uhctransitions pharmacy module - uhcprovider.com …€¦ · · 2017-11-03doc #:...

Doc #: PCA-1-008136-09272017_10302017

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UHCTransitions is UnitedHealthcare’s convenient online tool that can help you identify and address open care opportunities for your patients who are our Medicare Advantage Prescription Drug Plan members. The tool’s Pharmacy Module allows daily pharmacy claim information to be compiled so you can easily see which plan members have an upcoming or past due refi ll. You can also:

• View who may be a candidate for a 90-day supply of their medication. • See who has open care opportunities tied to these quality measures:

– Statin Use in Persons With Diabetes (SUPD) – Statin Therapy for Patients With Cardiovascular Disease (SPC) – Medication Therapy Management Program Completion Rate for Comprehensive

Medication Reviews (CMR) • Get high-risk medication alerts. • Add notes to track your eff orts.

This quick reference guide can help you get the most out of the Pharmacy Module.

Step 1: Go to the medication adherence landing page.First, start by logging in to UHCTransitions every day at uhc.healthcollaborate.com. Once you’re logged in, follow these instructions to see which of your patients are at risk for non-adherence to their medications:

• Under the Quality drop-down, select Member Rx Adherence to view your patient list.

UHCTransitions™ Pharmacy ModuleReview daily to help improve medication adherence for your patients.

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UHCTransitions™ Pharmacy Module

• Information provided for each patient includes: – First and last name – Date of birth – Adherence alerts showing past due or coming due refi lls for cholesterol (statin), diabetes and/or hypertension (RAS antagonist) medications

– High-risk medication alerts if a high-risk medication was fi lled

– A 90-day supply opportunity if the last refi ll of a medication was for less than 90 days

– SUPD, SPC and CMR care opportunity alerts

• Icons appear if an action is added for an alert. No icon appears if there hasn’t been an action taken. See Step 3 for details on how to document any follow-up with your patient to help improve their medication adherence.

Indicates Follow-up required. Indicates Action taken.

• Within the Member Rx Adherence page, columns can be sorted or fi ltered by: – Care provider – Prescribing care provider – Health system/facility – Medication category

– 90-day supply opportunity – Patient fi rst name – Patient last name – Date of birth

• Patients listed as highest priority have a refi ll past due date and, by default, are at the top of the list. Patient information is sorted lowest to highest by allowable days remaining — the number of days they can miss before they become non-adherent for the year.The next priority are patients with refi lls that are due in seven days or less from the current date. They’re also sorted lowest to highest by allowable days remaining.

– Past due medications are displayed in Red text with a count of the days past due.

– Medications that are coming due are shown in Yellow text with a count of the days before the next refi ll is due.

– If a patient is taking two oral diabetes medications and is timely with one but not the other, an alert won’t display for the second untimely medication. However, the prioritization will still apply to the second medication and the patient may appear high on the list despite not having any displayed alerts. For more details, click on the Rx icon and view Refi ll History — see Step 2 for instructions.

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Step 2: Review alert details — adherence scorecard and refi ll history.For a more detailed patient view, click on the Rx icon underneath each patient’s name on the Member Rx Adherence page. The Patient Rx Scorecard will appear with updated information about the patient’s medication adherence, and show any open SUPD, SPC and CMR care opportunities.

• From the Patient Rx Scorecard, click on the Patient Refi ll History tab to see when a patient last fi lled their prescription. An Adherence Category will display next to each name with adherence information for the cholesterol, diabetes and/or hypertension medications they’re taking.

SUPD, SPC and CMR care opportunity alerts will also show in the Patient Refi ll History view.

• The Rx Scorecard for each category includes: – Current proportion of days covered (PDC) — patient must fi nish the year with 80 percent to be considered adherent

– Allowable days remaining before a patient becomes non-adherent — number will go down every day a refi ll is past due

– Days missed year-to-date — number of days the patient has missed on the medication so far this year

– SUPD, SPC and CMR care opportunity alerts

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Refi ll past due or coming due adherence alerts will show: – Drug name – Most recent fi ll date and next refi ll due date – Quantity and days’ supply – Prescribing care provider – Pharmacy name/ID

– Pharmacy phone number – Adherence category – Refi ll status – Action — if an action has been taken and documented

High-risk medication alerts will simply display as “HRM” under the HRM column, while SUPD, SPC and CMR alerts will be on their own lines.

• At the bottom of the Patient Refi ll History tab, you can: – Exclude Patient — Hide a patient from all views for 30 days. For Part D medication adherence, hiding a patient from view or documenting that they no longer take a medication won’t remove them from the measure.

– Add a Note — View and/or add free text notes.

• To include a note, select Medication/Pharmacy from the drop-down menu. • Type your free text in the Add a Note box and click Submit. • To view a note, click on the Notes tab.

– Review Patient Demographics — Click to be redirected to general patient information.

• To view alert details, click on the Patient Refi ll History tab.

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Section 3: Manage alerts and document action taken.The Pharmacy Module also allows you to track the actions you’ve taken when following up with your patients about their medication adherence, or high-risk medication, SUPD, SPC and/or CMR care opportunities.

• To get started, go to the Patient Refi ll History tab and click the Manage button on the right side.

• The following alert details will appear, from top to bottom: – Adherence scorecard — same information as the Patient Rx Scorecard

– Adherence and high-risk medication — drug information including refi ll status and 90-day supply opportunity alert, if appropriate

– SUPD, SPC and CMR — general information about the care opportunity

– List of actions previously documented for this alert – Action Taken section

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• To document any actions you’ve taken with your patient, click the applicable boxes under the Action Taken header — more than one selection can be made.

– Choosing one of the following actions will hide the patient’s adherence alert from view, but won’t remove them from the adherence numerator. For Part D medication adherence, a patient can’t be removed from the numerator once indexed into the measure.

• “Patient no longer prescribed medication” • “Patient contacted”…

– “pays cash at pharmacy” – “receives prescriptions from VA”

– “receives free samples” – “performs pill splitting”

– To save action(s), click Add Action.

If you checked “Follow up is needed,” a follow-up icon will appear with the alert on the patient list.

If any other action is checked, an action taken icon will appear with the alert on the patient list.

• If a patient has multiple alerts, click on Previous or Next to view the next one and document any actions taken.

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Section 4: Export reports.Reports can be exported from the Pharmacy Module to share medication alerts and adherence information as needed. Exports can be sent to an Excel or CSV fi le.

• To begin your export, go to the Member Rx Adherence page from the Quality drop-down and click on Export on the left side.

• Information provided within the report includes: – Member and primary care provider details – For each adherence measure:

• Alerts — refi ll past due or coming due • Adherence information — proportion of days covered (PDC), allowable days remaining (ADR) and days missed • Drug information — name, quantity/days’ supply (DS), last refi ll date and refi ll due date

• Pharmacy information • Prescribing care provider • Documented actions taken

– High-risk medication — drug name, date of refi ll, prescribing care provider and documented actions taken – 90-day supply opportunity alerts – SUPD, SPC and CMR care opportunities

Contact us to learn more. For more information about how our programs can help support your patients who are UnitedHealthcare Medicare Advantage Prescription Drug Plan members, please contact your UnitedHealthcare representative.

– Choose between “All Records that match current fi lters” or “Checked Records Only.”

– Select the fi le format from the drop-down and then click Export.

Sample export report:


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Statins Pharmacy Name/Phone Statins Prescribing Provider Statins Actions Taken Diabetes Actions TakenHigh Risk Medications

HRM Drug Name

HRM Date of last refi ll

HRM Prescribing Provider

HRM Actions Taken 90 Days Supply Opportunity

2016/09/02 13:52 - Transport Consider switch to 90 Days Supply if appropriate

2016/09/02 13:52 - Transport Consider switch to 90 Days Supply if appropriate

<Prescribing Provider Name> Consider switch to 90 Days Supply if appropriate

<Prescribing Provider Name> Consider switch to 90 Days Supply if appropriate

<Prescribing Provider Name> 2016/08/29 16:23 - Follow Consider switch to 90 Days Supply if appropriate

Consider switch to 90 Days Supply if appropriate

WAL-MART PHARMACY 10-3377 103377/(520)908-2563 <Prescribing Provider Name> Consider switch to 90 Days Supply if appropriateWAL-MART PHARMACY 10-3377 103377/(520)908-2563

Member Name Member DOB Primary Provider Primary Practice StatinsStatins PDC

Statins ADR

Statins Days missed Statins Drug name

Statins Quantity/DS

Statins Date of last refi ll

Statins Next refi ll due Statins Pharmacy Name/Phone

<Patient Name> 08/31/1946 <Provider Name> <Practice Name>


<Patient Name> 03/24/1950 <Provider Name> <Practice Name> Refi ll Past Due (37 days late) 50% 0 59 CRESTOR TAB 40MG 30/30 03/31/2016 04/30/2016 MARANA HEALTH CENTER INC/520-682-

<Patient Name> 07/18/1940 <Provider Name> <Practice Name> Refi ll Past Due (13 days late) 50% 0 60 PRAVASTATIN TAB 80MG 30/30 04/06/2016 05/06/2016 WALGREENS 6766 6766/(520)889-3902

<Patient Name> 11/13/1940 <Provider Name> <Practice Name> Refi ll Past Due (11 days late) 61% 0 72 SIMVASTATIN TAB 40MG 28/28 04/28/2016 05/26/2016 QUALITY PHARMACY 2/(401)762-7526


<Patient Name> 07/27/1958 <Provider Name> <Practice Name> Refi ll Past Due (4 days late) 50% 0 59 ATORVASTATIN TAB 40MG 30/30 05/13/2016 06/12/2016 WAL-MART PHARMACY 10-3377 103377/(520)908-2563WAL-MART PHARMACY 10-3377 103377/(520)908-2563

uhctransitions pharmacy module - uhcprovider.com …€¦ · · 2017-11-03doc #:...

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