Lisa Scholz, PharmD, MBA Senior Vice President and Chief Operating Officer 340B Health

Transcription

1 Lisa Scholz, PharmD, MBA Senior Vice President and Chief Operating Officer 340B Health

2 Statements of Conflicts of Interest Patrick Dunham and Mary Elizabeth Marr have the following conflicts of interest in relation to this presentation. Curant Health has a contract pharmacy relationship with Thrive Alabama Andrew Lowe, Pharm.D. has no actual or potential conflict of interest in relation to this presentation. 2

3 Today s Agenda Review the landscape of healthcare Apply value based care to contract pharmacy Demonstrate how a Ryan White facility has revolutionized care to improve patient outcomes. Review clinical care programs in a hospital setting and how patient outcomes are impacted and costs reduced. 3

4 The Shift in Healthcare Landscape Continuity of Care Accountable Care Organization Coordinated Care Patient Centered Medical Home Mergers Population Health Management Value Based Purchasing Pay for Performance Quality of Care Meaningful Use Patient engagement Patient Experience Consumer Assessment Wellness Programs Next Innovation Care Model Specialty Pharmacy Care Integration 4

5 Navigating a changing system Patient Engagement Provider Collaboration Improved Outcomes 5

6 The Future of Patient Engagement Relationship with providers non traditional access Real time feedback on provider experience Personal engagement through technology innovations Incentive/Reward systems for health goal completion 6

7 How will the safety net resource these trends/shifts? 340B savings will continue to support safety net missions Practice model evaluation Continue to review and make adjustments in procurement, storage, prescribing, administration, distribution, monitoring, and evaluating Resource management Utilizing providers efficiently Development of a hybrid staff model that cross pollinates quality and cost to reduce silo effect Health coach concept to support patients Innovation staff that infuse creativity into healthcare going beyond science Shift underutilized resources and train staff up Pro active monitoring and assessment Continuous Cost Quality Assessment (new ccqa) Implementation of new tracking/reporting technology Incentives/Reward programs for patients and providers Disruptive innovation Uberize how care is provided 7

8 CE Question (1) Which of the following are patient barriers to medication adherence? A) High Cost B) Depression C) Health Literacy D) All of the Above 8

9 CE Question(2) 340B savings allows a covered entity to expand what types of services? A) Substance abuse B) Prescription access C) Prevention clinics D) All of the Above 9

10 CE Question (3) Which of the following services can be provided by pharmacists in the ambulatory care setting? A. Refill management B. Polypharmacy reduction C. Hepatitis C medication management D. Transition of care medication management E. All of the above 10

11 Patrick Dunham President and CEO Curant Health

12 Today s Agenda Define Value in the Value Based Care Model Identify potential impact Medication Adherence has on overall Value Suggest how Contract Pharmacy can affect Medication Adherence Discuss actual Outcomes realized by Contract Pharmacy 12

13 Curant Health Background Vital stats Unique Delivery Model Areas of Focus University led studies 13

14 Opportunity to Revolutionize Care In 2010 the Patient Protection and Affordable Care Act (ACA) mandated several changes in existing compensation programs and established the CMS Innovation Center to develop and test payment and service delivery models helping to steer the focus of provider payment systems from volume based to value based care. 14

15 Old Guard 15

16 Fee for Service Model Value = Patient Copay (Cost per Procedure) X (# of Procedures) 16

17 Fee for Service Model Misalignment Excessive use of low value services Insufficient incentives to improve quality of care Poor Coordination of Care 17

18 New Guard 18

19 Alternative Payment Models Accountable Care Organizations Bundled Payments Pay for Performance Patient Centered Medical Homes 19

20 % of Medicare payments through Alternative Payment Models 50% 40% 30% 20% 10% 0% 2010 actual 2014 actual 2016 goal 2018 goal 20

21 Bundled Payment Growth 120 # of Awardees

22 ACO Growth Non CMS ACOs Medicare ACOs

23 Value Based Model Value = Outcomes Costs 23

24 Impact of Medication Adherence $213 billion in total savings* * Avoidable Costs in U.S. Healthcare, IMS Institute for Healthcare Informatics 24

25 Poor Adherence = Misalignment Poor Adherence Increased Patient Costs Poor Health Outcomes Increased Healthcare Costs Increased Service Utilization 25

26 Barriers to Medication Adherence Complexity High Cost Difficulty remembering schedules Lack of understanding Not feeling sick Side effects Embarrassment / Stigma Depression Health literacy 26

27 Contract Pharmacy and Medication Adherence Access Affordability Adherence Clinical Outcomes 27

28 Access Reduce time to therapy Streamline PA process Convenient home delivery 28

29 Affordability Drug Manufacturer assistance Non profit grant assistance Sliding fee 29

30 Adherence Clinical Pharmacist oversight Enhanced Medication Therapy Management Risk Assessment Adherence packaging Adherence monitoring Targeted education Communication with the prescriber 30

31 Outcomes Purdue University Virginia Commonwealth University Thrive Alabama University of Alabama at Birmingham 31

32 Adherence produces Value Excellent Adherence Decreased Patient Costs Improved Health Outcomes Decreased Healthcare Costs Decreased Service Utilization 32

33 Adherence Aligns Stakeholders Covered Entities Payer Patient Contract Pharmacies Manufacturer 33

34 CE Question Which of the following are patient barriers to medication adherence? A) High Cost B) Depression C) Health Literacy D) All of the Above 34

35 CE Question & Answer Which of the following are patient barriers to medication adherence? A) High Cost B) Depression C) Health Literacy D) All of the Above 35

36 Additional Questions? Patrick Dunham President and CEO Curant Health 200 Technology Ct. SE, Suite B Smyrna, GA Phone: pdunham@curanthealth.com 36

37 Mary Elizabeth Marr Chief Executive Officer THRIVE Alabama

38 Today s Agenda THRIVE Alabama background Our pharmacy model Utilization of 340B savings/funding Patient treatment outcome results Patient care programs 38

39 BACKGROUND Ryan White Grantee since 2000 Parts B, C & D Davis and Hames Clinics 600+ Clients Additional site opening fall 2015 Full 340b Access for all Patients Contract with Walgreens & Curant Health (mail order)

40 PHARMACY MODEL Specialty Pharmacy Retail Store Front 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 Throughout 12 county region Some clients prefer a storefront & direct contact with a pharmacist Same day pickup

41 Use of 340B Funding INFRASTRUCTURE Administrative Costs Finance Staff (3) HR (1) ED (1) Data (1) Vehicles for Transportation Cut our Overall Transportation Costs Building Fund

42 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

43 340B Growth Clients Prescriptions Aug 2011 Apr 2015 $250,000 $237K $200,000 $150,000 $100,000 $50,000 $3K $ Revenue

44 Treatment Outcomes 100% Viral Load Suppression 90% 80% 70% 60% 50% VL<= % 74.9% 76.1% 79.2% 85.9% 87.2% VL<= % 68.4% 71.2% 72.6% 80.9% 84.5% VL<= % 56.8% 60.6% 64.1% 72.3% 79.7%

45 340B PrEP Program Potential Challenges ability to fund PrEP: Costs Physician Costs Laboratory Costs Insurance Assistance Patient Assistance Programs Becoming an STD Clinic through the Health Department. This will enable Thrive to collect PrEP medication costs through 340B

46 Substance Abuse

47 The Den

48 Prevention Services

49 Davis and Hames Clinics

50 CE Question 340B savings allows a covered entity to expand what types of services? A) Substance abuse B) Prescription access C) Prevention clinics D) All of the Above 50

51 CE Question & Answer 340B savings allows a covered entity to expand what types of services? A) Substance abuse B) Prescription access C) Prevention clinics D) All of the Above 51

52 Additional Questions? Mary Elizabeth Marr Chief Executive Officer THRIVE Alabama 600 St. Clair Ave. Building 3 Huntsville, AL Phone: (256) memarr@thrivealabama.org 52

53 Andrew Lowe, Pharm.D. Clinical Director Arrowhead Regional Medical Center/Comprehensive Pharmacy Services

54 Today s Agenda Describe the pharmacy services at the practice site Present outcomes of clinical initiatives Discuss the benefits of these services to the patients and to the payers Present upcoming initiatives 54

55 Arrowhead Regional Medical Center San Bernardino County owned and operated Level II trauma center Teaching institution 456 beds 361 Medical beds 30 NICU 48 ICU beds 22 Pediatrics 14 Burn

56 Trauma Center Burn Center Stroke Center ARMC Ambulatory Services Oncology Second busiest Emergency Department in California

57 ARMC Safety net hospital Numerous undocumented patients Transition from previous indigent program to managed care Medicaid slower than anticipated Many patients without primary care provider using Emergency Department 57

58 Teaching programs: Family Medicine ARMC Internal Medicine Surgery Neurosurgery Women s Health Psychiatry Ophthalmology Pharmacy (ASHP Accredited)

59 ARMC AND 340B Joined the program at the beginning of 1993 Immediate savings Annual outpatient drug cost savings of $12 million This has enabled us to care for more patients Using the savings to improve access to care to an increasing number of people who do not have coverage or cannot afford copayments More prescriptions filled Clinical initiatives

60 PHARMACY PRACTICE IN CALIFORNIA Eleven Schools of Pharmacy Expanded scope of practice SB 493 Pharmacists recognized as providers Prescriptive ability Advanced Practice Pharmacist licensure Many innovative programs Contracting with payers just the beginning 60

61 CLINICAL INITIATIVES Aimed at medication safety Antimicrobial stewardship now mandated by California law Anticoagulation management Cardiovascular risk prevention Oncology Transitions in care use of tele health Discharge education Hepatitis C Center of Excellence

62 AUDIENCE POLLING Which pharmacist managed clinical programs do you currently have? A. Anticoagulation clinic B. Cardiovascular risk reduction C. Congestive Heart Failure D. Transitions in care E. At least two of the above 62

63 HEPATITIS C Center of Excellence Inland Empire Health Plan One Hepatologist One Physician Assistant Clinical Pharmacist Resident Staff support

64 HEPATITIS C Center of Excellence Initial visit Liver biopsy Decision to treat Treatment based on the latest guidelines American Association for the Study of Liver Disease Infectious Disease Society of America Pharmacist counsels patients on and helps mitigate side effects Pharmacist focuses on enhancing compliance

65 Treatment The Old Pegylated interferon (approximately 80% no longer eligible) Ribavirin Boceprevir (Victrelis) Telapravir (Incivek) now off the market Lots of side effects Associated with only 50% SVR (sustained virologic response)rate

66 The New World of Treatment all oral therapy Simeprevir (Olysio) Sofosbuvir (Sovaldi) Ledipasvir sofosbuvir (Harvoni) Ombitasvir Paritaprevir Ritonavir + Dasabuvir (Viekira Pak)

67 Sticker Shock! $15,955,758 purchases of Hepatitis C medications in 2014 Discounted price to third party payers Managed care Medi Cal has saved $4,872,375 since the inception of the program Savings to the taxpayers

68 Outcome 210 patients Many with severe cirrhosis 75% SVR Compliance almost at 100% Side effects manageable Only two patients stopped therapy

69 TRANSITIONS OF CARE PROJECT Clinical pharmacists encounter the patient, facilitate obtaining medications, and provide education During hospital stay At discharge 2 and 14 days after discharge Record review at 30 days Disease states: CHF MI Pneumonia Diabetes mellitus 69

70 TRANSITIONS OF CARE PROJECT 1: Kumar Dharmarajan, MD, Angel F. Hsieh PhD. et al. Diagnosis and Timing of 30 Day Readmissions After Hospitalization for Heart Failure, Acute Myocardial Infarction, Pneumonia and Diabetes. JAMA, January 23/30, 2013; Vol 309, No. 4; pages

71 Patient Education at Discharge Pharmacist or student visits the patient and provides education on discharge medications. Patients are followed up 48 hours after discharge, then 14 days after discharge. Patients are called 30 days later to evaluate the outcome (re admission, Emergency Department visit, death, none) 71

72 Percent Readmissions Nat. Avg 2012 Nat. Avg 6 Center (Ctrl) 5 Center 6 South 72

73 UPCOMING INITIATIVES Clinical pharmacist embedded in Family Health Center Polypharmacy Refill management Geriatric management Congestive Heart Failure clinic 73

74 CE Question Which of the following services can be provided by pharmacists in the ambulatory care setting? A. Refill management B. Polypharmacy reduction C. Hepatitis C medication management D. Transition of care medication management E. All of the above 74

75 CE Question Which of the following services can be provided by pharmacists in the ambulatory care setting? A. Refill management B. Polypharmacy reduction C. Hepatitis C medication management D. Transition of care medication management E. All of the above 75

76 Additional Questions? Andrew Lowe, Pharm.D. (909)