The Pharmacy Care NetworkHow Expanding The Care Continuum Improves Patient Care and Delivers Financial Benefits

Mike Sanborn, President and CEOBaylor Health Carrolton

Introduction

• The Role of Pharmacy in a Continuous Care Model– Ambulatory & Retail – Inpatient Care– Home Health & Skilled Nursing– Clinic

• Food for Thought•Next Steps

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The Role of Pharmacy in a Continuous Care Model

Pharmacy ClinicHome Health & Skilled NursingHospital

Medication Therapy

Management

Comprehensive Medication

Reconciliation

Transitions with Medication

Therapy Management

Coordinated Prescribing &

Specialty

Ambulatory & Retail PharmacyRevenue Opportunity

• Patient Fill & Adherence • Employee scripts – Savings incentives– Self Insured

•Medication Therapy Management•Health Maintenance – Immunizations,

Screenings, etc.4

$$$

Pharmacy data helps improve adherence and

patient outcomes

Your Pharmacy Network

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Ambulatory & Retail PharmacyImpact on Readmissions

• Patient Monitoring– Disease state management–Medication management– Reduce adverse reactions and

side effects– Increase adherence

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*According to a study by the federal Agency for Healthcare Research and Quality.

4Mavoidable readmissions annually

69%stem from failed drug therapy

Local retail pharmacists can offer significant expertise in retail management

!

Inpatient PharmacyThe Current Value-Based Purchasing Landscape

Hospital Performance Readmissions

Clinical Process of Care (45% of total performance) Outcomes (25% of total performance)

Patient Experience of Care (30% of total performance)

Unfilled prescriptions

AMI-7a Fibrinolytic Therapy Received within 30 Minutes of Hospital Arrival

SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients

MORT-30-AMI Acute Myocardial Infarction (AMI) 30-day mortality rate

Communication with Nurses Patient comprehension

AMI-8a Primary PCI Received within 90 Minutes of Hospital Arrival

SCIP-Inf-3 Prophylactic Antibiotic Discontinued within 24 Hours After Surgery End Time

MORT-30-HF Heart Failure (HF) 30-day mortality rate

Communication with Doctors

Medical information or test results not provided

HF-1 Discharge InstructionsSCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m. Postoperative Serum Glucose

MORT-30-PN Pneumonia (PN) 30-day mortality rate

Responsiveness of Hospital Staff

Family lack of knowledge to provide adequate care

PN-3b Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital

SCIP-Inf-9 Urinary Catheter Removed on Postoperative Day 1 or Postoperative Day 2 (**new for 2014**)

Pain Management Patient follow up with doctor

PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patient

SCIP-Card-2 Surgery Patients on Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker During the Perioperative Period

Communication about Medicines

Adverse events

SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior to Surgical Incision

SCIP-VTE-1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered

Cleanliness and Quietness of Hospital Environment

Medication reconciliation

SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxes within 24 Hours Prior to Surgery to 24 Hours After Surgery

Discharge Information Clear discharge instruction

Overall Rating of Hospital

Inpatient PharmacyThe Current Value-Based Purchasing Landscape

Hospital Performance Readmissions

Clinical Process of Care (45% of total performance) Outcomes (25% of total performance)

Patient Experience of Care (30% of total performance)

Unfilled prescriptions

AMI-7a Fibrinolytic Therapy Received within 30 Minutes of Hospital Arrival

SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients

MORT-30-AMI Acute Myocardial Infarction (AMI) 30-day mortality rate

Communication with Nurses Patient comprehension

AMI-8a Primary PCI Received within 90 Minutes of Hospital Arrival

SCIP-Inf-3 Prophylactic Antibiotic Discontinued within 24 Hours After Surgery End Time

MORT-30-HF Heart Failure (HF) 30-day mortality rate

Communication with Doctors

Medical information or test results not provided

HF-1 Discharge InstructionsSCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m. Postoperative Serum Glucose

MORT-30-PN Pneumonia (PN) 30-day mortality rate

Responsiveness of Hospital Staff

Family lack of knowledge to provide adequate care

PN-3b Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital

SCIP-Inf-9 Urinary Catheter Removed on Postoperative Day 1 or Postoperative Day 2 (**new for 2014**)

Pain Management Patient follow up with doctor

PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patient

SCIP-Card-2 Surgery Patients on Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker During the Perioperative Period

Communication about Medicines

Adverse events

SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior to Surgical Incision

SCIP-VTE-1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered

Cleanliness and Quietness of Hospital Environment

Medication reconciliation

SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxes within 24 Hours Prior to Surgery to 24 Hours After Surgery

Discharge Information Clear discharge instruction

Overall Rating of Hospital

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Driving Results

• Interviews with top/bottom 5% hospitals for AMI mortality

• Among other factors, top performers heavily engage pharmacists, those at the bottom don’t.

• In high performing hospitals:– “pharmacists were closely

integrated into care processes, and they actively informed and influenced clinical decisions.”

Curry LA, et al. Ann Intern Med. 2011;154:384-390.

Inpatient PharmacyImpact on Readmissions

• Intake Medication Reconciliation– Pharmacist or technician real-

time engagement through EHR

• Discharge Medication Reconciliation• Discharge With Medication In

Hand– Counseling with patient and

family – Tech with iPad uses Facetime

with pharmacist

Comprehensive pharmacy management - from intake to discharge and beyond

Inpatient PharmacyClinical Initiatives

• Formulary management• Indigent support programs

– Pharmacy assistance programs recover medication and devices– 340B offers significant outpatient cost reduction

• Informatics – Streamline automated utilization and order-set process in EHR – Beware of automated over-prescribing

• Value analysis team – Comprehensive study should include pharmacy costs to determine lower

cost options– Focus on total care cost

• Shortage management – Shared communications of availability within the health system

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Pharmacist ValueEconomic effects of pharmacists on health outcomes

• Meta-analysis of 126 publications– Subdivided into several different

kinds of analyses

• Future studies should build on the literature and focus on using pharmacists’ expertise in medication therapy to increase access to health care, maximize the quality time providers spend with patients, and improve the quality of care delivered in an efficient and cost-effective manner.

Chisolm-Burns MA, et al. Am J Health-Syst Pharm. 2010;67:1624-1634

Pharmacist Impact on Heart Failure VBP and Core Measures

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• Pharmacist-managed heart failure medication education and discharge instruction

“Significant reduction in 30-day all cause readmissions, increase in rate of ACEI/ARB prescribing at discharge for LVSD, and positive impact on patient satisfaction”

Warden BA, et al. Am J Health-Syst Pharm. 2014;71:134-9

Home Health and SNFTransitions with Medication Therapy Management

•Outreach on medication coordination and reconciliation•Good marketing and relations

with health system• Care coordination with primary

care physician – Understand expectations for

post-hospital care

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Positive relations with local SNF’s demonstrates health system ease of doing business

Clinic Pharmacy ServicesThe Growing Specialty Market

• Convergence of health systems with clinics• Significant growth projected• Opportunity to source purchasing

through hospital• Become a provider or partner to

control costs and quality – Better quality than white bag/brown

bag– Significant 340B opportunity 14

Improve quality and coordination of care

Clinic Pharmacy ServicesHelping to Manage Disease

• Complex disease state management– Diabetes, anti-coagulation, heart

failure, etc.

•High touch increases patient satisfaction•Drug selection• Prescription capture to improve

medication adherence

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Additional Food for Thought

• Re-evaluate compounding expenses • Harmonize your formulary with your provider

network• Specialty pharmacy is a growing business• Medication Therapy Management services – New revenue – Volume needed– Outcomes will demonstrate more opportunity

• PBM evaluation – Evaluation of alternatives

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…And the Pharmacist’s Role in ACOs

Benefits of Future State

• Pharmacy services leveraged as clinical, strategic and financial asset• Incorporation into care teams• Drives patient adherence and satisfaction• Reduces readmissions• Pharmacy leaders now lead an effective,

coordinated pharmacy enterprise across system• Better relationships and coordination of care

across the continuum18

Next Steps

•How you can engage your pharmacy team–Meet with your pharmacy leaders–What are the first feasible steps pharmacy can take

to support the changing dynamics of your health system?

–What resources are needed to support long-term goals?

– Are vendors and GPOs partnering to deliver value and support your goals?

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Thank you

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