Approach to Population Management

Transcription

1 ReThink Pharmacy: New Models of Payment Population Health Management Upon successful completion of this article, the pharmacist (or technician) should be able to: Describe strategies for positioning yourself in a value based workspace and payment models for value added services. Describe opportunities for community pharmacy in the larger healthcare system and models for patient referrals between healthcare providers. Describe ways in which you can differentiate the service sets you provide as a high performing community pharmacy. Pharmacy is an investment, not a cost center. It may be an efficient investment at times or it may be an inefficient investment at times depending on how the system performs, but it is an investment made to avoid downstream costs from sick care nonetheless. The future of community pharmacy is about maximizing that investment to the greatest effect. Troy Trygstad Population Management engaged network of healthcare professionals that participates in care improvement and cost effectiveness strategies for a specified group of patients Approach to Population Management Identify the Right Patients At the Right Time In the Right Settings Provide the Right Care With the Right Team CCNC SERVICES Improving care through shared knowledge 22 Slide courtesy of Community Care of North Carolina

2 Population Population To Touch How To Touch Them Need Generalized Med Management Some Have More Specific Needs Adherence/Coaching Patient Needs Therapeutic Discrepancies Intervention Selection Therapeutic Considerations Interventions Actors- Settings Prioritize Patients with most need Identify best intervention based on data Deliver intervention guidance Logistics Engine Slide courtesy of Community Care of North Carolina Payment models Current: Volume, Growth, Market Share, Contract Price Future: Quality, Efficiency, Partnerships, Improving Population Health, Per Capita Costs, Services Volume vs. Value Value = Health Outcomes Achieved Dollars Spent per Care Cycle 1 How do we get into a valued workspace? o Help payers with their metrics o Help providers with their metrics o Differentiate yourself as a higher performer o Differentiate yourself as someone who can influence outcomes How do we get compensated for valued services?

3 o o o Fee for service Fee for performance Per member per month How do we get into a different payment model? o Ask o Communicate your value Principles of Accountable Care Responsible for Outcomes Prescribing Rates vs. Filling Rates vs. Heart Attacks Longitudinal View of both Cost and Quality Responsible for a patient s health over a defined period of time (no dumping) Responsible for Care Delivered by Others Responsible for a patient s care regardless of time and place Reaching Outside the Four Walls of the Your Practice Site Established care team with meaningful and efficient relationships Moving Away from an Encounter Based Payment Model.And the Shift is a Fundamentally Different Approach to Payment and Delivery Slide courtesy of Troy Trygstad, PharmD, PhD, MBA VP Pharmacy Programs, Community Care of North Carolina Opportunity for Community Pharmacy in a New System How can I help other Health Care entities improve their metrics? Pharmacy is highly underutilized in relation to education It is all about Panel Management (working with a group of the highest preventable risk patients) The new game for community pharmacy is REFERRAL

4 Pharmacy is an investment not a cost center Referrals Drive referrals through quality We are accountable and measured on quality Recognize a patient with a need and connect them with a healthcare professional that can fulfill that need Generate Ability to Differentiate High Performing Pharmacies o So Payers can Differentiate Relationship o So Providers can Differentiate Relationship What Are We Learning? How to divide the workforce of pharmacy to deliver outcomes The connection the community pharmacist has with the healthcare team may be as important as the connection with the patient The ability to connect a healthcare provider with a patient in the home is highly valuable The value we bring may not be just clinical What Does Victory Look Like? Preserve Product Reimbursement Preserve In Network Status with PBMs Penetrate Medical Benefit/Budget Distinguish High Performing Pharmacies from Everyday Pharmacies in Minds of Providers and Patients/Caregivers for At Risk Patients Develop a sustainable model where payment is based off of value of the CMS Triple Aim and not a race to the bottom 2 1 Adapted from Harvard Business Review Webinar The Strategy that Will Fix Health care (20601)Featuring Harvard Business School Professor Michael E. Porter and Press Ganey CMO Dr. Thomas H. Lee, Sept. 24, Berwick,DM, et al. The Triple Aim: Care, Health, and Cost. Health Affairs. no. 3 (2008): About the Author: Joe Moose, PharmD, is a clinical pharmacist and co owner of Moose Pharmacy and its 6 locations in NC. Joe received his Doctorate of Pharmacy from Campbell University (1990). Joe serves as a primary preceptor with the UNC Eshlman School of Pharmacy Community Pharmacy Residency Program. He is also a preceptor for students completing introductory and advanced practice experiential education rotations with the UNC Eshelman School of Pharmacy, Campbell University, and Wingate. He has contributed to the state of North Carolina by serving on a variety of committees, including chairperson for the NC Medicaid Drug Utilization Review. In his role at Moose Pharmacy, he has established collaborative practice agreements with local physician s offices to

5 integrate community pharmacists into a patient centered medical home. Under his leadership, Moose pharmacy has also partnered with the City of Charlotte and Union County to manage employees enrolled in the diabetes management program. Working with his pharmacy staff, Joe has implemented and enhanced a variety of clinical services in his pharmacy, including MTM. Joe also serves as a consultant to Community Care of North Carolina in the position of Lead Community Pharmacy Coordinator. In this role he has built a network of high quality community pharmacies that strive to offer enhanced value to payors. He has maintained professional affiliations with the National Community Pharmacists Association and North Carolina Association of Pharmacists. NCPA is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program will provide 1.0 contact hours (0.1 CEUs) of continuing pharmacy education. Total CPE Credit: 1.0 contact hours (0.1 CEUs) ACPE UAN: H04 P ACPE UAN: H04 T Activity Type: Knowledge Based Release date: September 16, 2015 Expiration date: September 16, 2018