mtm conference documents · during our final presentation of the day, you’ll have the opportunity...
TRANSCRIPT
MTM Conference Documents Agenda 1-2
HealthPartners MTM Conference Presentation 3-36
HealthPartners MTM Drug List 36-38
HealthPartners Case Management Criteria 39-40
Gathering Medical Information to Support the MTM Visit Monica Brands, Cub Pharmacy 41-52 Cub Pharmacy Lab Request Form 53 Cub Pharmacy Authorization to Disclosure of Protected Health Information 54 HealthPartners Content Review Checklist 55 2015 Medicare Part D Reporting Requirements 56-57 Treatment of Patients with Serious Mental Illnesses 58-105 HealthPartners Behavioral Health Case Management 106-118 MTM Marketing Workshop 119-137
1st Annual HealthPartners MTM Conference Agenda Friday, June 12th, 2015
HealthPartners, Bloomington MN
8:45 – 9:15 Registration and Continental Breakfast
9:15 – 9:30 Welcome and Introductions
Dan Rehrauer, PharmD, Sr. Manager MTM Program Molly Kaehler, Pharmacy Programs Coordinator
9:30 – 9:45 Conference Kickoff
HealthPartners President and CEO, Mary Brainerd
9:45 – 10:45 HealthPartners MTM Program, RxCheckup Dan Rehrauer, PharmD, Sr. Manager MTM Program, HealthPartners You’ll learn about our program philosophy, history, and hear about our results. We will discuss the challenges we face in a strict regulatory environment and how that shapes our program requirements. We will discuss our program goals and demonstrate and discuss tools available for you to support your practice.
10:45 – 11:00 HealthPartners Disease Case Management Services Jill Davis, MSN, RN, CCM, Manager of Disease and Case Management, HealthPartners HealthPartners has demonstrated synergy when MTM and Disease and Case Management Partner. Learn about how and when you can partner with Disease and Case Management to help your HealthPartners patients
11:00 – 11:30 Gathering Medical Information to support the MTM Visit Monica Brands, RPh, Pharmacy District Manager, Residency Director, Cub/SUPERVALU Pharmacies Performing a thorough medication history and assessment without access to medical records leads to missed opportunities to optimize medication use. This session will provide you with tips and tricks for accessing necessary information for the patients you care for.
11:30 – 12:00 HealthPartners Chart Auditing
Dan Rehrauer, PharmD, Sr. Manager MTM Program Veronica Jagatnarain, Pharmacy Programs Coordinator Hear about the findings of HealthPartners first quarter chart audit. Understand the common findings and how you can assure that your documentation meets HealthPartners requirements.
12:00 – 1:00 Lunch
1:00 – 2:00 Treatment of Patients with Serious Mental Illnesses
Michael Trangle MD, Associate Medical Director, HealthPartners Medical Group/Behavioral Health Division Jacob Held, PharmD, Clinical Pharmacist - - Psychiatry, Regions Hospital In this interactive session you will learn about serious mental illness: HealthPartners commitment to bringing awareness and removing stigma, the serious negative outcomes associated with a diagnosis, and how you can best help to maximize pharmacotherapy related outcomes.
2:00 – 2:15 HealthPartners Behavioral Health Case Management
Quanah Walker, MSW, LICSW, Manager of Case Management, Disease Management, WellBeing, Integration, HealthPartners Behavioral HealthPartners Learn about the services available and how you can access HealthPartners Behavioral Health Case Management support for your HealthPartners patients.
2:15 – 2:45 MTM Marketing Workshop Elaina McMillan, Senior Marketing and Communications Consultant During our final presentation of the day, you’ll have the opportunity to learn basic marketing techniques and tools to help you support your MTM practice. We will also seek your input for shaping future MTM marketing materials you will be able to utilize in your practice setting.
2:45 – 3:00 Closing Remarks
HealthPartners MTM Conference
Friday June 12, 2015
Everyone at the table take 5-6 pieces of candy
Don’t eat them yet!
Where is your favorite
vacation spot?
What are your hobbies?
WILD CARD! Tell us one thing
about you – doesn’t matter
the topic.
What is your favorite TV
show?
What is the craziest thing that has ever happened to
you?
FREE PASS! You lucked out! You don’t have
to share anything!
Today’s Agenda
Objectives
• Understand HealthPartners commitment to MTM • Appreciate the regulatory environment that MTM lives
within • Become familiar with tools and information available
to you through the HealthPartners provider portal • Learn about resources available to help support your
practice and the patients you serve • Meet other progressive pharmacists working to build
sustainable MTM practices • Leave excited to provide excellent patient care for
HealthPartners members
Welcome!
Integrated health care organization providing health care services and
health plan financing and administration
Largest consumer governed nonprofit
health care organization in the nation
Founded in 1957 as a cooperative
Offer an MTM benefit across our
population delivered by a
network of community based
pharmacists
Serves more than 1.5 million medical and dental health plan
members nationwide
…at a glance
Triple Aim
HealthPartners will be recognized as a local and national leader in the delivery of MTM services to our members. The core of our program lies in the belief that pharmacists integrated into patient care have the ability to vastly improve the medication use experience, leading to improved health care quality and reduced total cost of care. By leveraging our unique strengths as an open but integrated health care organization we will develop and utilize innovative payment and service delivery models that support integrated MTM services and that stress accountability to our care providers and members. We strive to minimize administrative burdens that take time away from the provision of care and do not contribute to improved member outcomes. We will utilize pharmacists within our own care delivery system to their fullest potential and share our successes and failures with our broader network of care delivery systems and providers to assure that our members have a consistent and excellent experience everywhere they receive MTM services.
Our Vision for RxCheckup
MTM services must
leverage pharmacists unique skill
set to optimize the medication
use experience
for the patients
MTM services are
most effective
when delivered through existing patient
relationships and when they are
integrated with primary
care
Drug therapy problems are
identified and resolved
in the context of the whole
patient
Optimal medication use occurs
on a continuum
and requires ongoing
assessment and support
HealthPartners RxCheckup Program Pillars
HealthPartners RxCheckup Program Goals
• Administer an MTM program that meets all regulatory requirements
• Assure consistent high quality care delivered across our MTM network
• Grow our provider network to match the needs of our membership
• Engage more of our targeted members
What is MTM?
• The service needs to be delivered directly to a specific patient • The service must include an assessment of the specific patient’s
medication-related needs to determine if the patient is experiencing any drug therapy problems. A care plan is developed to resolve the problems, establish specific therapy goals, implement personalized interventions and education, and follow up to determine the actual outcomes the patient experienced from taking the medications
Comprehensive Medication Management (CMM)
• The care must be comprehensive because medications impact all other medications and all medical conditions
• The work of pharmacists and medication therapy
practitioners needs to be coordinated with other members of the health care team
Comprehensive Medication Management (CMM)
1. Assess the patient’s medication related needs 2. Identify the patient’s medication related problems 3. Develop a care plan with individualized goals 4. Follow up to determine actual patient outcomes
Comprehensive Medication Management (CMM)
Take responsibility for all of the medication related outcomes of your patients
Expectations
MTM History at HealthPartners
HealthPartners MTM Timeline
MTM Services Buy-up option
to all Self-Insured
Employers
MTM Services for Medicare Part D and
Medicaid and establishment
of MTM provider network
Diabetes MTM Pilot
MTM Services for all Fully
Insured HealthPartners
Members
Integrated MTM with CM & DM
Vended MTM
System to meet CMS reporting requirements
Expanded to all
Self-Insured
MMROI Committee shows 11:1
ROI
2006 2009 2012 2007 2010 2015
MTM Vendor eliminated
Baseline (no MTM) N=370
5 years (no MTM)
Baseline (MTM) N=296
5 years (MTM)
LDL controlled 70.2% 69.6% 73.9% 85%
A1C controlled 52.9% 68.1% 48% 78.3%
BP controlled 79.6% 77.8% 84.6% 92.2%
Aspirin Use 85.2% 100% 90.9% 100%
Not smoking 86.2% 89.5% 92.6% 92.2%
Optimal diabetes control 16.5% 39.9% 16.2% 61.1%
20 percent increase in Optimal control resulted in 78 fewer ER visits and 36 fewer hospital admits between MTM group and control group.
Cost avoidance of approximately $392,000
Diabetes Pilot Results
Patient Experience
92% •Said they
‘always’ or ‘usually’ followed recommend-ations
97% •made one
or more lifestyle changes that could reduce their need for medicine
88% •said they
had 100% medication adherence
74% •said they
were able to keep glucose at optimal level
85% •said that
the program was completely worth their time
99% •said that
they would recommend HealthPart-ners MTM to their friends or family
After first full year of program, participants reported the following…
Patient Quotes…
“ …I’m taking all [my
medications] pretty
regularly for the first time
since my diagnosis.”
“…has really kept me on
track and has been just
what I needed to do a
better job of self
management. ”
• Randomized controlled clinical trial •Physician usual care vs. Pharmacist provided care with telemonitoring component • Active pharmacist intervention for 12 months followed by 6 months observation • Published in JAMA 2013;310(1):46-56
Intervention BP Control N=228
Usual Care BP Control N=222
P Value
6 months 71.8 % 45.2% <.001
12 months 71.2% 52.8% .005
18 months 71.8% 57.1% .003
Hyperlink
• Fully insured MTM population compared to a matched self insured population without an MTM benefit – ACG score exact match – Total claims costs in past year within $1000 – Gender exact match – Age within 5 years – CDC disease grouping within 1
• Total Costs compared 1 year pre/post MTM invitation • 11:1 ROI
– Reduction in ER visits and inpatient hospitalizations – Drug costs did not change – ACG-PM probability of high pharmacy cost and ACG-PM probability of
high total costs lower in Fully insured MTM population
MTM ROI
How about the network?
• 2014 – 17% of HealthPartners visits by network providers
• 1st quarter 2015 – 20% of HealthPartners visits by network providers
• Outside of MTM, 60% of care for HealthPartners members provided by network providers
• Clinical information for network visits generally not available
HealthPartners Documentation
• We want you to own your own data!! • In the perfect future world, you will document
your care in 1 system, bill utilizing 1 platform, and have the ability to care for patients from any health plan or Medicare PartD plan
Why can’t you do that today?
Medicare PartD Reporting Requirements!!
HealthPartners CCD
• Created to allow providers to document care in the system of their choice while still allowing HP to collect and report required data accurately
• For those without access to software to generate a CCD, portal tools created
Resources
• https://www.healthpartners.com/provider-public/pharmacy-services/mtm-services/ CMS Format/CCD Creator Documentation Requirements and Provider Expectations Claims submission Requirements Program Descriptions Invite Letter Templates Participation Agreements (for programs with an incentive) Access to Registries (where your assigned patients are
provided to you) Eligibility
Visual Medication Adherence Tool
Visual Medication Adherence Tool
Buy Up Groups
MTM Drug Lists (Effective June 1, 2015)
ANTICOAGULANTS ELIQUIS ENOXAPARIN SODIUM FONDAPARINUX SODIUM HEPARIN SODIUM PRADAXA WARFARIN SODIUM XARELTO ANTIPSYCHOTICS ABILIFY ABILIFY DISCMELT CHLORPROMAZINE HCL CLOZAPINE CLOZAPINE ODT FAZACLO FLUPHENAZINE HCL HALOPERIDOL LITHIUM CARBONATE LITHIUM CARBONATE ER LOXAPINE OLANZAPINE OLANZAPINE ODT PERPHENAZINE QUETIAPINE FUMARATE RISPERIDONE RISPERIDONE ODT SEROQUEL XR THIORIDAZINE HCL THIOTHIXENE TRIFLUOPERAZINE HCL ZIPRASIDONE HCL ASTHMA ADVAIR DISKUS ADVAIR HFA ALBUTEROL SULFATE ALBUTEROL SULFATE ER ASMANEX BUDESONIDE CROMOLYN SODIUM DULERA FLOVENT DISKUS FLOVENT HFA FORADIL HYDROCORTISONE MEDROL METHYLPREDNISOLONE METHYLPREDNISOLONE DOSE PACK MILLIPRED
MONTELUKAST SODIUM MONTELUKAST SODIUM CHEW MONTELUKAST SODIUM GRANULES MAXAIR AUTOHALER PREDNISOLONE PREDNISONE PREDNISONE DOSE PACK PREDNISONE INTENSOL PULMICORT PULMICORT FLEXHALER QVAR SEREVENT DISKUS STRIVERDI RESPIMAT SYMBICORT TERBUTALINE SULFATE THEOPHYLLINE VENTOLIN HFA CORONARY ARTERY DISEASE AGGRENOX ALDACTAZIDE AMILORIDE HCL AMILORIDE-HYDROCHLOROTHIAZIDE AMLODIPINE BESYLATE AMLODIPINE BESYLATE-BENAZEPRIL AMLODIPINE/VALSARTAN/HCTZ AMLODIPINE-VALSARTAN ATENOLOL ATENOLOL-CHLORTHALIDONE ATORVASTATIN CALCIUM BENAZEPRIL HCL BENAZEPRIL-HYDROCHLOROTHIAZIDE BISOPROLOL FUMARATE BISOPROLOL-HYDROCHLOROTHIAZIDE BRILINTA BUMETANIDE CAPTOPRIL CAPTOPRIL-HYDROCHLOROTHIAZIDE CARDIZEM CD CARVEDILOL CHLOROTHIAZIDE CHLORTHALIDONE CHOLESTYRAMINE CHOLESTYRAMINE LIGHT CILOSTAZOL CLONIDINE CLOPIDOGREL COLESTID COREG CR DILTIAZEM ER
DILTIAZEM HCL DIPYRIDAMOLE DIURIL DOXAZOSIN MESYLATE EDECRIN EFFIENT ENALAPRIL MALEATE ENALAPRIL-HYDROCHLOROTHIAZIDE EPLERENONE FENOFIBRATE FOSINOPRIL SODIUM FOSINOPRIL-HYDROCHLOROTHIAZIDE FUROSEMIDE GEMFIBROZIL GUANFACINE HCL HYDRALAZINE HCL HYDROCHLOROTHIAZIDE INDAPAMIDE IRBESARTAN IRBESARTAN-HYDROCHLOROTHIAZIDE ISORDIL ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE ER ISOSORBIDE DINITRATE SUBL ISOSORBIDE MONONITRATE ISOSORBIDE MONONITRATE ER LABETALOL HCL
LISINOPRIL LISINOPRIL-HYDROCHLOROTHIAZIDE LOSARTAN POTASSIUM LOSARTAN-HYDROCHLOROTHIAZIDE LOVASTATIN METHYLDOPA METOLAZONE METOPROLOL SUCCINATE METOPROLOL TARTRATE METOPROLOL-HYDROCHLOROTHIAZIDE MINOXIDIL MOEXIPRIL HCL MOEXIPRIL-HYDROCHLOROTHIAZIDE NADOLOL NIFEDIPINE ER NITRO-BID NITRO-DUR NITROGLYCERIN PATCH NITROSTAT OMEGA-3 ACID ETHYL ESTERS PERINDOPRIL ERBUMINE PRADAXA PRAVASTATIN SODIUM
PRAZOSIN HCL PROPRANOLOL HCL PROPRANOLOL HCL ER PROPRANOLOL-HYDROCHLOROTHIAZID QUINAPRIL HCL QUINAPRIL-HYDROCHLOROTHIAZIDE RAMIPRIL RESERPINE SIMVASTATIN SPIRONOLACTONE SPIRONOLACTONE-HCTZ TERAZOSIN HCL TORSEMIDE TRANDOLAPRIL TRIAMTERENE-HYDROCHLOROTHIAZID VALSARTAN VALSARTAN/HYDROCHLOROTHIAZIDE VASCEPA VERAPAMIL ER VERAPAMIL HCL VYTORIN WARFARIN SODIUM ZETIA COPD ADVAIR DISKUS ADVAIR HFA ALBUTEROL SULFATE ALBUTEROL SULFATE ER ASMANEX ATROVENT HFA BUDESONIDE COMBIVENT COMBIVENT RESPIMAT FLOVENT DISKUS FLOVENT HFA IPRATROPIUM BROMIDE IPRATROPIUM-ALBUTEROL MAXAIR AUTOHALER PULMICORT PULMICORT FLEXHALER QVAR SEREVENT DISKUS SPIRIVA SYMBICORT TERBUTALINE SULFATE THEOPHYLLINE VENTOLIN HFA DEPRESSION AMITRIPTYLINE HCL BUPROPION HCL
BUPROPION HCL SR BUPROPION XL CITALOPRAM HBR CLOMIPRAMINE HCL DESIPRAMINE HCL DOXEPIN HCL DULOXETINE HCL EMSAM ESCITALOPRAM OXALATE FLUOXETINE HCL FLUVOXAMINE MALEATE IMIPRAMINE HCL MIRTAZAPINE NEFAZODONE HCL NORTRIPTYLINE HCL PAROXETINE HCL PHENELZINE SERTRALINE HCL TRANYLCYPROMINE SULFATE TRAZODONE HCL VENLAFAXINE HCL VENLAFAXINE HCL ER
DIABETIC AGENTS ACARBOSE BYDUREON BYETTA CYCLOSET GLIMEPIRIDE GLIPIZIDE GLIPIZIDE ER GLIPIZIDE-METFORMIN GLUCAGEN GLUCAGON EMERGENCY KIT GLYSET HUMALOG HUMALOG PEN HUMULIN 70-30 HUMULIN N HUMULIN R JENTADUETO LANTUS LANTUS SOLOSTAR LEVEMIR LEVEMIR FLEXTOUCH METFORMIN HCL METFORMIN HCL ER NATEGLINIDE PIOGLITAZONE HCL PIOGLITAZONE-GLIMEPIRIDE PIOGLITAZONE-METFORMIN REPAGLINIDE
TRADJENTA VICTOZA 2-PAK
DIABETIC SUPPLIES ACCU-CHEK ACCU-CHEK ACTIVE ACCU-CHEK AVIVA PLUS ACCU-CHEK COMFORT CURVE ACCU-CHEK COMPACT ACCU-CHEK COMPACT BLUE CONTROL ACCU-CHEK COMPACT PLUS ACCU-CHEK COMPACT PLUS CONTROL ACCU-CHEK FASTCLIX DEVICE ACCU-CHEK MULTICLIX LANCET DEVICE ACCU-CHEK NANO DESIGNER CARE KIT ACCU-CHEK SMARTVIEW CARE KIT (FOR NANO) ACCU-CHEK SMARTVIEW CONTROL SOLUTION ACCU-CHEK SMARTVIEW STRIPS (FOR NANO) ACCU-CHEK SMARTVIEW TEST STRIP ACCU-CHEK SOFTCLIX ACCU-CHEK SOFTCLIX DEVICE CHEMSTRIP K CHEMSTRIP UG CHEMSTRIP UGK CONTINUOUS GLUCOSE SENSOR DIASTIX REAGENT DISP.SYRINGES W/WO NEEDLES (IN GUARDIAN RT SOFTWARE GUARDIAN TEST PLUG GUARDIAN TRANSMITTER INSULIN SYRINGE KETO-DIASTIX REAGENT KETONE KETONE CARE KETOSTIX REAGENT LANCETS MEDTRONIC REMOTE CONTROL MINILINK REAL-TIME TRANSMITTER MINIMED MINIMED RESERVOIR MIO INFUSION SET MONOJECT INSULIN SYRINGE NOVOPEN 3 NOVOPEN JR PARADIGM PARADIGM INFUSION PARADIGM INSULIN PUMP PATHWAY PARADIGM REAL-TIME PARADIGM REMOTE CONTROL
PARADIGM SILHOUETTE PENLET PLUS BLOOD SAMPLER POLYFIN POLYFIN QR QUICK RELEASE SOFT TEFLON SEN-SERTER SILHOUETTE SIL-SERTER SOF-SERTER SOF-SET SOF-SET MICRO SOFT TOUCH SURESTEP CONTROL SOLUTION SURE-T TRUE METRIX BLOOD GLUCOSE MONITOR TRUE METRIX GLUCOSE CONTROL (HIGH) TRUE METRIX GLUCOSE CONTROL (LOW) TRUE METRIX GLUCOSE CONTROL (NORMAL) TRUE METRIX TEST STRIPS TRUE2GO BLOOD GLUCOSE SYSTEM TRUERESULT BLOOD GLUCOSE SYSTM TRUETEST GLUCOSE CONTROL TRUETEST TEST STRIPS VGO 20 THYROID LEVOTHYROXINE SODIUM SYNTHROID LIOTHYRONINE SODIUM METHIMAZOLE PROPYLTHIOURACIL
To make referral, fax completed form to 952-853-8745 or call the intake line at 952-883-5469 or 1-800-871-9243
All member referrals will be evaluated. Enrollment criteria must be met to qualify for program admission.
Program Referral Criteria
Program Triggers Complex Case Management .
Members deemed to be at-risk for hospitalization in the coming year, should be referred to CCM for assessment and potential intervention. An at risk profile may include some or all of the following criteria:
• Medical conditions(s) deteriorating clinically • Inability to work due to deteriorating health • Patterns of care and treatment (including places of service) that indicate
current, impending, or potential high utilization of health care services • Patient is not following treatment plan, resulting in high risk for inpatient
admission • Inpatient or acute rehab stays with complex needs at discharge (e.g.
multiple/new/chronic diagnoses, potential for readmission) • 2 hospital admissions within 6 months with same diagnosis / complex
needs • Multiple chronic or complex diagnoses • Multiple ER / Urgent Care visits • Pediatric members with the following diagnosis:
o Prematurity < 33 weeks with ongoing complex needs o New onset diabetes o Pediatric member discharged to home with vent/trach
• Chronic Pain/Low Back Pain • High Risk Maternity
Behavioral Health Case Management
For Patients and Members who are at risk for hospitalization
• Schizophrenia – All members with this diagnosis o Includes those with Diagnosis of Schizoaffective DO
• Bipolar Disorder – All members with this diagnosis • Major Depression
o Has had 2 hospitalizations in the last year • Has dual diagnosis of mental health and chemical health • Children/Adolescents at risk of out of home placement/psychiatric
residential treatment
Restricted Recipient Program
• Chemical misuse/addiction; inappropriately seeking care from multiple providers
CONFIDENTIAL MATERIAL OF HEALTHPARTNERS CONTROLLED COPY – DO NOT REPRODUCE WITOUT PERMISSION OF HEALTHPARTNERS
To make referral, fax completed form to 952-853-8745 or call the intake line at 952-883-5469 or 1-800-871-9243
All member referrals will be evaluated. Enrollment criteria must be met to qualify for program admission.
Program Referral Criteria
Program Triggers Disease/Condition Management
Diagnosis of: Asthma Coronary Artery Disease COPD Diabetes Heart Failure Cancer Pregnancy Low Back Pain
Rare & Chronic Disease and Case Management
Confirmed diagnosis of: ALS Myasthenia Gravis CIDP Parkinson’s Disease Cystic Fibrosis Polymyositis Dermatomyositis Rheumatoid Arthritis Gaucher Disease Scleroderma Hemophilia Sickle Cell Anemia Multiple Sclerosis Systemic Lupus
Other available programs: • Medication Therapy Management • Tobacco Cessation
CONFIDENTIAL MATERIAL OF HEALTHPARTNERS CONTROLLED COPY – DO NOT REPRODUCE WITOUT PERMISSION OF HEALTHPARTNERS
Monica Brands, RPh Residency Program Director Pharmacy District Manager
Cub/SUPERVALU Pharmacies
Regional Grocery Store chain ◦ 200 locations across 7 states ◦ 14 pharmacists in Minnesota
MTM and Diabetes services ◦ Medicare Part D ◦ Medicaid ◦ Employer programs ◦ Vendor programs
Reviewed at Initial Training and Monthly meetings
Complete Medical Information ◦ Social ◦ Immunizations ◦ Medications ◦ Medical Conditions ◦ Laboratory values
SOAP note format Patient Action Plan and follow-up
Review of Pharmacist documentation ◦ Complete medical history ◦ Social history ◦ Laboratory values ◦ Clinical guidelines ◦ SOAP note ◦ Patient action plan ◦ Follow-up
Directly from patient/caregiver ◦ Not always accurate
Previous Appointment summary Medication profile My Chart, etc. Clinic
Request from clinic Request patient bring to appointment ◦ Recent lab tests ◦ Blood glucose logs, etc.
Patient access to chart during appointment Point of Care testing ◦ Blood pressure ◦ Blood glucose ◦ A1C ◦ Lipids
Fax requests prior to initial appointment not effective ◦ Works with established follow-up patients
Faxing request through traditional means not effective ◦ Medical Records ◦ Patient consent
Patient requests prior to appointment very effective ◦ Recap of previous MD appointment
Best practices ◦ Include request in appointment summary ◦ Phone call to clinic ◦ Patient consent form ◦ Medical records ◦ Work with patient
Technology Share what works with colleagues Appointment Summary to Physician ◦ Action requested Laboratory values Prescription change requests ◦ Information Only
Lab Request
SUPERVALU Pharmacies Medication Therapy Management Page 1 of 1
Fax Confidentiality Warning: The information contained in this facsimile message is privileged and confidential information intended only for the review and use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any disclosure, dissemination, distribution or copying of this communication of the information contained herein is strictly prohibited. If you have received this communication in error, please immediately notify sender by telephone, and destroy the original documents.
Date _______________ Total Pages (including cover) _ _____
Your patient, _____________________________ (DOB ___/___/_____), has an appointment on ___________________ to receive a one-on-one comprehensive medication review with their local CUB Pharmacist as a benefit provided through _______________, their Medicare Part D plan.
As benefits of your patient’s MTM appointment, you will receive: o Your patient’s current medication list o Recommendations for therapy adjustments or cost-savings opportunities o Peace of mind knowing that your treatment plan is being reinforced o A solution to providing continuity of care in the ambulatory setting
To maximize the patient’s appointment time, please fax
Treatment plans and/or education you would like the pharmacist to reinforce:
Most recent labs (as an attachment)
Feel free to call me or the pharmacy to discuss this patient. Thank you for the opportunity to collaborate to improve your patient’s health. Sincerely,
Pharmacist, CUB Pharmacy
TO: Provider ____________________________
Phone ____________________________
Fax _____________________________
FROM: Pharmacist __________________________
Phone _____________________________
Fax _____________________________
Store Stamp
Content Review Checklist
The unchecked items below are missing in the documentation of the patient’s MTM visit. Please see the attached sheets for a visual of the missing items.
Documentation elements that must be present for each visit in order to meet documentation requirements:
� Patient demographic information � Date of encounter � Chief complaint/Reason for the visit � Current medication list � History of present illness for conditions treated by medications � Relevant objective clinical findings (ie. lab results, results of physical exam) � Drug therapy problems identified (must clearly document how many problems and describe the problem(s)) � Drug therapy problems resolved (must clearly document how many resolutions and justify resolution(s)) � Plan to resolve drug therapy problems � Plan for follow-up � Communication to primary provider and/or other care providers or documentation patient wishes to talk to
primary/other providers about findings � Patient instructions � Time spent with patient � Social history (tobacco/alcohol use) � Medication allergies/adverse events � CMS Required Materials matching CMS standard format (required for the 1st visit of the year for Medicare
Patients only) � Cover letter � Medication Action Plan � Personal Medication list
CCD Audit Checklist
� CMS Required Materials matching CMS standard format � Date on CMS standard format letter matches CCD date � Sent to patient within 14 days of visit � “What we talked about”
� # DTP identified � # DTP resolved � Recipient of visit � Method of delivery of Assessment � Cognitive Status
2015 Medicare PartD Reporting Requirements
A. Contract Number. B. HICN or RRB Number. C. Beneficiary first name. D. Beneficiary middle initial. E. Beneficiary last name. F. Beneficiary date of birth. G. Met the specified targeting criteria per CMS – Part D requirements. (Y (yes) or N (no)). H. Beneficiary identified as cognitively impaired at time of comprehensive medication review (CMR) offer or delivery of CMR. (Y (yes), N (no), or U (unknown)). I. Date of MTM program enrollment. J. Date met the specified targeting criteria per CMS – Part D requirements. Required if met the specified targeting criteria per CMS – Part D requirements. (May be same as Date of MTM program enrollment) K. Date of MTM program opt-out. L. Reason participant opted-out of MTM program (Death; Disenrollment from Plan; Request by beneficiary; or Other). Required if Date of MTM program opt-out is applicable M. Offered annual CMR. (Y (yes) or N (no)). Required if met the specified targeting criteria per CMS – Part D requirements. N. If offered, date of (initial) offer. O. Received annual CMR with written summary in CMS standardized format. (Y (yes) or N (no)). Required if offered annual CMR. P. Number of CMRs received with written summary in CMS standardized format. Required if received annual CMR. **Q. Date(s) of CMR(s) with written summary in CMS standardized format. (If more than 1 CMR is received, up to 5 dates will be allowed.) Required if received annual CMR.
R. Method of delivery for the annual CMR. (Face-to-face; Telephone; Telehealth consultation; or Other). (If more than 1 CMR is received, report the method of delivery for the initial CMR). Required if received annual CMR. S. Qualified Provider who performed the initial CMR. (Physician; Registered Nurse; Licensed Practical Nurse; Nurse Practitioner; Physician’s Assistant; Local Pharmacist; LTC Consultant Pharmacist; Plan Sponsor Pharmacist; Plan Benefit Manager (PBM) Pharmacist; MTM Vendor Local Pharmacist; MTM Vendor In-house Pharmacist; Hospital Pharmacist; Pharmacist – Other; or Other). Required if received annual CMR. T. Recipient of CMR. (Beneficiary, Beneficiary’s prescriber; Caregiver; or Other authorized individual). Required if received annual CMR. U. Number of targeted medication reviews. Required if met the specified targeting criteria per CMS – Part D requirements. **V. Number of drug therapy problem recommendations made to beneficiary’s prescriber(s) as a result of MTM services. (For reporting purposes, a recommendation is defined as a suggestion to take a specific course of action related to the beneficiary’s drug therapy. If the same recommendation is made to multiple prescribers or repeated on multiple dates, then that recommendation should only be counted and reported once. Examples include, but are not limited to: Needs additional therapy; Unnecessary drug therapy; Dosage too high; Dosage too low; More effective drug available; Adverse drug reaction; or Medication Non-compliance/Non-adherence). **W. Number of drug therapy problem resolutions resulting from recommendations made to beneficiary’s prescriber(s) as a result of MTM recommendations. (For reporting purposes, a resolution is defined as a change or variation from the beneficiary’s previous drug therapy. Examples include, but are not limited to: Initiate drug; Change drug (such as product in different therapeutic class, dose, dosage form, quantity, or interval); Discontinue or substitute drug (such as discontinue drug, generic substitution, therapeutic substitution, or formulary substitution); Medication compliance/adherence). **X. Topics discussed with the beneficiary during the CMR, including the medication or care issue to be resolved or behavior to be encouraged. (If more than 1 topic discussed, up to 5 topics will be allowed to be reported.) These are the descriptions of the topics listed on the beneficiary’s written summary in CMS standardized format in the Medication Action Plan under ‘What we talked about’. Required if received annual CMR.
** - indicates measures that undergo primary source verification (provider documentation) during annual CMS PartD data validation audit
Treatment of Patients with Serious Mental Illnesses
1
Michael Trangle, MD Associate Medical Director
HealthPartners Medical Group/Behavioral Health Division
Jacob Held, PharmD Clinical Pharmacy Specialist--Psychiatry
Regions Hospital
Disclosures
• The authors of this presentation have the following to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation: – No disclosures
• Potential off-label discussion: Agents for the treatment of SMI
Objectives
• Review HealthPartners commitment to improving treatment of mental illness
• Provide general overview of complications caused by mental illness
• Describe the potential roles/interventions of a pharmacist working as part of the treatment team
• Briefly review pharmacotherapy for serious mental illnesses
HealthPartners Commitment to Mental Health
HealthPartners: Improving Lives of Patients with SMI
• Make it OK • New MH Building and Model of Care • DIAMOND
– Depression Protocols in BH and PC
• PCP/BH Integration • Collaboratives
5
CV Wizard: RCT to Reduce CV Risk in Adults with SMI
Primary Aim: Determine whether adults with SMI receiving care in intervention clinics will have, compared to those receiving care in control clinics,: Hypothesis 1: Lower total modifiable CV risk Hypothesis 2: Better control of specific modifiable risk factors: BP, Lipids, Obesity, A1c, Smoking, Aspirin Use Hypothesis 3: Lower rates of prescriptions for obesogenic SMI medications at 12 months post-index Secondary Aim: Explore the impact of CV Wizard and care management on CV risk factor identification, treatment initiation and intensification, medication adherence, outpatient and inpatient utilization, risky prescribing events, and CV events.
6
How HP MTM Pharmacists May Be Involved
7
• If patients with SMI are: a) in clinics randomized to intervention clinics, b) have a BMI > 25 (or a normal BMI but >7%
weight gain in past year), and c) are on a potentially obesogenic SMI med, then
• their info will be sent to a registry for consideration of changing their SMI med
How HP MTM Pharmacists May Be Involved
• MTMs will review Epic to make sure patient is eligible, and if appropriate, will contact pt’s BH provider to determine whether they also think change in SMI med may be appropriate
• BH provider may decline change, decide to discuss change with pt, or request MTM discuss with pt
• For many patients, best choice (happy medium between risks for TD and weight gain) may be medium potency first generation antipsychotics (loxapine, Perphenazine, thiothixene)
• More training and discussion to come!
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Failure Modes & Effects Analysis
80 Causes of Failure (31
Meds, 38%)
The Need for Psychiatric Pharmacists
Medical Complications of SMI
Overview – The Problem
• People with serious mental illness (SMI) die, on average, 25 years earlier than the general population.
• Suicide and injury account for about 30-40% of excess mortality.
• 60% of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases.
Source: Morbidity and Mortality in People with Serious Mental Illness, October 2006, National Association of State Mental Health Program Directors Medical Directors Council
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Increased Mortality and Morbidity are Largely Due to Preventable Conditions
Among persons with SMI, the “natural causes” of death include:
• Cardiovascular Disease • Diabetes (including related conditions
such as kidney failure) • Respiratory disease (including
pneumonia, influenza) • Infectious disease (including HIV/AIDS) The rates of mortality from these diseases
for the SMI population are several times those of the general population
13
Higher Rates of Modifiable Risk Factors
• Smoking • Alcohol Consumption • Poor Nutrition/Obesity • “Unsafe” Sexual Behavior • IV Drug Use • Residence in group care facilities and homeless
shelters (exposure to TB/infectious diseases; and less opportunity to improve nutrition)
14
Causes of the Health Disparities Include:
• Medications, especially atypical antipsychotics and impact on weight gain, dyslipidemia and glucose metabolism
• Lack of access to/utilization of preventive community healthcare, including health promotion services and resources
• Poverty • Social isolation • Separation of health and mental health into separate systems at the
federal, state and local level with lack of coordinated infrastructure, policy, planning, quality improvement strategies, regulation or reimbursement
15
*Data from MN Health Care Programs (MHCP from 2003-2007 includes Medicaid, GAMC, MN Care PMAP, patients 18 years of age and older)
Source: Trangle, M., G. Mager, P. Goering, and R. Christensen, Minnesota 10 By 10: Reducing Morbidity and Mortality in People with Serious Mental Illnesses, Minnesota Medicine, June 2010, 38-41.
In Minnesota: Results confirmed that people with SMI died considerably younger than controls regardless of subset.
Median Age of Death (MHCP population*) 82 Median Age of Death (people with SMI) 58 People with SMI in Minnesota die 24 years earlier that the general population!!
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Medication Therapy Management
Experiences at MHR
• 20 clients chosen randomly (well, mostly based on ability to make it to an appointment) –11 Males, 9 Females
• 20 documented visits
Number of Clients by Ages
# of Clients
Age in Years
Average age: 41
The number of medical conditions being treated or prevented per client ranged from 3 to
13.
The average was 8.5 medical conditions per client.
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A Review of 20 ACT Patients: Medical Conditions
A Review of 20 ACT Patients: Medications
The number of medications per client ranged from 7 to 20.
The average number of medications
per client encounter was 14.
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Most frequent indication for drug therapy
1. Esophagitis 2. Depression 3. Allergic Rhinitis 4. Hyperlipidemia 5. Hypertension 6. Schizophrenia
These 12 conditions represent 62% of all indications for drug therapy
7. Anxiety State 8. Diabetes 9. MI prevention (ASA) 10. Tobacco-Use 11. Asthma/COPD 12. Constipation
Drug Therapy Problems
86 drug therapy problems were identified and resolved in these 20 clients
19 clients (95%) had > 1 drug therapy problem 17 clients (85%) had > 3 drug therapy problems 14 clients (70%) had > 5 drug therapy problems
Ten most common drug therapy problems and their associated medical conditions
• Dosage Too Low Bipolar • Adverse Drug Reaction Diabetes • Dosage Too Low Depression • Dosage Too High Bipolar • Adverse Drug Reaction Depression • Adverse Drug Reaction Hypothyroidism • Different Drug Needed Diabetes • Dosage Too Low Hypertension • Unnecessary Drug Therapy Allergic Rhinitis • Unnecessary Drug Therapy Tobacco Use
Resolution of drug therapy problems with Physicians
• Initiate Monitoring (non-lab) 16% • Initiate New Therapy 15% • Discontinue Drug 14% • Change Dose 13% • Change Product 12% • Change Interval 9% • Therapeutic Interchange 7%
Health Care Cost Avoidance*
Health Care Cost Avoidance*
20 clients 20 encounters
# of events $ Savings
Clinic outpatient visit avoided 23 $9,131
Specialty office visits avoided 18 $11,358
Long Term Care admission avoided 0 $0
Hospital admission avoided 4 $133,632
Laboratory service avoided 7 $350
Urgent care visit avoided 2 $342
Emergency department visit avoided
1 $1,021
Total 55 $155,834
Health Care Costs Incurred
Health Care Costs
Incurred
20 Clients with
20 Encounters
# Events Costs ($)
Clinic outpatient visit incurred
7 $2,779
Specialty office visit incurred
11 $6,941
Laboratory monitoring services incurred
15 $750
Total 33 $10,470
Level Assess Meds.
ID Drug Prob.
Med condition
Approx. time
Bill CPT codes
Units Rate
1 1 med 0 1 15 99605 or 06
1 $52 or $34
2 2 meds 1 1 16-30 99605, 06 & 07
1 1
$76 or $58
3 2 – 5 meds
2 2 31-45 99605 or 06, 07
1 2
$100 or $82
4 6-8 meds 3 3 46-60 99605 or 06, 07
1 3
$124 or $106
5 >=9 meds
>4 >4 60 + 99605 or 06, 07
1 4
$148 or $130
Health Care Savings
Savings – Costs Incurred – MTM Pharmacist pay/20clients = Average savings of
$7,135/patient
Return on Investment: $54 saved for every $1 spent on the pharmacist
Pharmacotherapy for SMI
Pharmacotherapy in Patients with SMI: Schizophrenia Level of Intervention
TMAP (2006) APA (2004) PORT (2009) IPAP (2005)
First Episode SGA SGA SGA (other than clozapine and olanzapine), FGA
SGA
Second Choice SGA, FGA, Clozapine
SGA, FGA, Clozapine
SGA, FGA SGA
Third Choice Clozapine Clozapine
Clozapine
Clozapine
Fourth Choice Clozapine Augmentation
Clozapine Augmentation
--- Clozapine Augmentation, SGA
Pharmacotherapy in Patients with SMI: Bipolar Disorder
Level of Intervention Monotherapy Adjunctive/Combination First-Line Li, Lamotrigine, VPA, Olanzapine,
Quetiapine, Risperidone LAI, Aripiprazole
Li or VPA + : Quetiapine, Risperidone LAI Aripiprazole Ziprasidone
Second-Line CBZ, Paliperidone Combination: Li + VPA Li + CBZ Li or VPA + Olanzapine Li + Risperidone Li + Lamotrigine Olanzapine + Fluoxetine
Third-Line Asenapine Adjunctive: PHT, Clozapine, ECT, Topiramate, OXC, Omega 3s, gabapentin, asenapine
Not Recommended Gabapentin, topiramate, antidepressants
---
Guidelines for Maintenance Treatment: Canadian Network for Mood and Anxiety Treatments (CANMAT). 2013.
Pharmacotherapy in Patients with SMI: Schizoaffective Disorder
• Thought disorder symptoms similar to schizophrenia
• Also affective component to illness: mania, depression, or mixed features
• Treatment may consist of APs, Mood Stabilizers, and Antidepressants
First Generation Antipsychotics
• Haloperidol (Haldol) High Potency • Fluphenazine (Prolixin) • Pimozide (Orap) • Thiothixene (Navane) • Trifluoperazine (Stelazine) • Perphenazine (Trilafon) • Loxapine (Loxitane) • Thioridazine (Mellaril) • Chlorpromazine (Thorazine)
– 1st antipsychotic drug – 1951 Low Potency
Second Generation Antipsychotics
• Clozapine (Clozaril) 1990 – orally dissolving tablets (ODTs) • Risperidone (Risperdal) 1994 – ODT, (LAI Consta) • Olanzapine (Zyprexa) 1996 – ODT, IM, (LAI Relprevv) • Quetiapine (Seroquel) 1997 and Seroquel XR - 2007 • Ziprasidone (Geodon) 2001 – IM • Aripiprazole (Abilify) 2002 – ODT, IM, (LAI Maintena) • Paliperidone (Invega) 2006 – (LAI Sustenna; Trinza) • Asenapine (Saphris) 2009 • Iloperidone (Fanapt) 2009 • Lurasidone (Latuda) 2013
FGAs vs. SGAs
• FGA – MOA: Primarily through D2 receptor blockade. Low potency
agents also effect: alpha, serotonin, histamine, and muscarinic receptors
• SGA – MOA: 5HT2/Dopamine antagonism. Also some are partial
5HT1 agonist/5HT2A antagonists. One agent is partial D2 agonist.
• Tardive Dyskinesia/EPSE
Antipsychotics in Schizophrenia: Typical vs. Atypical
The Catie Trial: Phase I • All cause discontinuation longer with
olanzapine vs quetiapine or risperidone • No difference between olanzapine and
ziprasidone or perphenazine
N Engl J Med. 2005;353(12):1209-23.
Antipsychotics in Schizophrenia: Typical vs. Atypical
The CUtLASS Trial • Results showed no difference in SGA vs FGA in
regards to quality of life scores • Participants reported no clear preference for
either drug group • Costs were similar
Arch Gen Psychiatry. 2006;63(10):1079-87.
Antipsychotics in Schizophrenia: Typical vs. Atypical
The Catie Trial: Phase II • Discontinuation times for olanzapine and
risperidone were longer than ziprasidone and quetiapine
• Olanzapine associated with greatest lipid/glucose abnormalities
Am J Psychiatry. 2006;163(4):600-10.
Adverse Effects: SGAs
• Weight Gain – Approximate percentage of patients who gain > 7 % of
TBW • Olanzapine 26 • Quetiapine 17 • Iloperidone 13 • Risperidone 9 • Lurasidone 6 • Ziprasidone 6 • Aripiprazole 5 • Asenapine 5 • Paliperidone 4
http://dailymed.nlm.nih.gov/dailymed/index.cfm CPNP Psychiatric Pharmacotherapy Review
Adverse Effects: SGAs • Lipid Abnormalities • Glucose Intolerance • Sedation • Orthostasis • Hyperprolactinemia • Anticholinergic Burden • Extrapyramidal Side Effects • Tardive Dyskinesia
Monitoring Medications: SGAs
Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004;27:596-601.
Discussion
Clinical Pearls • Shared decision making is key • Standardization of MTM referrals on discharge • Question prolonged duplicate therapies and
anticholinergic use • Encourage smoking cessation • Discuss long acting injectable agents in
patients with adherence issues • Cost and insurance coverage can be
problematic with the newer SGAs
Red Flags
• Untreated medical conditions and/or lack of primary care provider
• Illicit substance use • Non-adherence • Antidepressant monotherapy for bipolar
disorder
Questions? [email protected]
HealthPartners Behavioral Health Case Management
MTM Conference
June 12th, 2015
Strategy/Philosophy • Intervene early in BH and CH conditions
and reduce costly complications that are a the result of no intervention or delayed intervention.
• We work to engage members in the management of their illness. The goal is for the members to have access to the right care and information in order to optimally manage their BH condition.
Centralized BH Case Management
• Outreach to identified members and patients in a timely manner to engage them in the program.
• Brief assessment, goal setting, health education, motivational interviewing, health coaching, crisis prevention planning, and decision support are key activities.
Centralized BH Case Management
• Coordinating access to needed care including referrals to providers and community resources.
• Provider collaboration, supporting provider’s treatment goals, and increasing outpatient treatment adherence and decreasing the likelihood of predictable, preventable hospitalizations are important outcomes.
Inpatient Management
• We have real time data for all inpatient and residential mental health and chemical health admissions.
• We contact facilities when we are notified about an inpatient admission and we work with hospital discharge planner to identify needed resources for discharge back to the community.
Restricted Recipient Program • This program limits members to one primary
care provider, one urgent care clinic, one pharmacy and one hospital unless referred by their Primary Care Physician.
• The goal of this program is to address excessive use or inappropriate use of benefits, such as frequent ER visits or excessive prescription use; or use of benefits that would be considered fraudulent.
• Aligned with DCM and DHS Program.
Referral Criteria for BHCM • HealthPartners members who are at risk for
psychiatric hospitalization and members with the following diagnoses: Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depression (with 2 psychiatric hospitalizations within the last year), dual diagnosis of Chemical Health and Mental Health, and children/adolescents at risk of out of home placement in psychiatric residential treatment.
Documentation
• BH Case Managers document in CarePartner and in the Epic system for patients at HealthPartners Medical Group and Park Nicollet. We also have view access into HCSS so we can see claims (including pharmacy claims).
Co-Management • MTM and BHCM are services that
complement each other for those patients that have complex BH conditions and are also taking several medications and who can use MTM support.
• Coordination and collaboration between MTM and BHCM is encouraged to work towards goals that will help the patient improve their health/safety.
BH Department Contact Information
• Consultation during business hours: • 8am-5pm • Triage line 952-883-7774
• On call licensed staff will consult on case and answer questions about the case.
• Send referrals through HealthPartners Connect at Phone 952-883-5469 or Fax 952-883-6664
BH Navigators
• For HealthPartners Members who need referrals to Behavioral Health providers and services such as therapy and psychiatry.
• For assistance in finding an in-network provider, members may call the Behavioral Health Network Navigator line at 952-883-5811 or 1-888-638-8787.
Other BH Programs
• On Your Way-to support antidepressant medication adherence
• Moving Forward-to support antipsychotic/mood stabilizer adherence
Questions
MTM Marketing Workshop
Elaina McMillan June 12, 2015
Activity time!
Honda vs. Ford
HP Member
55+
Medicare
7+ meds
50/50 male/ female
What are they looking for?
• Feeling good • Being safe • Saving money
Motivators
A partner to help them manage their health.
What they want
YOU are what they want!
You are what SHE needs!
Flip your thinking
FROM We’re going to tell you: • About our features and benefits • How you should get care • What you need to do
TO We’re going to understand: • The problem you’re trying to solve • How we can help you solve it • How we can change what we do to
make things easier for you
What you can do
3 Make it simple
1 Make it
about the patient
2 Make it a
conversation
Ask: What’s important to you?
How: Be positive,
respectful, engaging, partnering
Ask: Am I talking as I would to a
friend?
How: Use caring, supportive and
thoughtful language
Ask: Are you using technical works or
acronyms?
How: Explain big words in a
conversational way
Activity time!
Flip your thinking
Before The Medication Therapy Management program provides confidential appointments with an experienced clinical pharmacist. This program is offered at no cost to you. It goes beyond traditional pharmacist counseling by working closely with you, your doctors and your family to ensure you get the results you want. We use a comprehensive approach that identifies factors that place you at risk for medication-related problems.
Flip your thinking
After HealthPartners RxCheckup helps you understand everything about your medicines. In a one-on-one appointment with a pharmacist, you’ll review your medicines to make sure they’re safe, effective and fit your lifestyle.
Additional resources
Member Services Understanding benefits, network and claims
Pharmacy Navigators Answers to complex pharmacy questions
CareLineSM Service 24/7 trusted nurse advice
GOAL! 50% participation for Medicare members
What can we do for you?
No one likes to be told what to do
They like to be listened to