Steve Simenson, BPharm, FAPhA, DPNAP APhA … - NCPO...Goodrich Pharmacy Anoka, Minnesota ....
Transcript of Steve Simenson, BPharm, FAPhA, DPNAP APhA … - NCPO...Goodrich Pharmacy Anoka, Minnesota ....
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?