Mike Gifford President & CEO, ARCW Katy Caldwell Executive Director, Legacy Community Health...

Pharmacy Models for ASOs & CBOs: Increasing Revenue and Improving

Treatment for Clients

Mike GiffordPresident & CEO, ARCW

Katy CaldwellExecutive Director, Legacy Community Health

Services

Mary Elizabeth MarrCEO, Thrive Alabama

Rick FonsVice President of Pharmacy Services, ARCW

Introduction to Pharmacy Services

Mike Gifford, MBAPresident and Chief Executive OfficerAIDS Resource Center Wisconsin

Pharmacy is among the most important HIV services for our patients and clients.• Medications are life-prolonging, life-

saving• Challenges to access medications

remain significant• Access and adherence is critical to viral

suppression

Importance of Pharmacy Services

Truly integrated care is the emerging best-practice model of care for HIV patients and clients.• Quality over quantity; improved quality

outcomes• Pharmacy is still often times left out of

health care service delivery models• Payment reform

Importance of Pharmacy Services

Unpredictable revenue sources risk the sustainability of HIV services• Government funding has been level or

decreasing• Private funding has been stagnant• Many AIDS service providers are facing

difficult choices because of financial constraints

• Pharmacy services can be a new, earned, large revenue source

Importance of Pharmacy Services

The presentation includes important examples of different models of pharmacy services for HIV patients• Contracted pharmacy• In-house pharmacy• On-site pharmacy• Off-site pharmacy

It is important for HIV/AIDS service providers to evaluate and decide the best model of pharmacy services for their organization, patients and clients

Models of Pharmacy Services

Pharmacy at Legacy Community Health

Katy CaldwellExecutive DirectorLegacy Community Health Services

Ryan White Grantee since the Beginning• Parts A, B, C & D

Family Planning Grantee• Title V & X

FQHC Status since 2004• First look-alike and then fully deemed

Full 340b Access for all Patients• Contract with Walgreens & Wellpoint (mail-

order)

Legacy Community Health

2004

CHOICESContract or Start Our

Own

Pros & Cons of Each

Decision Process for Pharmacy Model

Control

Retain Profit

Start-up Pros & Cons

Cost

Knowledge

Drug Pricing

Ins. Contracts

Liability

DEA RaidsClass A License

Control

Retain Profit

Cons Pros

Contract Pros & Cons

Control

Retain Profit

Lack of Control

Dispensing Fees

Reputation

Accountability

Ins. Contracts

Corp. Decisions

No Cost

Core Comp

Inventory Tracking

Shared Liability

Buying Power

Locations

Cons Pros

5 years• One location on site

Separate lease• Market rate rent

We own inventory We pay dispensing fee We contract with distributor• At their approval

They bill insurance companies• Detailed reconciliation

Contract Terms

They prepare/file all docs to OPA May request staff changes• For any reason

Pharmacist must be trained• In HIV, Behavioral Health & Hep C

Standard insurance• On both sides

Must meet our LEED standards Must honor all methods of pay• Sliding scale, ADAP & grant funded meds

Contract Terms (continued)

Pharmacy at Thrive Alabama

Mary Elizabeth MarrCEOThrive Alabama(formerly AIDS Action Coalition of Alabama)

Ryan White Grantee since 2000• Parts B, C & D

Davis and Hames Clinics• 600+ Clients• Additional site opening 2015

Full 340b Access for all Patients• Contract with Walgreens & Curant

Health (mail-order)

Thrive Alabama

Largest independent specialty 340B pharmacy in the nation

Home Delivery – FedEx

In-care Coordinators• Client Adherence• Collaborate with Clinical

staff on adherence issues• Clients have $0 co-pay

when dispensed

Pharmacy Model

Specialty Pharmacy

Throughout 12 county region

Some clients prefer a storefront & direct contact with a pharmacist

Same day pickup

Store Front

INFRASTRUCTURE• Administrative Costs• Finance Staff (3)• HR (1)• ED (1)• Data (1)

• Vehicles for Transportation• Cut our Overall Transportation Costs

• Building Fund

Use of 340B Funding

Use of 340B Funding SMMAP (Sandra Moon Medical Assistance

Program)• Medical Co-Pays • Physician Appointments• Medication Co-pays• Laboratory Co-pays

INSURANCE• Monthly Premiums• Insurance Deductibles

340B Growth

Revenue $-

$50,000

$100,000

$150,000

$200,000

$250,000 Aug 2011 Apr 2015

$237K

Clients Prescriptions0

50

100

150

200

250

300

350

29

195

40

325

$3K

Treatment OutcomesViral Load Suppression

2009 2010 2011 2012 2013 2014

VL<=1000 0.712418300653595

0.748945147679325

0.760649087221096

0.791896869244936

0.858736059479554

0.872413793103448

VL<=200 0.627450980392157

0.683544303797468

0.711967545638945

0.725598526703499

0.808550185873605

0.844827586206897

VL<=48 0.546840958605665

0.567510548523207

0.606490872210954

0.640883977900553

0.723048327137547

0.796551724137931

55%

65%

75%

85%

95%

Potential Challenges ability to fund PrEP:• Costs• Physician Costs• Laboratory Costs• Insurance Assistance• Patient Assistance Programs

340B / PrEP Program

Pharmacy at ARCW

Richard Fons, RPh, AAHIVPVice President of Pharmacy ServicesAIDS Resource Center of Wisconsin

Nation’s first CMS Approved HIV Medical Home

191 staff 13 clinics and offices Operates an in-house pharmacy

model Six pharmacist and ten technician

staff Two pharmacy locations: Milwaukee

and Madison

AIDS Resource Center of Wisconsin

ARCW 5 Year Look BackARCW2009

ARCW2014

Patients

Number served 2,523 est. 2,950

% with an Undetectable Viral Load 69% 85%

Financial

ARCW budget $12.5 million $45.9 million

Net Income $303,000 $1.8 million

Net Assets $4.2 million $8.9 million

Cash on hand $653,000 $3.4 million

Staff

Employees 132 191

1. Expanded our Medical Home model of care

2. Improved clinical outcomes• HIV• Primary care

3. Improved organizational talent4. Improved overall margin over

outside contract pharmacy model of care

Why did ARCW open its own pharmacy?

Pharmacist-Driven Institutional Protocols• Improved patient outcomes

• Anticoagulation, Hypertension, tobacco cessations• HIV therapy selection/ Adherence

Medical-Home Pharmacist• Comprehensive medication reviews• Medication procurement• Education/research/clinical decision support

Revenue Generation• Medical-home patient management fee• Clinical outcome incentive bundle payments (Medicare/3rd

Party)• Prescription capture• “Incident to” CPT billing

Clinical Pharmacy Services

Clinical OutcomesARCW2009

ARCW2014

Patients With an Undetectable Viral Load

69% 85%

Prescribed HAART 74% 95%

With diabetes that is well managed

NA 83%

Prescribed preventative PCP treatment

91% 95%

With controlled hypertension NA 59%

Full time, in-clinic pharmacist Dental clinic in Green Bay office Expanding behavioral health to 5

more offices Medication Copayment Assistance

Program Increased number of food pantries Additional staff: medical provider,

case managers and psychiatrist

Programs Supported by Pharmacy Margin

Year Pharmacy revenue Pharmacy revenue reinvested in patient services

2011 $7,019,604 $915,322

2014 $33,044,565 $5,683,483

Pharmacy at a Glance

Q&A

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Conclusion Slide