Community-Based Case Study: MEDNETCommunity-Based Case Study: MEDNET© ©

A Collaborative Approach to Prescription Drug A Collaborative Approach to Prescription Drug AccessAccess

Presented to National Congress on the Uninsured by

Elizabeth Rugg, Executive Director, The Health Councils, Inc.

Karen van Caulil, Executive Director, Health Council of East Central Florida, Inc.

Steve Lesky, Regional Vice President, Allegany Franciscan Ministries

Chronically Ill Chronically Ill Adults Adults

Bridges Gap Between Prescription Drug Bridges Gap Between Prescription Drug Needs and Prescription Drug AccessNeeds and Prescription Drug Access

MEDNETMEDNET©©

Prescription Drug Prescription Drug AccessAccess

Origin: 2003 Health Systems Origin: 2003 Health Systems PlanPlan

Collaborative community health planning processCollaborative community health planning process

Engaged multi-tiered approach to identify health Engaged multi-tiered approach to identify health needsneeds

Step 1: Data AnalysisStep 1: Data Analysis Population DemographicsPopulation Demographics Mortality/Morbidity IndicatorsMortality/Morbidity Indicators Health Care Access (Resource Analysis)Health Care Access (Resource Analysis) Health Care Coverage OptionsHealth Care Coverage Options

Step 2: Community Survey Step 2: Community Survey (web-based & in-(web-based & in-person)person)

Step 3: Focus Group DiscussionsStep 3: Focus Group Discussions

Step 4: Issue Summary & PrioritiesStep 4: Issue Summary & Priorities

Step 5: Action PlanningStep 5: Action Planning

Finding: Aging population will increase Finding: Aging population will increase need for careneed for care

Source: 2003 Health Systems Plan

AgeAge NumbeNumberr

PercentPercent

0 - 140 - 14 147,81147,8144

16.0%16.0%

15 - 2415 - 24 88,81688,816 9.6%9.6%

25 - 4425 - 44 251,95251,9544

27.3%27.3%

45 - 6445 - 64 225,33225,3355

24.5%24.5%

> 65> 65 207,56207,5633

22.5%22.5%

Adult Population, 2000 Composition of Seniors, 2000

NumbeNumberr

PercentPercent

65 - 7465 - 74 96,53796,537 10.5%10.5%

> 75> 75 111,02111,0266

12.0%12.0%

45 – 6445 – 64 > 65> 65

20002000 225,33225,3355

207,56207,5633

20202020 294,69294,6977

281,39281,3900

% % GrowthGrowth

31.0%31.0% 36.3%36.3%

Growth in Seniors & Near-Seniors, 2000-2020

Finding: Income will limit access to careFinding: Income will limit access to care

PinellasPinellas FloridaFlorida

$33,765$33,765 $37,307$37,307

< 65< 65 675,452675,452

# # UninsuredUninsured

91,99991,999

% % UninsuredUninsured

13.6%13.6%

Source: 2003 Health Systems Plan

Uninsured Non-Elderly, 2000

Commercial Premium Costs, 1996-2001

Household Income, 2000

12021297 1379

15531680

1932

0

500

1000

1500

2000

2500

1996 1997 1998 1999 2000 2001

Pre

miu

m C

ost

Per

En

rolle

e

61% Increase 1996-2001

Finding: Lack of care will increase cost Finding: Lack of care will increase cost of careof care

45055

7101077341

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

1992 2000 2001

In $

Mil

lio

ns

Personal HealthCare

Source: 2003 Health Systems Plan

Health Care Expenditures - 1992 – 2001 (Florida)

4683

10156

11459

0

2000

4000

6000

8000

10000

12000

14000

1992 2000 2001

In $

Mil

lio

ns

Medicinal Drugs

72% increase 1992-2001

145% increase 1992-2001

Greatest Health System Impact: Greatest Health System Impact: Medication AccessMedication Access

• #1 Health Issue in Pinellas County#1 Health Issue in Pinellas County• Circle of Influence Circle of Influence

• 45% - Issue to Self or Family 45% - Issue to Self or Family • 85% - Issue to Entire Community 85% - Issue to Entire Community

• Barriers to Prescription Drug Access include:Barriers to Prescription Drug Access include:• Lack of Health Coverage for Prescription DrugsLack of Health Coverage for Prescription Drugs• Cost of Prescription DrugsCost of Prescription Drugs• Lack of Awareness about Alternate Resources for Lack of Awareness about Alternate Resources for

Prescription Drug Access Prescription Drug Access

Source: 2003 Health Systems Plan (Pinellas County)

Community Solution: Community Solution: MEDNETMEDNET©©

Four Essential Program Components:Four Essential Program Components:

• Patient AdvocatesPatient Advocates – deployed – deployed strategically throughout community to work strategically throughout community to work one-on-one with chronically ill adults, either one-on-one with chronically ill adults, either in a clinic setting or at a one-stop service in a clinic setting or at a one-stop service centercenter

• Program SoftwareProgram Software – web-based data – web-based data system tsystem too coordinate client intake, forms coordinate client intake, forms processing, and service deliveryprocessing, and service delivery

• Pharmacy VouchersPharmacy Vouchers – – short-term short-term support to at-risk clients accessing free support to at-risk clients accessing free long-term use through MedNetlong-term use through MedNet

• Health LiteracyHealth Literacy – t– to teach frontline care o teach frontline care givers and able-bodied adults to access givers and able-bodied adults to access free medications on their ownfree medications on their own

Patient Advocates (MedNet Navigators)Patient Advocates (MedNet Navigators) Receive referrals from local Receive referrals from local

physicians and clinicsphysicians and clinics Record prescription drug Record prescription drug

needsneeds Determine eligibility for free Determine eligibility for free

use of prescription drugs use of prescription drugs from pharmaceutical from pharmaceutical manufacturersmanufacturers

Download and complete Download and complete application forms – request application forms – request vouchers, if appropriatevouchers, if appropriate

Coordinate provider relationsCoordinate provider relations Initiate refill requestsInitiate refill requests Advocate for patient needs to Advocate for patient needs to

expedite medication receiptexpedite medication receipt Confirm receipt of free Confirm receipt of free

medicationsmedications

Program Locations

Free Clinic

FQHC

Sliding Fee Residency Clinic

Public Health Department

Local Hospital

Community Organization

8 FTE Total

Site Options, Program Needs & Cost FactorsSite Options, Program Needs & Cost FactorsSite Options & Program NeedsSite Options & Program Needs

Staffed SiteStaffed Site• 1 FTE Patient Advocate 1 FTE Patient Advocate

Volunteer SiteVolunteer Site• 3-5 reliable volunteers3-5 reliable volunteers• 1 FTE Volunteer Coordinator1 FTE Volunteer Coordinator

Both Site Types Need:Both Site Types Need:• Office SpaceOffice Space• Computer w/Internet AccessComputer w/Internet Access• Printer, Copier & Fax MachinePrinter, Copier & Fax Machine• PostagePostage• Office SuppliesOffice Supplies• Locally-developed or Locally-developed or

commercially-produced client commercially-produced client enrollment & services enrollment & services tracking databasetracking database

Cost & Other FactorsCost & Other Factors Salary & Fringe Salary & Fringe (1FTE (1FTE

advocate advocate OROR volunteer volunteer coordinator)coordinator)

Need to:Need to:• develop & maintain develop & maintain

client enrollment & client enrollment & services tracking services tracking database database OROR

• subscribe tosubscribe to commercial productcommercial product

Prioritize chronic disease concerns • Reason: Reason: Establish eligibility criteria for pharmacy Establish eligibility criteria for pharmacy

voucher component (30 day supply of medications)voucher component (30 day supply of medications)

Establish program policies • Reason: Reason: EstablishEstablish consistent program practices across consistent program practices across

multiple partner sites; e.g., policy requiring validation of multiple partner sites; e.g., policy requiring validation of secured medication against patient chart, etc.secured medication against patient chart, etc.

Create targeted referral system • Reason: Respond to specific health care needs; e.g.,

access to mental health medications Develop patient advocate training program

• Reason: Create well-educated network of community-based patient advocates

Review client enrollment & service utilization • Reason:Reason: Recognize emerging trends, assess community Recognize emerging trends, assess community

return on investment, and establish best practicesreturn on investment, and establish best practices

Community Consensus: A Critical Success Community Consensus: A Critical Success FactorFactor

What to Expect: Return on What to Expect: Return on InvestmentInvestment

MEDICATIONS BY DRUG MEDICATIONS BY DRUG CLASSCLASS

1 Site1 Site11stst 9 Months of 9 Months of

OperationOperation% OF ALL% OF ALL

ArthritisArthritis $2,732.12$2,732.12 0.7%0.7%

Asthma/Allergy/LungAsthma/Allergy/Lung $46,498.46$46,498.46 13.0%13.0%

Diabetes/EndocrineDiabetes/Endocrine $46,414.21$46,414.21 10.7%10.7%

Gastro-IntestinalGastro-Intestinal $22,670.45$22,670.45 9.4%9.4%

Heart, Cholesterol & StrokeHeart, Cholesterol & Stroke $124,621.58$124,621.58 25.1%25.1%

Mental HealthMental Health $121,742.26$121,742.26 19.0%19.0%

Migraine/Other PainMigraine/Other Pain $11,122.92$11,122.92 6.1%6.1%

Other, Including Seizure Other, Including Seizure $19,226.09$19,226.09 16.0%16.0%

TOTAL MEDICATIONS TOTAL MEDICATIONS (9-Month (9-Month

Return)Return) $395,028.10$395,028.10 $10 : $1$10 : $1

Program EvaluationProgram Evaluation Reviewed MedNet database to identify Reviewed MedNet database to identify

potential data points for studypotential data points for study

Qualitative analysis – observation, Qualitative analysis – observation, interviewsinterviews

Convened evaluation team meetings Convened evaluation team meetings to discuss implementation, outreach to discuss implementation, outreach and processing efforts and challenges, and processing efforts and challenges, lessons learned and “best practice” lessons learned and “best practice” differences between clinic and differences between clinic and community based sitescommunity based sites

Developing client satisfaction survey Developing client satisfaction survey instrument and processinstrument and process

Continuing to review/analyze outcome Continuing to review/analyze outcome data differences between program data differences between program sitessites

OutcomesOutcomes High level of satisfaction by High level of satisfaction by

program staff with MedNet program staff with MedNet software and technical supportsoftware and technical support

General Finding: Clinic sites General Finding: Clinic sites have an easier time securing have an easier time securing needed paperwork from MDs; needed paperwork from MDs; however, community sites however, community sites achieve a strongachieve a strong return to the return to the community community

Major Strength: Ability to Major Strength: Ability to share “hot tips” and network share “hot tips” and network best practices across program best practices across program sitessites

Next Steps…Next Steps…

Measure impact of MedNet on clinical Measure impact of MedNet on clinical health outcomes to determine:health outcomes to determine:

• Does MedNet reduce the incidence and Does MedNet reduce the incidence and impact of “avoidable admissions” to local impact of “avoidable admissions” to local hospitals? hospitals?

• Has MedNet reduced the cost of Has MedNet reduced the cost of managing chronic disease for low-income managing chronic disease for low-income residents?residents?

Program DesignElizabeth Rugg, Executive Director

727-217-7070 rugg@healthcouncils.org Program Evaluation

Karen van Caulil, Executive Director

Health Council of East Central Florida, Inc.

407-493-6808 kvancaulil@hcecf.org

Program FundingSteve Lesky, Regional Vice President

Allegany Franciscan Ministries

727-741-2744 slesky@afmfl.org