Mike Gifford President & CEO, ARCW Katy Caldwell Executive Director, Legacy Community Health...
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Transcript of 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
Webinars are available on our website for on-demand viewing.
You will find slides from today’s presentation posted to the front page of our website: www.nationalhivcenter.org.
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Join us for our other webinars this month!
Engagement in Care: From Cascade to Continuum to Control
Wednesday, May 20, 2015 @ 2:00 PM ET(Registration will soon be open at our website: www.nationalhivcenter.org )
Conclusion Slide