Lydia Klinger Director, Ryan White & HIV Clinical Service Programs Virginia Commonwealth University. Mark Loafman MD, MPH

Transcription

1 Lydia Klinger Director, Ryan White & HIV Clinical Service Programs Virginia Commonwealth University Mark Loafman MD, MPH Chair, Family and Community Medicine, Cook County Health and Hospitals System Lead, Alliance for Integrated Medication Management Ed Shanshala Chief Executive Officer Ammonoosuc Community Health Services

2 Statement of Conflicts of Interest Mark Loafman Edward Shanshala Lydia Eklinger Have no actual or potential conflicts of interest in relation to this presentation. 2

3 Today s Agenda Moving from volume to value calls for transforming practices and processes to improve quality outcomes Practice transformation requires resources Vulnerable populations are often among the: Hardest to reach Highest cost Largest impact on value Comprehensive 340B programs generate quality/value at systems and local level & in rural and urban settings Share models that work and leave in action 3

4 CE Question (1) Transforming practices to enhance quality and value can best be achieved through? A) Clinical Integration with shared goals B) Alignment around organizational goals C) Population risk stratification based on impact D) Comprehensive medication management E) All of the Above 4

5 CE Question (2) 340B cost savings for Ryan White programs are subject to the same guidelines as the Federal grant funding. A) True B) False 5

6 Level Setting 6

7 Volume Value Doing Things Right Clinical Encounters Documentation Billing Compliance QA Processes Liability If it doesn t work out? Its not my fault, and We still get paid Patient Panel Patient Visits Total Population of Care 7

8 Volume Value Doing Things Right Doing the Right Things Clinical Encounters Documentation Billing Compliance QA Processes Liability If it doesn t work out? Its not my fault, and We still get paid Patient Panel Patient Visits Total Population of Care Population Health Utilization managed Patient Engaged Team Care Satisfied QA Outcomes If it doesn t work out? Its on us, and We won t get paid 8

9 Volume Value Re$ource$ + Leadership Practice Transformation Doing Things Right Doing the Right Things What Drives the Change? Patient Panel Patient Visits Total Population of Care Population Health Utilization managed Patient Engaged Team Care Satisfied QA Outcomes If it doesn t work out? Its on us, and We won t get paid 9

10 Volume Value Re$ource$ + Leadership Practice Transformation Doing Things Right Doing the Right Things What Drives the Change? Alignment Not another to do But a new way to do Integration Teams, Synergy Top of License Coordinated Risk Stratification Highest Risk 20% = 80% $$ 5% = 50% $$$ Impactable issues (Optimize Med Rx) Comprehensive Care Adherence based Accountable Patient Panel Patient Visits Total Population of Care Population Health Utilization managed Patient Engaged Team Care Satisfied QA Outcomes If it doesn t work out? Its on us, and We won t get paid 10

11 Volume Value Re$ource$ + Leadership Practice Transformation Doing Things Right Doing the Right Things Total Population of Patients Under Rx Panel Patients w/ Uncontrolled Conditions Clinic Visit Consider our Approach to Safe AND Effective Medication Use Population Health Utilization managed Patient Engaged Team Care Satisfied QA Outcomes If it doesn t work out? Its on us, and We won t get paid 11

12 Who are the highest risk, highest cost, most vulnerable patient populations at your organization? Clinical setting and volume Vulnerable populations served Clinical pharmacy programs and staffing Medication usage drug spend Biggest opportunity for quality and value 12

13 Ammonoosuc Community Health Services 13

14 ACHS Clinical setting and volume 1975 ACHS was establish 1994 became an FQHC 1996 GE Centricity EHR/PMS 1998 HRSA Chronic Disease Collaborative 2008 HRSA High Performer 2009 NCQA PCMH 2010 HRSA PSPS Collaborative 2012 CMS ACO as a founding member of the North Country ACO. 14

15 ACHS Vulnerable populations served $10 million budget 40% Medicare population 5 Sites through 110 Staff ACHS Provides Integrated Medical, Behavioral, Dental, Pharmacy, and enabling services Over 30K Encounters Unfavorable social determinates of health ACHS Vulnerable Population Geographically Isolated 26 Towns 31K Residents Multiple Comorbidities 15

16 ACHS Clinical pharmacy programs and staffing ACHS pharmacy is located at the ACHS Littleton, staffed with two pharmacist, two pharmacy technicians, and two cashiers. ACHS pharmacy dispenses an average of 650 Rx/Week. ACHS has a tele pharmacy arrangement between ACHS Littleton and ACHS Warren. ACHS provides clinical pharmacy services (CPS). ACHS integrates CPS into the North Country ACO (CMS Advanced Payment Shared Savings Pilot). ACHS integrates CPS with our collaborating Critical Access Hospital transition in care teams 16

17 ACHS Medication usage drug spend (POF 62 diabetics with 12 or more meds) Pre Collaborative / 12 Months Post Collaborative Prevalence of Poly Pharmacy for Diabetic Population of Focus Pre N Value = 62 Post N Value = 54 90% 80% 82% 70% 60% 50% 40% 30% 33% 43% 20% 10% 0% 11% 15% 6% 0% 9% Pre 12 or less 13 to to or more Post Post Pre 17

18 ACHS Biggest opportunity for quality and value (POF 62 diabetics with 12 or more meds) Non Trauma Related Emergency Department Visits (32% improvement) and Hospitalizations (22% improvement) 1.40 Visits or Admissions per Population of Focus Patient Emergency Department Visits per POF Patient, 1.34 Hospitalizations per POF Patient, 0.40 Pre Emergency Department Visits per POF Patient, 0.91 Hospitalizations per POF Patient, 0.31 Post Emergency Department Visits per POF Patient Hospitalizations per POF Patient 18

19 ACHS Biggest opportunity for quality and value Solution After Next: Follow the Patient, the meds, money, information, & staff Charter a Team for Continuum of Care Clinical Pharmacy Services Create a Process Flow Responsibility Matrix 19

20 Virginia Commonwealth University 20

21 VCU HIV Clinical Services Primary site is an urban academic medical center More than 2500 HIV+ patients at five clinical sites Demographics of patients 21

22 VCU HIV Clinical Services Vulnerable Population Served Insurance Type Race Am. Indian/Alaska Native 30% 38% 32% Medicaid/Medicare Private Uninsured 2.11% 22.16% 73.85% Asian Black or African American More than one race Not Specified Other Pacific Islander White Age 10.05% % 16.98% 17.03% 23.87%

23 HIV Care Continuum 23

24 Ryan White Services Offered Outpatient medical care Clinical Pharmacist Medical case management Mental health services Oral health care Copay/cost sharing assistance Medication assistance Adherence Counseling Medical Transportation 24

25 VCU RW 340B Medication Usage 1200 Total Patients and Prescriptions Shipped (by month) Total: 13,040 Prescriptions Total Patients Total Prescriptions 25

26 VCU RW Medication Spending 26 $32, $50, $75, $94, $145, $166, $179, $172, $176, $207, $182, $201, $232, $193, $235, $222, $209, $253, $291, $588, $700, $600, Medication Purchases (Total: $3,910,637) $500, $400, $300, $200, $100, $ COGS

27 VCU: Leveraging 340B Savings $250, B Cost Savings (Total: $2,278,519) $200, $150, $100, $50, $ $(50,000.00) $(100,000.00) $(150,000.00) $(200,000.00) 27

28 Audience Response Who are the highest risk, highest cost, most vulnerable patient populations at your organization? Clinical setting and volume Vulnerable populations served Clinical pharmacy programs and staffing Medication usage drug spend Biggest opportunity for quality and value 28

29 How do you leverage 340B savings to improve patient outcomes in ways that matter to you organization? Quantify 340B savings 340B types of programs offered Data/measures you have access to that matter What s working that others might replicate? 29

30 Virginia Commonwealth University 30

31 VCU: Improving Patient Outcomes Medication Therapy Management services provided by contract pharmacy Medication co pay & cost sharing assistance Over $266,000 in assistance provided to date Nurse Educator for Safe Discharge Initiative Dedicated full time Clinical Pharmacist HCV/HIV Co Infection Treatment program 31

32 VCU: Improving Patient Outcomes 340B cost savings are considered program income to the Ryan White Part C grantee. Program income is NOT considered Federal funding and is therefore not subject to Federal regulations. Can fund any activities or costs associated with the provision of services at a Ryan White funded program. 32

33 VCU: Cost Savings Reinvestment Family HIV Camp Administrative expenses (i.e. Director, data entry, quality management, supplies, computer equipment, telephones, professional development): not subject to 10% cap Quality Improvement Database creation & data analysis Facilities improvements 33

34 Ammonoosuc Community Health Services 34

35 ACHS Quantify 340B savings Operating Margin enables Clinical Pharmacy Efforts that: Decrease potential adverse drug events Decrease adverse drug events Decrease clinically unnecessary poly pharmacy Decrease unnecessary avoidable Hospital admissions and readmissions Emergency department visits Enable realization of the CMS Triple Aim through ACO activities. 35

36 ACHS 340B types of programs offered Tele pharmacy Medication Reconciliation Medication Therapy Management Pill Box replenishment Medication Synchronization Bedside Delivery of discharge medications (in planning phase) 36

37 ACHS Data/measures you have access to that matter ACHS General Electric Centricity Electronic Health Record and Practice Management Solutions QS1 Critical Access Hospital Collaborating Partner Data ACO Data Patient Experience Clinical Outcomes Claims Financial 37

38 ACHS What s working that others might replicate? Reinvest the 340B Margins into the mission FQHC and CAH Collaborations Accountable Care Organizations Integrated Multi Disciplinary Care Teams Tele Pharmacy 38

39 Audience Response How do you leverage 340B savings to improve patient outcomes in ways that matter to you organization? Quantify 340B savings 340B types of programs offered Data/measures you have access to that matter What will you do by next Tuesday to drive this change? 39

40 CE Question Transforming practices to enhance quality and value can best be achieved through? A) Clinical Integration with shared goals B) Alignment around organizational goals C) Population risk stratification based on impact D) Comprehensive medication management E) All of the Above 40

41 CE Question (1) Transforming practices to enhance quality and value can best be achieved through? A) Clinical Integration with shared goals B) Alignment around organizational goals C) Population risk stratification based on impact D) Comprehensive medication management E) All of the Above 41

42 CE Question (2) 340B cost savings for Ryan White programs are subject to the same guidelines as the Federal grant funding. A) True B) False 42

43 CE Question & Answer 340B cost savings for Ryan White programs are subject to the same guidelines as the Federal grant funding. A) True B) False 43

44 Additional Questions? 44