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CareTriage: Recognizing Pharmacists as Valuable Members of the Healthcare Team
Troy Trygstad PharmD MBA PhD – CCNC VP Pharmacy Programs
Joe Moose PharmD – CCNC CPESN Coordinator
Improving care through shared knowledge
•Learning Objectives (for CE)1. Be able to identify various "actor-setting"
combinations that contribute to patient-centered medication optimization within the Medical Neighborhood.
2. Understand the role of community pharmacy as an advantageous point of capture in a population management strategy.
3. Identify strategies to match interventionists to patients based on patient specific medication management needs.
The Challenge
The Opportunity
“Create a Pharmacy Home, virtual or otherwise, where drug use
information from multiple sources* is gathered to better inform
prescribing and intervention strategies”
Medication Optimization is a Team Sport
What does the Medical Neighborhood look like?
Patient Panel
Hospital
PharmacySpecialty Providers
Community Resources
Prospective and Retrospective Quality Data
HH/Rehab/SNF
PCP & Clinic TeamCare
Management Team
Quality Improvement
Teams
“It Takes a Village”
8
Diversity of Participants in Medication Management
• PHARMACeHOME Participationpatient count (in past 30 days):
RN 7,469 PharmD 5,296 CPhT 2,627 Non-Licensed Program Support 675 RPA/RPT 621 RPh 592 Non-Licensed CM 179 Non-Licensed Program Personnel 177 LPN 170 CCM 157
BS 118 Non-Licensed CM Support 113 MSW 79 BSW 60 LCSW 46 TBD 33 NP 11 LCAS 5 LPC 4 MPH 4
What’s the role of community pharmacy?
10
CCNC Enrollees
CCNC Enrollees with total
medical cost > $10,000
Enrollees on CCNC
Priority list
Enrollees on TC Priority
list
Enrollees on Medication
Management Priority list
Total number of members 1,348,229 112,529 17,753 153,241 6,377 Total medical cost 4,078$ 27,527$ 23,813$ 18,215$ 25,345$ # of Inpatient visits 0.11 0.52 1.41 0.45 1.04 Inpatient costs 369$ 3,464$ 5,337$ 2,924$ 6,456$ # of mental health inpatient visits 0.01 0.04 0.04 0.04 0.04 ED visits 0.67 1.65 2.94 1.74 3.05 ED cost 178$ 745$ 1,262$ 816$ 1,657$ Outpatient visits 4.30 9.43 12.04 8.70 12.28 Mental health outpatient visits 0.62 1.88 1.04 1.53 1.14 PCP visits 2.09 2.91 2.53 2.65 3.52 Pharmacy visits 4.97 19.63 16.95 23.05 35.03 Pharmacy costs (Pre Rebate) 721$ 5,177$ 3,342$ 4,298$ 6,183$
CCNC Focus Population(s)
Value Added Services
Required Services
Standard Services Included within TECCA Participation Agreement Exhibit C• Proactive waste management program
• Patient counseling and adherence coaching
• Assist with medication reconciliation
**Although not required, all current pharmacies have also indicated availability of comprehensive medication review services
Incremental Benefit of a Multi-Credential, Multi-Setting Pharmacy Care Team to Transitional Care Process
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Pharmacy Home Activities (n=1,087) Usual Care (n=1,087)
Pharmacy Home Activities plus Home Visit (n=1,004) Usual Care (n=1,004)
Pharmacy Home Activities plus Hospital Visit (n=2,590) Usual Care (n=2,590)
Time to First Re-admission from Discharge (in days)
Pro
po
rtio
n o
f N
ot
Ho
spit
aliz
ed
0 90 180 270 0 90 180 270 0 90 180 270 360 360
How can all of this activity be done efficiency and with a high level of coordination?
(who, what, when, where, and how)
15
Product Overview
16
Population Population To Touch How To Touch Them
Need Generalized Med Management
Some Have More Specific Needs
Adherence/Coaching
Therapeutic Discrepancies
Therapeutic Considerations
Patient Needs
Intervention Selection
Actors-SettingsInterventions
Prioritize Patients with most need
Identify best intervention based
on data
Deliver intervention guidance
Logistics Engine
CareTriage and Prescriptive Analytics
17
RIG
HT
PATI
ENT
RIG
HT
INTE
RVEN
TIO
N
RIG
HT
CARE
TE
AM M
EMBE
R
RIG
HT
SETT
ING
RIG
HT
TIM
ING
/PRI
ORI
TY
Motivational Interviewing to Improve Adherence
General Medication Education
Comprehensive
Medication Therapy
Management
Medication Reconciliation Post Hospital
Discharge
Nurse Care Manager
Social Worker
Pharmacy Technician
Pharmacist
Pharmacy
Home
HH/Rehab/SNF
Hospital
Telephone
CareTriage identifies patients at risk for negative outcomes, and provides intervention guidance for the right providers in the appropriate setting and time.
CareTriage can be used to guide a wide array of interventions including transitional care services, critical follow-up appointment prioritization, and medication reconciliation services.
Engine Guidance
ClaimsClinical
Program ListsModel Outputs
User ImputationWorkforce Status
Intervention Status
Data
Any Problems?How Important?
What Should be Done?Who Should do It?
Where Should it be Done?When Should it be Done?
Should there be Follow-Up?
Answer:Credential: Pharmacist
Setting: Community DwellingTask: Help Afford Meds
Rec: Pt. Assistance Program
Conventional Approach
Next Generation Approach
Engine AlertDataClaimsClinical
Any Problems? Yes/No
High Positive Predictive Value
Population View
What are patients, employers, taxpayers paying for?
Some expenditures are investments, others are the result of lack of investment
The Value Proposition at the End of the Day
For more information contact Troy Trygstad at [email protected] or 919.260.5241
Visit us on the web at communitycarenc.org