Steve Simenson, BPharm, FAPhA, DPNAP APhA President

Goodrich Pharmacy Anoka, Minnesota President / Managing Partner

Optimal therapeutic recommendations are

based on the experience/needs of

the patient

Patient

Comprehensive Medication Management in the PCMH

Clinical Pharmacist/ Pharmacotherapy

Manager

Physicians/ Providers - PCMH

Patient understands his/her medications and participates in a care plan to

improve health

Clinical goals of therapy are determined and medication

recommendations are considered

Gaps in clinical goals are determined, drug therapy

problems identified, and therapeutic

recommendations made

Appropriate, Effective, Safe and Adherent Medication Use!

www.pcpcc.net/PCMH

Vision: Pharmacists, who improve patient health outcomes and provide value and cost savings, will be recognized…

• Specific: What services do pharmacists provide? • Predictable: Can we consistently provide the needed

level of service? • Measurable: How will the public or payers measure our

value and outcomes? Activities needed to be undertaken: • State Scope of Practice Changes • Outreach to Medicine • Provider Status

• Purchasers of healthcare are pushing risk down to providers • Accountable Care Organizations • Global Payment • Capitated Payment • Shared Risk/Savings Contracting

• Where does a profession supported largely by product-based reimbursement fit within these models based on accountability for outcomes? Where is the value – product , service, hybrid?

• Consistency in patient care process, terminology • Patient-centeredness/patient engagement • How to function on a health care team • Collaborative relationships with physicians • Accountability for patient outcomes • Population management • Managing risk • Quality metrics • Care delivery using different modes • Advocacy

• Principle I: Improve Patient Access to Pharmacists’ Patient Care Services in Where Ever They Are

• Principle II: Improve Health Care Quality by Recognizing Pharmacists’ Patient Care Services

• Principle III: Control Health Care Costs and Improve Efficiencies Using Pharmacists’ Patient Care Services

Thank you for choosing us!

• If we are successful, consumers will be well served by pharmacists’ quality team-based patient care services, and our services will be valued and covered

• What to do you have to offer that is valuable?

• Why would others want to

collaborate?

• What would be good for the patient?

Optimal therapeutic recommendations are

based on the experience/needs of

the patient

Patient

Comprehensive Medication Management in the PCMH

Clinical Pharmacist/ Pharmacotherapy

Manager

Physicians/ Providers - PCMH

Patient understands his/her medications and participates in a care plan to

improve health

Clinical goals of therapy are determined and medication

recommendations are considered

Gaps in clinical goals are determined, drug therapy

problems identified, and therapeutic

recommendations made

Appropriate, Effective, Safe and Adherent Medication Use!

www.pcpcc.net/PCMH

• Identify Decision Makers

• Identify Champions

• Identify Payers

• Sell…You are their best option

Accountable Care Economics, Financial Leadership Council. The Advisory Board Company. 2011, p80.

RPh

RPh RPh RPh RPh

Pharmacists Can… • Review current medication regimens for any drug related

problems such as duplications and drug-drug interactions.

• Provide recommendations for lower cost alternatives and assistance in choosing insurance related formulary alternatives.

• Facilitate patient understanding of the medication regimen and the impact of their medication(s) on the disease state.

• Monitor and coach on adherence to current chronic medications.

• Provide patient medication lists • Assist in achieving medication adherence outcomes

Physicians Can… • Share clinical information and therapy

goals • Consider entering into collaborative

practice agreements with pharmacists to work with patients in achieving therapy goals

• Engage the knowledge and skillsets of team members

Foundation: 1) Bi-directional access to clinical data; 2) aligned financial incentives

• Hypertension • Hyperlipidemia • Asthma & COPD • Diabetes • Smoking Cessation • Opioid Management • Therapeutic Substitution • Clinic Practice

Agreements

• Health System Alliances • Collaborative Adherence

Relationships • Value added Research

Projects • Systems testing and

Performance testing related to Health Outcomes

“How can I help you with your patients?” • Manage high risk, complex patients • Chronic disease management • Care transitions • Drug therapy consultations • Meet with pharmaceutical reps • Manage Coupons and Samples • Assist with attaining PCMH

recognition • Expand patient panel size

• Needs Determined by Environment

• Build Capacity, Develop Resources

• Scalable

• Sustainable

• Economically & Professionally Rewarding

• Star Ratings…..shared pay for performance

• Gaps in Provider Skills….Clinic Contracting

• New HCP’s….Clinic Contracting Team Member

• Health System/Clinic Needs…MDH Measures

• Specific Population Needs…Immunizations

• MTM Part D, State, Private Payers

Pick Your

Target

Diabetes

Cardiovascular

Asthma / COPD

Anticoagulation

• Patients with congestive heart failure spend $7,823 less on health care annually if they stay on their prescribed medications (1)

• Treatment for hypertension costs $3,908 less per patient per year if they are adherent (1)

• Patients with high cholesterol on average spend $1,258 less every year if they stay on their medications (1)

• Each incremental 25% increase in proportion of days covered (PDC ) for statins is associated with ~3.8 mg/dl reduction in LDL cholesterol (2)

• Adherence lowers the medical bills for patients with diabetes by $3,756 every year (1)

(1) Medication Adherence Leads To Lower Health Care Use And Costs Despite Increased Drug Spending Health Aff January 2011 vol. 30 no. 1 91-99 ; (2) Ho, Circulation 2009; (3) Kneeland PP, Fang MC. Current issues in patient adherence and persistence: focus on anticoagulants for the treatment and prevention of thromboembolism. Patient Prefer Adherence. 2010; 4:51-60; (4) Int J Chron Obstruct Pulmon Dis. 2008 September; 3(3): 371–384

• 1 in 5 patients started on warfarin therapy for atrial fibrillation discontinue therapy within 1 year (3)

• An average of 40%–60% of patients with COPD adheres to the prescribed regimen and only 1 out of 10 patients with a metered dose inhaler performs all essential steps correctly. (4)

• Technology • Collaborative Practice • Electronic Health Records • Develop Relationships • Language

• Medical Home • ACO • Star Ratings

• Practice demonstrating pharmacists’ value within evolving health care delivery systems

• Education of HCP’s, pharmacists and student pharmacists

• Adopt Tools that improve/support quality patient care delivery and health outcomes

• Advocacy of pharmacists’ expanding patient care role

Poor Clinical Outcomes >>> Increased ACS admissions,

readmissions, and ED visits

Transition of Care GAP

Adherence to Appropriate

Drug Treatment

GAP

Lack of Patient “Buy

In” GAP

Case Management

Drug Therapy Management

Health Coaching

Pharmacy Referral

Community Hospital

Patient Medication Adherence

Patient Knowledge

Counseling & Accountability

Self-monitoring Costs

Personalizing the program

JAMA. Published online November 21, 2013. doi:10.1001/jama.2013.282818

PATIENT CARE SUCCESS

AFRAID TO TRY

“Capable providers in an

incapable System”

What questions do you have for me?