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JanetNormanRPh

Co-Director

ServiceSets&QA,CPESN-UTAH

StaffPharmacist,MountainWestApothecary

UtahCommunityPharmacyEnhancedServicesNetwork(CPESN)Update

•  Describethechangingclimateofhealthcareandhowthisaffectsfuturereimbursementandpracticeopportunities

•  IdentifytherationalebehindtheformationofaCPESNonanationalandlocallevel

•  DiscussthebasicstructureandservicesofferedbytheUtahCPESN

•  IdentifythecurrentandfutureactivityoftheUtahCPESN

Objectives

•  PharmacyrecognizedasaninvaluablepartoftheMedicalNeighborhoodthatcontributestoongoingmedicationCoordinationandOptimization

•  Paymentreformtakingplace:increasinglytiedtothequalityofcareprovidedasmeasuredbypatientoutcomesandhealthcarecostsavings.

•  Reimbursementaccordingto“valuebasedsystem”

AChangingHealthcareLandscape HealthCareSpendinginAmerica

90%

10%

Medical/Non-Pharmacy

Medication/Pharmacy

Throughtheformationofnetworksofcommunity-basedpharmacieswhosemembersprovideahigherlevelofservicethatdemonstratesanimprovementinpatientoutcomesandtherapeuticgoalachievement,demonstratemedicalcostssavingsandarewillingtocoordinatewithabroadercareteam.

MovingForward:ForourPatientsandProfession

CommunityPharmacyEnhancedServicesNetwork(CPESN)Pharmacies

•  TheseuniquepharmaciesaremembersofCommunityPharmacyEnhancedServicesNetworks.CPESNNetworkpharmaciesoffer:

•  Aclearfocusoninterventionsthatchangepatientbehaviorandleadtoimprovedhealthoutcomes

•  Theexperiencenecessarytoprovidemedicationoptimizationactivitiesandotherenhancedservices

•  Acollaborativeapproachwithotherhealthcareteammemberswhoareheldjointlyaccountable

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•  NationalCPESNbeganinNorthCarolina•  ReceivedgrantfromDepartmentofHealthandHuman

Services,CentersforMedicare&MedicaidServicestodevelopnetworks.

•  Currentlyinsomeformofdevelopmentinatleast24States.

•  NationalOrganizationProvidessupportforLocalnetworks–  SubjectMatterExpertiseand&NetworkConsultation–  ValueExpression&MarketingSupport–  QualityAssurance&BestPracticeIdentification

CommunityPharmacyEnhancedServicesNetwork(CPESN)

CPESNUSAAffiliatedNetworks

CPESNNetworkStructure

Servicesthattranscendconventionalrequirementsofanoutpatientpharmacyprogramcontractthatarefocusedonimprovingclinicalandglobaloutcomes

EnhancedServices

•  MedicationReconciliation•  ClinicalMedicationSynchronization•  AdherencePackaging•  Immunizations•  CompleteMedicationReviewswithChronicCare

Management•  HomeDelivery/HomeVisits•  PointofCareTesting•  VitalSignCollection•  NutritionalCounseling•  SmokingCessation•  Compounding•  EmergencyServices

TypesofEnhancedServices

•  CommunitybasedpharmaciesPatienttargeting•  Wholepatientorientation•  Accountabilityonglobaloutcomesandquality

(sharedmetricswiththerestofcareteam)•  Localcareteamclinicalintegrationandcoordination•  Supportforpracticetransformation•  ApproachtoHealthInformationTechnology

(PharmacisteCarePlans)

WhatmakestheCPESNmodeldifferent?

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•  PartnershipbetweenUtahDepartmentofHealth,UPhAandinterestedUtahpharmacists/pharmacyorganizations

•  Goal:Createanetworkofcommunity-basedpharmacistsinUtahwhoarecurrentlyprovidingand/orwillingtoprovideenhancedservicesandcoordinatecarewiththebroadercareteam.

CPESNUtahTimeline

May2016

Septem

ber

2017

Octob

er2017

June

2017

Augu

st2017

Novem

ber

2017

Curren

t

Steeringcommitteeassembled

Informa/onalmee/ngheldinSLCWorkgroupscreated

ServicesdefinedNetworkInfrastructuredevelopedQAprocessestablishedLookingfor“purchasersofvalue”

PharmaciessignnetworkagreementCollabora/veASTHOprojectGrantobtainedCon/nuedRecruitmentandfurthernetworkrefinement

WorkbeginsonASTHOproject

ASTHOprojectlaunched

Con/nuedRecruitment:91pharmaciesnowLookingfor“purchasersofvalue”MembersupportDocumenta/on/ClinicalIntegra/onTools(QA)

G. Benjamin Berre,, PharmD, BCPS, BC-ADM U of U Healthcare Neal Catalano, BSPharm, CDE Novo Nordisk, Inc. Kevin DeMass, BSPharm Apothecary Shoppe, Inc. Jeff Gatzemeier, BSPharm Oquirrh Mountain Pharmacy Karen Gunning, PharmD, BCPS, BCACP, FCCP University of Utah Mike Johnson , BSPharm Maple Mountain Pharmacy Ashley Rush, MPP, MPH Domain III Specialist for EPICC program Utah Department of Health

CPESNUtahExecutiveCommitteeJaime Montuoro, PharmD Smith’s Food and Drug Dan Richards, PharmD Meds in MoRon Pharmacy Buck Stanford, BSPharm, MBA Intermountain Healthcare Linda Tyler, PharmD U of U Health Care Jim Webster, BSPharm, CDE Santaquin Pharmacy & Diabetes Center Adam Jones ExecutiveDirector,UPhA

•  AdherencesupportServices•  Comprehensivemedicationmanagement•  Immunizations•  MedicationReconciliation•  MedicationSynchronization

CPESN-UTRequiredCoreEnhancedServices

•  Providepatient-specificsupportinoneoravarietyofmechanismsincludingsupportivecounseling,educationandprovidingadherence-enhancingtools

AdherenceSupportServices

•  Followthe10stepprocessdescribedbythePatient-CenteredPrimaryCareCollaborative(PCPCC)

ComprehensiveMedicationManagement

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ComprehensiveMedicationManagement

hWps://www.pcpcc.org/sites/default/files/media/medmanagement.pdf

•  Activelyscreen,recommendandadministerimmunizationsbasedonACIPrecommendationsandaspermittedbytheUtahVaccineProtocol

Immunizations

•  Especiallyimportantduringcaretransitions

1.  Developalistofcurrentmedications2.  Developalistofmedicationstobeprescribed3.  Comparethemedicationsonthetwolists4.  Makeclinicaldecisionsbasedonthecomparison5.  Communicatethenewlisttoappropriatecaregiversand

tothepatient

MedicationReconciliation

1.  Activelyidentifyandrecruitpatients2.  Developanaccuratelistofcurrentmedications,

evaluatingwhichmedicationscanbesynchronized3.  Sync/timetherefillsonaschedulethatworksforthe

patient4.  Reviewmedicationswiththepatientpriortorefilling

(toidentifyproblemswithorchangestotherapy)5.  Refillmedications6.  Meetwithpatientuponpick-up/deliveryofmedications

toassess/monitorprogressiontowarddesiredtherapeuticgoalsofmedications

7.  Follow-upasneededwithprovidersregardingnon-adherenceorfailuretoreachtherapeuticgoals

MedicationSynchronization

•  CollaborationbetweenCPESN-UT,UtahDeparmentofHealth,EducatorsMutualInsurance(EMI),UtahOfficeofHealthcareStatistics,RosemanUniversity,andpharmacyleaders.

•  SelectedCPESN-UTPharmacieswillbecaringforhighutilizerHypertensionpatientsaccordingtothePharmacistCareModel(wholepatient,chroniccare)for6months

ASTHOProjectIdentifyandsupportasustainablepharmacypracticemodelleveragingfrequentcontactbetweencommunitypharmacyandthehighestriskpatients.Thisinitiativewill:•  Demonstrateadditionalvalueofcommunitypharmacy

practice•  Demonstrateadifferenceintheoutcomes(clinicaland

economic)ofthepatientscaredforbythepharmacist•  Incentivizeplanstoreimbursecommunitypharmacyforthe

valuedcontributiontopatienthealth

ASTHOProject

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•  MemberSupport–  TrainingandQualityAssuranceforCoreServices–  DocumentationandClinicalIntegrationTools(ecareplans)–  ReimbursementSchemes

•  MemberRecruitment•  Fundingformoredemonstrationprojects•  ContactandMarketingto“purchasersofvalue”•  PharmacyLocationApp

CurrentandFutureActivities

•  BecomeamemberofCPESNUtah–  AccessParticipationAgreementandbasicinformationathttp://www.upha.com/?page=CPESN

–  ContactAdamJonesdirectly,ajones@associationsutah.com

–  ContactanymemberoftheExecutiveCommittee•  Getinvolvedinourworkgroups•  PrepareyourpharmacyforCPESN-UtahActivities•  Raiseawarenesstocolleagues,otherHealthCare

Professionals,andPatients

HowCanYouHelp? BecomeInvolved!

•  DeanJolleyRPh,OwnerJolley’sCompoundingPharmacy

AnAdditionalProspective

True/FalseReimbursementisincreasinglybeingtiedtothequalityofcareprovidedasmeasuredbypatientoutcomesandhealthcarecostsavings,otherwiseknownasa“valuebasedsystem”.

Self-AssessmentQuiz#1

CommunityPharmacyEnhancedServicesNetwork(CPESN)PharmaciesOffer:A.Aclearfocusoninterventionsthatchangepatientbehavior

andleadtoimprovedhealthoutcomesB.Theexperiencenecessarytoprovidemedication

optimizationactivitiesandotherenhancedservicesC.  Acollaborativeapproachwithotherhealthcareteam

membersbutarenotheldjointlyaccountableD.  AandBE.  A,B,andC

Self-AssessmentQuiz#2True/FalseEnhancedServicesareservicesthattranscendconventionalrequirementsofanoutpatientpharmacyprogramcontractthatarefocusedonimprovingproductreimbursementrates.

SelfAssessmentQuiz#3

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MembersofCPESNUTarerequiredtoofferallofthefollowingCoreEnhancedServicesEXCEPT:A.AdherencesupportServicesB.ComprehensivemedicationmanagementC.ImmunizationsD.SmokingCessationE.MedicationReconciliationF.  MedicationSynchronization

SelfAssessmentQuiz#4

ThankYou!

QuestionsandDiscussion

JanetNormanRPh janet@normanfamily.org