October 22nd Healthcare Transformation Learning Session

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Healthcare Transformation Learning Session

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October 22nd Webinar, 1:00 - 2:00 PM

Learning Topic: How pharmacists are expanding their roles to improve value-based healthcare.

Featured speakers:Jim Gartner, Vice President Pharmacy and Medical Management Services, CareSourceKelli Barnes, Assistant Professor of Clinical Pharmacy, The Ohio State University General Internal MedicineEmily Vrontos, Specialty Practice Pharmacist, Department of Family Medicine, The Ohio State University1The expanding role of the pharmacistJim Gartner RPh, MBACareSource

10 28 20142I will open with this slideWhy did we want to launch a MTM program?Craig.key points as to why we would want a MTM program3MTM Program ApproachAs a part of the MTM program, CareSource members are eligible for a full menu of covered services, which include: Comprehensive Medication Review Prescriber Consultation Patient Adherence Consultation Patient Education & MonitoringMembers receive MTM coverage through a network of more than 85,000 local pharmacists nationwide, including nearly 3,300 pharmacists in Ohio alone.

4CareSource Pharmacy NetworkStatewide kick-off tour to promote the MTM opportunity within MedicaidCollaboration with Ohio Colleges of Pharmacy and Ohio Pharmacy Association Ongoing support from OutcomesMTM Network Performance team Team dedicated to providing the necessary support, encouragement and resources pharmacists need to operationalize MTM locally within a community

5Year-One ResultsIn the first 12-months of the CareSource MTM program:Total MTM Services Delivered106,239

Consultations provided that helped members avert events such as ER visits, hospitalizations and life-threatening complications2,246

6Key Activity in OhioTotal Patients122,413Total Claims281,209TIP Claims35%Pharmacist Driven Claims65%Total Acting MTM Pharmacies2,420Estimated Cost Avoidance (AIM)$57,029,321ROI 1.57:1(Year 1)$ 3,483,523.63 actual cost savingsJuly 1, 2012 June 30, 2014Jim7Key Activity in Ohio Claim TypeCMR20%Patient Ed/Monitoring28%Adherence35%Prescriber Consultation17%Prescriber Refusal7%Patient refusal37%8Year 2 ResultsAnalysis is still in works; however, showing similar 4:1 ROI.Savings are driven by reduction of hospital avoidanceThen ED avoidanceDrug product cost savings are still being determined.

9Year 2 ResultsCMR before and after review completed4500 CMRs reviewed12 months utilization before and after

10UtilizationPMPM ChangeRX CostIncrease 13%Inpatient CostDecrease 6%Outpatient CostIncrease 9%Professional CostDecrease 3%DentalIncrease 1%ER RateDecrease 11%MTM ActivitiesJim11MTM StoriesMedication Adherence and monitoring of BP a concern for member

Pharmacist worked with member to obtain a BP monitor and explained usePharmacist explained importance of adherence and provided a pill box and set up weekly check points for member to show pharmacist status of taking medicationsJim12MTM Stories

Member prescribed multiple medications; two identified as able to be discontinuedUsed two medications from same class; NSAIDsJim13MTM Stories

Diabetes medication reviewDiscussed losing weightAdherence of medicationsMonitoring Blood Sugars

Member was not using Inhaler and Stomach Medication (discontinued)Jim14Member Stories

Member with 9 disease states and 20 medicationsHas asthma; shortness of breathIncorrectly using maintenance inhalerNeed identified forrescue inhalerJim15Case FindingsPharmacists have become health coachesThe CMR conversation leads to greater findingsPharmacists truly part of the health care teamCareSource members move to the head of the linePharmacists are able to practice at a high level of the profession

16Reimbursement ModelPharmacies are no longer achieving strong reimbursement for dispensing of RXsNeed to move to service modelCurrent MTM Model$10.00 Successful Patient Education and Monitoring$20.00 Successful Physician Outreach$75.00 Complete Medication Review$2.00 for trying17Reimbursement ModelPay for Performance for pharmacists will be an evolutionAchieving success with MTM model will only lead to greater P4P successReimbursementsHealth CoachBlood drawsVaccinations

18Pharmacist Collaboration to Maximize Value-based HealthcareKelli Barnes, PharmD, BCACPEmily Vrontos, PharmD, CDE

General Internal Medicine ClinicsMartha Morehouse GIM ClinicCarePoint East GIM ClinicStoneridge GIM ClinicGrandview GIM ClinicHilliard GIM ClinicLewis Center Primary Care

National Committee for Quality Assurance (NCQA) tier 3 patient-centered medical homes (PCMH)21

Family Medicine ClinicsBethel Road FMUpper Arlington FMCarePoint East FMRardin FMCarePoint Gahanna FMWorthington FMCarePoint Lewis Center FMNew Albany Primary Care

National Committee for Quality Assurance (NCQA) tier 3 patient-centered medical homes (PCMH)


Clinic PersonnelAttending physicians and residentsPharmacists and pharmacy residentsNurse practitionersCare coordinators (RN)Social workersMedication assistance program coordinatorMedical assistants23Disease State ManagementPopulation ManagementTransitional Care Management2424GIM Interdisciplinary Diabetes Clinic25Patient referred by PCPPatient interviewed by pharmacist and physicianShared Plan making, goal settingPharmacist provides follow-up between visitsPharmacist delivers patient educationPhysicians follows labs, communicates with PCPDiabetes Clinic Outcomes

Average Between Readings 333 + 138 daysHemoglobin A1cp < 0.001Started clinic at CPE in 2013 and saw percentage of patients with A1c