PHARMACY UPDATE 2015 Town Hall Meeting Utah Pharmacy Association Annual Convention Objectives Discuss how the Utah Pharmacy Association can better serve the profession Discuss Star Ratings and how they could impact community pharmacy Discuss provider status and the effects locally and nationally Discuss pharmacist involvement in Medical Homes Discuss how pharmacy can help with transitions of care List what you can do to become more involved in the profession of pharmacy this year 1
Principles of the Utah Pharmacy Association Organizational Excellence Advocacy Education Member Support Promotion Organizational Excellence Transparent to Members and Management Defined and Strong in Purpose and Mission Educated and Informed Advocacy Protection of the Profession Resource for Information Legislators Professionals Public 2
Education Be The Resource for Pharmacy Continuing Education Pharmacists Technicians Maintain a High Standard of Education Current Practices Evolving Opportunities Member Support Networking Opportunities Business Improvement Self Improvement Strategic Partnerships and Alliances Recognition Scholarships Promotion Promote the Value of Pharmacy Help Direct, Change and Improve the Perception of the Pharmacy Profession Throughout the State 3
Star Ratings What are they? How do they impact community pharmacy? What is our role? Why Measure Quality of Care? Star Ratings emphasize patient care and satisfaction, using national clinical quality measures, including screenings and preventive care quality measures, as well as patient feedback. Goal of Star Ratings Health plans, physicians, and members can work together to improve individual and total population quality of care and experiences By improving, health care becomes more personalized and tailored to the individual Reduction in overall healthcare costs 4
CMS Star Ratings: Key Points CMS reports scores and compares plans based on performance CMS also uses Star Ratings to determine reimbursement The ratings are used to compare Medicare Advantage and Prescription Drug Plans Ratings emphasize patient care and satisfaction through feedback: Clinical and service quality measures Health outcomes and patient feedback Star Ratings CMS developed a 5-star quality rating system for Medicare Prescription Drug Plans (Part D) and Medicare Advantage (MA-PD) Plans are scored on different measures Roll up to individual/overall star rating Consumers access websites to view plan s ratings 5 Star = high performing icon <3 Star = low performing icon Important Why? BONUS! Today s performance impacts payment model in 2 years Why are Star Ratings Important to Pharmacies? 90% of prescriptions are paid with insurance Est. by 2017 the government will pay for approx 65% of all medication claims Currently star ratings affect Medicare Part D and Medicare Advantage Private insurers are currently tracking same quality measures What is being tracked? 5
Key Points to Star Ratings Health plans earn star ratings, not pharmacies Pharmacies can drive health plan performance 2 key categories ~45% of a plans overall rating Improve Medication Adherence Focus on chronic conditions (diabetes, cholesterol, HTN) Gaps in Care Interventions Pharmacist to identify missing or inappropriate medications ACE or ARB in diabetes patient Avoidance of high risk medications in elderly MTM Transitions of Care What are transitions of care? How can we help? Should we be involved? What benefit comes to us? To our patients? 6
The Utah Medical Home Utah Partnership for Value-driven Health Care UPV Standards and Measures Work Group Goal for this group is to develop a model that will allow all interested Utah Primary Care providers to transform into medical homes, regardless of their size, location or affiliation. They want our feedback that is the only place I see pharmacy or pharmacists mentioned Accountable Care Organizations Pharmacist Roles Medication non-adherence - $300 Billion cost annually Pharmacists as members of clinical care teams Allina Health, Minneapolis Banner Health, Phoenix Atrius Health, Newton, Mass. University of Utah Intermountain Healthcare - SelectHealth Roadblocks Not paid for pharmacist visits Opportunities Retail pharmacies role in coaching, teaching, helping 7
Pharmacists as Providers We are well known, trusted, and the most accessible health care professional Presently a shortage of primary care doctors in many parts of the United States Expansion of healthcare coverage to millions will make this shortage even worse Reliance on nurse practitioners, physician assistants, and pharmacists to provide routine services 8