM ET– Registration is required!

▪ Register athttps://qualitynet.webex.com/qualitynet/onstage/g.php ?MTID=e2d340f09d591ad2d9934e18480a054a4

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Streamlined QIN NCC Event Schedule

• Starting in June 2017– QIN-QIO Sharing Calls will take place every other Wednesday and are now 90 minutes

▪ Reduces their frequency by half▪ Adds 30 minutes for optional Q&A and discussion at the end

– Each task will host a monthly task-specific Think Tank on a pre-determined day/time▪ Increases their frequency and improves date/time consistency

– LAN Events will take place on the 2nd Wednesday of each month; 90 minutes▪ Alternating between National LAN Events, Medication Safety LAN Events, and

Disparities LAN Events– The 4th Wednesday of each month will be reserved for ad hoc calls, which we now refer to

as Timely Topics (as needed); also 90 minutes▪ Improves date/time consistency

– Programmatic & Analytic Office Hours will be renamed QIN NCC Office Hours▪ Appropriate team members will be available to answer any Access-related questions

• For the most up-to-date event information, visit the Healthcare Communities Calendar.

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Thank you!

This material was prepared by Telligen, the Quality Innovation Network National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QINNCC-01450-05/15/17