va pharmacy conference 2008 consolidated mail outpatient pharmacy operations kenneth siehr deputy...
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VA Pharmacy Conference2008
Consolidated Mail Outpatient Pharmacy Operations
Kenneth SiehrDeputy Chief Consultant-Pharmacy Benefits Management ServiceConsolidated Mail Outpatient Pharmacy OperationsDepartment of Veterans Affairs
Overview
• A little about me• Life of a VA mail out prescription• Outpatient prescription fulfillment system• CMOP today• CMOP history
– How we got to where we are• CMOP of Tomorrow• How does this affect you?
Who Is This Guy?
• 30+ years in Federal Pharmacy– Pharmacy Intern VA Madison 1977
• Army Pharmacist 1978-81• VA Staff Pharmacist 81-82• VA Pharmacy Supervisor since 1982• Chief of Pharmacy 1988• Managed Multiple Services at Medical Center• VISN Formulary Leader (VISN 12) when
positions were established• PBM Manager 2004• Present Position 10/07
Awaiting Verification
1 Hour to ?? 10 Hr 12 – 48 Hrs 48 Hrs to ??
Awaiting Transmission to CMOP
CMOP Filling
Delivery to Patient
Provider Orders Medication
Patient Receives
Goal: Delivery to Patient with 10 days of Patient/Provider request
Life of a VA Mail Out Prescription
VHA Outpatient Medication Fulfillment System
Medical Centers CMOP
Contracting and Procurement
Delivery to Patient
Goal: Delivery to Patient with 10 days of Patient/Provider request
Medical Center• Interface between
– Patient and fulfillment system– Provider and fulfillment system
• Ensures right – Medication for patient clinically– Dose, frequency– Cost efficiency
• Dispenses Prescriptions (20%)– Window– Mail
• Responsible for Performance– Chief of Pharmacy, Facility TMT, VFL
CMOP
• Dispenses Prescriptions (80%)– Mail
• Primary Interface – Patient delivery services
• USPS, FedEx• Mail consolidators• Direct to patient vendors
– NAC for outpatient medication contracts– Contractors for direct to patient delivery
• Responsible for Performance– CMOP Director, National CMOP and PBM
Contracting and Procurement• National Pharmacy Benefits Management
Services– Formulary Management– Identifies contacting opportunities– Monitors utilization– Contract compliance
• National Acquisition Center (NAC)– National contracts, BPAs, FSS
• Procurement and Contracting staff at each site and CMOP
• Responsible for Performance– Chief of Pharmacy, CMOP Director– National PBM, NAC
Delivery to Patient
• Window at Medical Centers• To Patient’s Home
– Contracted or third party vendors• US Postal Service• Federal Express or similar vendor
– Mail consolidators• Facilitate and speed process
– Direct to patient contractors
• Responsible for Performance– Contracting Officer for contracted services– USPS
VHA Outpatient Medication Fulfillment System
Medical Centers CMOP
Contracting and Procurement
Delivery to Patient
Goal: Delivery to Patient with 10 days of Patient/Provider request
VA CMOP National SystemVA CMOP National System
TucsonTucson
Dallas
Murfreesboro
Leavenworth
Charleston
Hines Chelmsford
CMOP Today• 7 separate locations• Each highly automated and highly efficient and
successful but with different equipment and software
• Different practices, processes and products– Murfreesboro – Media Mail– Hines – mail manifesting– Various prescription and mailing labels
• Limited national CMOP information system• Beginnings of organizational support structure• Collection of 7 individuals, not an integrated
system
CMOP: Grass Roots Effort
• Grass roots effort– Concept proven at West LA and Leavenworth
• RFP Process– Equipment centrally funded– Medical Centers selected were to provide support
• Facilities Management, Contracting, Human Resources etc.– Medical Centers serviced provided inventory funding
• CMOP Director reported to local Board• CMOP needed and fostered entrepreneurial
culture– Highly successful results
Each CMOP a Contract
• Each CMOP the result of a turn key contract with a vendor– Vendor provided all equipment and software
• Different vendors = different equipment and software not designed to integrate with other CMOPs
Early CMOP Organization
• Each CMOP essentially owned by the Medical Centers it serviced
• Reporting to a Board made up of customers
• Unique equipment and software• Organizational support provided by host
site
CMOP Tomorrow
• 7 integrated locations• Each highly automated and highly efficient with different
equipment but the same software• Standardized practices, processes and products
– Same product list– Centralized customer interface, QA etc.– Patient medications from any CMOP
• Robust national CMOP information system accessible by users– Standardized reports– ProClarity cubes
• Mature and effective organizational support structure
How Does This Affect You?
• Ability to seamlessly shift workload between CMOPs– Equipment breakdown, disaster recovery– Specialty CMOPs– Patient centric, ship from closest CMOP
• More tools– Track Rx and package– Report and trend problems– Track and validate costs
How Does This Affect You?
• Standardized product lists– Medical/Surgical supplies– Medications and pack sizes
• Medication event prevention– Screen and identify inappropriate Rx
directions– Rx quantity checks