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JanetNormanRPh
Co-Director
ServiceSets&QA,CPESN-UTAH
StaffPharmacist,MountainWestApothecary
UtahCommunityPharmacyEnhancedServicesNetwork(CPESN)Update
• Describethechangingclimateofhealthcareandhowthisaffectsfuturereimbursementandpracticeopportunities
• IdentifytherationalebehindtheformationofaCPESNonanationalandlocallevel
• DiscussthebasicstructureandservicesofferedbytheUtahCPESN
• IdentifythecurrentandfutureactivityoftheUtahCPESN
Objectives
• PharmacyrecognizedasaninvaluablepartoftheMedicalNeighborhoodthatcontributestoongoingmedicationCoordinationandOptimization
• Paymentreformtakingplace:increasinglytiedtothequalityofcareprovidedasmeasuredbypatientoutcomesandhealthcarecostsavings.
• Reimbursementaccordingto“valuebasedsystem”
AChangingHealthcareLandscape HealthCareSpendinginAmerica
90%
10%
Medical/Non-Pharmacy
Medication/Pharmacy
Throughtheformationofnetworksofcommunity-basedpharmacieswhosemembersprovideahigherlevelofservicethatdemonstratesanimprovementinpatientoutcomesandtherapeuticgoalachievement,demonstratemedicalcostssavingsandarewillingtocoordinatewithabroadercareteam.
MovingForward:ForourPatientsandProfession
CommunityPharmacyEnhancedServicesNetwork(CPESN)Pharmacies
• TheseuniquepharmaciesaremembersofCommunityPharmacyEnhancedServicesNetworks.CPESNNetworkpharmaciesoffer:
• Aclearfocusoninterventionsthatchangepatientbehaviorandleadtoimprovedhealthoutcomes
• Theexperiencenecessarytoprovidemedicationoptimizationactivitiesandotherenhancedservices
• Acollaborativeapproachwithotherhealthcareteammemberswhoareheldjointlyaccountable
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• NationalCPESNbeganinNorthCarolina• ReceivedgrantfromDepartmentofHealthandHuman
Services,CentersforMedicare&MedicaidServicestodevelopnetworks.
• Currentlyinsomeformofdevelopmentinatleast24States.
• NationalOrganizationProvidessupportforLocalnetworks– SubjectMatterExpertiseand&NetworkConsultation– ValueExpression&MarketingSupport– QualityAssurance&BestPracticeIdentification
CommunityPharmacyEnhancedServicesNetwork(CPESN)
CPESNUSAAffiliatedNetworks
CPESNNetworkStructure
Servicesthattranscendconventionalrequirementsofanoutpatientpharmacyprogramcontractthatarefocusedonimprovingclinicalandglobaloutcomes
EnhancedServices
• MedicationReconciliation• ClinicalMedicationSynchronization• AdherencePackaging• Immunizations• CompleteMedicationReviewswithChronicCare
Management• HomeDelivery/HomeVisits• PointofCareTesting• VitalSignCollection• NutritionalCounseling• SmokingCessation• Compounding• EmergencyServices
TypesofEnhancedServices
• CommunitybasedpharmaciesPatienttargeting• Wholepatientorientation• Accountabilityonglobaloutcomesandquality
(sharedmetricswiththerestofcareteam)• Localcareteamclinicalintegrationandcoordination• Supportforpracticetransformation• ApproachtoHealthInformationTechnology
(PharmacisteCarePlans)
WhatmakestheCPESNmodeldifferent?
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• PartnershipbetweenUtahDepartmentofHealth,UPhAandinterestedUtahpharmacists/pharmacyorganizations
• Goal:Createanetworkofcommunity-basedpharmacistsinUtahwhoarecurrentlyprovidingand/orwillingtoprovideenhancedservicesandcoordinatecarewiththebroadercareteam.
CPESNUtahTimeline
May2016
Septem
ber
2017
Octob
er2017
June
2017
Augu
st2017
Novem
ber
2017
Curren
t
Steeringcommitteeassembled
Informa/onalmee/ngheldinSLCWorkgroupscreated
ServicesdefinedNetworkInfrastructuredevelopedQAprocessestablishedLookingfor“purchasersofvalue”
PharmaciessignnetworkagreementCollabora/veASTHOprojectGrantobtainedCon/nuedRecruitmentandfurthernetworkrefinement
WorkbeginsonASTHOproject
ASTHOprojectlaunched
Con/nuedRecruitment:91pharmaciesnowLookingfor“purchasersofvalue”MembersupportDocumenta/on/ClinicalIntegra/onTools(QA)
G. Benjamin Berre,, PharmD, BCPS, BC-ADM U of U Healthcare Neal Catalano, BSPharm, CDE Novo Nordisk, Inc. Kevin DeMass, BSPharm Apothecary Shoppe, Inc. Jeff Gatzemeier, BSPharm Oquirrh Mountain Pharmacy Karen Gunning, PharmD, BCPS, BCACP, FCCP University of Utah Mike Johnson , BSPharm Maple Mountain Pharmacy Ashley Rush, MPP, MPH Domain III Specialist for EPICC program Utah Department of Health
CPESNUtahExecutiveCommitteeJaime Montuoro, PharmD Smith’s Food and Drug Dan Richards, PharmD Meds in MoRon Pharmacy Buck Stanford, BSPharm, MBA Intermountain Healthcare Linda Tyler, PharmD U of U Health Care Jim Webster, BSPharm, CDE Santaquin Pharmacy & Diabetes Center Adam Jones ExecutiveDirector,UPhA
• AdherencesupportServices• Comprehensivemedicationmanagement• Immunizations• MedicationReconciliation• MedicationSynchronization
CPESN-UTRequiredCoreEnhancedServices
• Providepatient-specificsupportinoneoravarietyofmechanismsincludingsupportivecounseling,educationandprovidingadherence-enhancingtools
AdherenceSupportServices
• Followthe10stepprocessdescribedbythePatient-CenteredPrimaryCareCollaborative(PCPCC)
ComprehensiveMedicationManagement
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ComprehensiveMedicationManagement
hWps://www.pcpcc.org/sites/default/files/media/medmanagement.pdf
• Activelyscreen,recommendandadministerimmunizationsbasedonACIPrecommendationsandaspermittedbytheUtahVaccineProtocol
Immunizations
• Especiallyimportantduringcaretransitions
1. Developalistofcurrentmedications2. Developalistofmedicationstobeprescribed3. Comparethemedicationsonthetwolists4. Makeclinicaldecisionsbasedonthecomparison5. Communicatethenewlisttoappropriatecaregiversand
tothepatient
MedicationReconciliation
1. Activelyidentifyandrecruitpatients2. Developanaccuratelistofcurrentmedications,
evaluatingwhichmedicationscanbesynchronized3. Sync/timetherefillsonaschedulethatworksforthe
patient4. Reviewmedicationswiththepatientpriortorefilling
(toidentifyproblemswithorchangestotherapy)5. Refillmedications6. Meetwithpatientuponpick-up/deliveryofmedications
toassess/monitorprogressiontowarddesiredtherapeuticgoalsofmedications
7. Follow-upasneededwithprovidersregardingnon-adherenceorfailuretoreachtherapeuticgoals
MedicationSynchronization
• CollaborationbetweenCPESN-UT,UtahDeparmentofHealth,EducatorsMutualInsurance(EMI),UtahOfficeofHealthcareStatistics,RosemanUniversity,andpharmacyleaders.
• SelectedCPESN-UTPharmacieswillbecaringforhighutilizerHypertensionpatientsaccordingtothePharmacistCareModel(wholepatient,chroniccare)for6months
ASTHOProjectIdentifyandsupportasustainablepharmacypracticemodelleveragingfrequentcontactbetweencommunitypharmacyandthehighestriskpatients.Thisinitiativewill:• Demonstrateadditionalvalueofcommunitypharmacy
practice• Demonstrateadifferenceintheoutcomes(clinicaland
economic)ofthepatientscaredforbythepharmacist• Incentivizeplanstoreimbursecommunitypharmacyforthe
valuedcontributiontopatienthealth
ASTHOProject
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• MemberSupport– TrainingandQualityAssuranceforCoreServices– DocumentationandClinicalIntegrationTools(ecareplans)– ReimbursementSchemes
• MemberRecruitment• Fundingformoredemonstrationprojects• ContactandMarketingto“purchasersofvalue”• PharmacyLocationApp
CurrentandFutureActivities
• BecomeamemberofCPESNUtah– AccessParticipationAgreementandbasicinformationathttp://www.upha.com/?page=CPESN
– ContactAdamJonesdirectly,[email protected]
– ContactanymemberoftheExecutiveCommittee• Getinvolvedinourworkgroups• PrepareyourpharmacyforCPESN-UtahActivities• Raiseawarenesstocolleagues,otherHealthCare
Professionals,andPatients
HowCanYouHelp? BecomeInvolved!
• DeanJolleyRPh,OwnerJolley’sCompoundingPharmacy
AnAdditionalProspective
True/FalseReimbursementisincreasinglybeingtiedtothequalityofcareprovidedasmeasuredbypatientoutcomesandhealthcarecostsavings,otherwiseknownasa“valuebasedsystem”.
Self-AssessmentQuiz#1
CommunityPharmacyEnhancedServicesNetwork(CPESN)PharmaciesOffer:A.Aclearfocusoninterventionsthatchangepatientbehavior
andleadtoimprovedhealthoutcomesB.Theexperiencenecessarytoprovidemedication
optimizationactivitiesandotherenhancedservicesC. Acollaborativeapproachwithotherhealthcareteam
membersbutarenotheldjointlyaccountableD. AandBE. A,B,andC
Self-AssessmentQuiz#2True/FalseEnhancedServicesareservicesthattranscendconventionalrequirementsofanoutpatientpharmacyprogramcontractthatarefocusedonimprovingproductreimbursementrates.
SelfAssessmentQuiz#3
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MembersofCPESNUTarerequiredtoofferallofthefollowingCoreEnhancedServicesEXCEPT:A.AdherencesupportServicesB.ComprehensivemedicationmanagementC.ImmunizationsD.SmokingCessationE.MedicationReconciliationF. MedicationSynchronization
SelfAssessmentQuiz#4
ThankYou!
QuestionsandDiscussion
JanetNormanRPh [email protected]
