Care Planning: Keys to Surviving and Thriving Mark McCurdy, RPh - - PDF document

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Care Planning: Keys to Surviving and Thriving Mark McCurdy, RPh - - PDF document

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10/18/19 1 Care Planning: Keys to Surviving and Thriving Mark McCurdy, RPh Marks Pharmacy Cambridge, NE 2 1 10/18/19 Disclosure There are no relevant financial relationships with ACCME- defined commercial interests for anyone who was

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Care Planning: Keys to Surviving and Thriving

Mark McCurdy, RPh

Mark’s Pharmacy Cambridge, NE

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Disclosure

There are no relevant financial relationships with ACCME- defined commercial interests for anyone who was in control

  • f the content of the activity.

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Pharmacist and Pharmacy Technician Learning Objectives

  • Define the elements of a care plan that are needed to

document patient care interactions.

  • Describe strategies for implementing care planning into

pharmacy workflow.

  • Identify various types of interventions that should be

documented in a care plan.

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TH THIS SESSION WILL BE E UTI UTILIZING G AUD UDIEN ENCE E PO POLLING G SOFTW TWARE

Pl Please se go to ME MEET.PS/CAREPLA LANNING to to answer poll que questi tions ns

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Why is Care Planning Important?

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Why is Care Planning Important?

  • Designed to improve patient care through documentation

and communication

  • We all provide patient care every day, but who knows about

it?

  • Coordination and follow-up of a patient’s care with the

patient, provider or other entities

  • Improves internal & external workflow efficiency
  • Tracks goals, both personal and therapeutic
  • This documentation is on the “medical side”

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Why is Care Planning Important?

  • If you don’t document it, it didn’t happen!

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Why is Care Planning Important?

  • Care Planning is a growing opportunity to increase income

through increased patient care activities

  • Who thinks they can survive on dispensing alone?
  • Examples of income from increased care activities
  • Direct Care Contracts
  • Select Networks
  • Improved customer loyalty

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Why is Care Planning Important?

  • Reimbursement for our medical care services REQUIRES that

we document our activities …

  • The Care Plan

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Why is Care Planning Important?

  • In medicine, it’s all about Value Based Reimbursement –

highest value for monetary investment.

  • Complex patients visit their pharmacy 35 times per year vs 4

for their MD

  • We need to show these contact points are worth something

by documenting how we are contributing to patient medical care and not just dispensing medications.

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Why is Care Planning Important?

  • Payers want a network with providers ready to go (ex. NE

Medicaid Smoking Cessation)

  • Helps payers see we are doing more than dispensing. Proof

that we are doing it

  • Scalability of services – will they listen to me or we?
  • Prepares pharmacies to be ready when paying opportunities

come

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Why Pharmacy is Prepared to Succeed

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Why Pharmacy is Prepared to Succeed

  • Cost, Quality, Access – The Key Considerations in Health Care

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Why Pharmacy is Prepared to Succeed

  • Cost – what services can and do we provide that are cheaper

than:

  • MD visit
  • ER visit
  • Ambulance transport
  • Delay in LTC placement
  • Readmission
  • Many others

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Why Pharmacy is Prepared to Succeed

  • Access – Patients see us more than any other health care

provider (35 to 4)

  • Patients come to us at their convenience and our availability.

We are highly accessible.

  • Deliveries – who makes house calls anymore? It is a point of

contact where care can be provided.

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Why Pharmacy is Prepared to Succeed

  • Quality – We have been trained for and have the scope

within our licenses to provide this care

  • We were all trained in “Clinical Pharmacy”. The long-held

promise is coming true.

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Why Pharmacy is Prepared to Succeed

  • We currently provide a large amount of medical care that is

not compensated.

  • By taking the time to document that care, the

uncompensated can become compensated.

  • Need to convert from Care activity to Care and

Documentation activity. Get credit for what you do!

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Please go to MEET.PS/CAREPLANNING to answer poll questions!

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Mark’s Pharmacy

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What’s so special about Mark’s?

  • Nothing really. Typical community pharmacy providing a lot
  • f uncompensated care, except:
  • We adopted a community wellness mentality
  • Advice from Clarence
  • Staff meeting: “Patient care is the way things are headed.

We may as well get started.” Buy-in!

  • “Am I the one that needs to be doing this?”
  • When things bog down, “FORWARD!”

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Introducing Care Planning to You and Your Staff

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Basic Definitions and Concepts

  • eCare Plan vs Care Plan
  • Required Components of a Care Plan
  • Currently Available Platforms
  • SNOMED codes
  • 90/10 concept of health care spend
  • Time to set up patients vs care data entry
  • Rule of thumb – care time vs care documentation

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Care Plan Components

Traditional Care Plan

  • Health Concerns
  • Identified health or risk concerns such as

problems, allergies, or social issue, etc.

  • Interventions
  • Includes active medication list, medication

administered, and planner medications

  • Goals
  • Includes patient goals
  • Health Status Evaluation & Outcomes
  • Includes disposition and outcomes
  • Laboratory Results and Vitals

Pharmacist Care Plan

  • Health Concerns
  • Add documentation of medication therapy

problems

  • Interventions
  • Add more medication history
  • Prescription fill history may be added
  • Goals
  • Emphasis on goals of therapy
  • Health Status Evaluation & Outcomes
  • Emphasis on sections related to medications
  • Laboratory Results and Vitals
  • Payer Section

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www.ecareplaninitiative.com

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Reviewing, Adopting and Implementing a Care Plan Platform

  • What are your needs?
  • Inputs
  • Outputs
  • Vendors making changes based on user needs
  • Try to record care by SNOMED whenever possible
  • Platforms are changing rapidly. Your first may not be your

last

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Please go to MEET.PS/CAREPLANNING to answer poll questions!

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Examples of What Pharmacists and Staff are Documenting

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Current Care Plan Activities

  • Daily Activities by a pharmacist “On the Fly”
  • Adverse reaction to medication
  • Allergy to medication
  • Dosing / Dosing changes
  • Medication education
  • Disease education
  • If you think every single event is documented, you are mistaken.

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Current Care Plan Activities

  • Med Sync calls and contacts
  • These are medication reconciliations
  • Use call script
  • No questions or changes? Technician
  • Questions or changes? Pharmacist

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Current Care Plan Activities

  • Visiting Pain Specialist
  • Access PDMP and perform med reconciliation for each monthly visit
  • Next step: mid-month call for pain assessment, medication compliance

and medication tolerance and efficacy.

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Current Care Plan Activities

  • Blood Pressure Service
  • Portable, downloadable meters sent home with patients
  • Meters are brought in monthly by patients or picked up on deliveries
  • Pharmacist reviews results . “Reportable” results are forwarded to

providers with comments from pharmacist

  • “Acceptable” results are forwarded to providers with care plan

completed by technicians

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Other Care Plan Considerations

  • Where do students fit in?

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Other Care Plan Considerations

  • The Book of Screenshots – How-to Guide to Document Routine Care

Plans (a.k.a. Teaching how to fish.)

  • Screen shots with descriptions on where data needs to be entered into

your care platform.

  • Can be vendor generated – see CPESN workflow Wednesdays for online

videos from vendors

  • Other outside examples – ex. Flip The Pharmacy
  • Self-generated – ex. Snap Tool on Windows machines for personal use

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Mark’s Pharmacy – Changes in Workflow

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Changes in Workflow

  • “At first I tried to fit the clinical flow into my dispensing flow. Now I’m

thinking the other way around.”

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Changes in Workflow

  • Adoption of med sync and compliance packaging – controlling the

demand.

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Changes in Workflow

  • Two questions have been and are still key to us
  • Do I/We need to be doing this?
  • Am I the one that needs to be doing this?
  • Automation of Processes
  • Vendors to help manage processes – cost vs benefit
  • Self generated & managed? Use the 2 questions

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Changes in Workflow

  • Use of scrap sheets and crib sheets to record data for later entry
  • We use this frequently but there is a limited time window for entry

before they are lost in flow.

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Changes in Workflow

  • Get your staff involved!

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Changes in Workflow

In case I wasn’t clear ...

  • Get your staff involved!

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Impacts of Care Plans on Medical Providers, Support Staff and Patients

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Impacts of Care Plans on Physicians

  • Stages of Responses:
  • 1st: What is this? What am I looking at? What is this for?
  • 2nd: Incorporate into patient visits & interactions
  • 3rd: Flow of additional information back to us for our records
  • 4th: Asking for updates for upcoming office visit
  • “I’d like you to see a specialist for this.”

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Impacts of Care Plans on Staff

  • Similar Stages to physicians, plus fifth:
  • 1st: What is this? What am I looking at? What is this for?
  • 2nd: Incorporate into patient visits & interactions
  • 3rd: Flow of additional information back to us for our records
  • 4th: Asking for updates for upcoming office visit
  • 5th: Become therapeutic and information source

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Impacts of Care Plans on Patients

  • Personalized Care (contrasted to a physician or hospital visit)
  • Enhanced view as a valued healthcare provider
  • Pledged loyalty to the pharmacists & pharmacy – Would not think of

going anyplace else

  • Improved care. You will be surprised at what you think you know and

what is actually happening

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Comments from Pain Control MD

  • We love them. They save us so much time!
  • The quality and accuracy is great. They really improve our care.
  • Patients are not the best historians. They may not be forthcoming or just

don’t remember

  • We incorporate them in our plans
  • You stand out. We call you from our other clinics over other pharmacies
  • We wish more pharmacies would do this

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Comments from General Practice MD

  • “Really helpful.” Listed several patients with impacts and improvements
  • n each
  • We don’t have a true picture of what is going on outside the office. This

fills in a lot of gaps.

  • This improves quality. Likens to a case manager
  • Patients are losing trust in MD’s. Helps with trust factor when we

reaffirm care points

  • Care plans set the pharmacy apart from others and would like us to do

more.

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Low Hanging Fruit and How to Get Started

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How to Get Started

  • Med Sync and Medication Reconciliation
  • Filter to appropriate level
  • Cheat sheet for common activities to jot down notes on the fly
  • Screenshots in a folder for all staff to use

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How to Get Started

  • Change of philosophy – This is the way that pharmacy will be practiced in

the future and we are going there. (Forward!)

  • Identify something that happens in your pharmacy regularly but not too
  • ften
  • Pledge that you and your staff will complete a plan every time that

situation arises

  • Have cheat sheets ready and available for staff

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Potential Care Plan Activities

  • Things that you might hear in your pharmacy:
  • Can my medicine cause me to _____________? ex. Rash, loss hair,

glow in the dark

  • Will my insurance cover this medication?
  • My doctor told me to take this less/more often than what is on the

bottle.

  • This is the doctor’s office. Can you send me a med list on this patient?

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Some Other Potential Care Activities

  • Recording of vitals
  • Medication education
  • Disease state education
  • Vaccination
  • Preparation of personal medication record
  • Point of care testing
  • OTC medication selection and education
  • Enrollment in copay assistance program

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Barriers to Care Planning

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Perceived Barriers to Care Planning

  • Anxiety – What am I doing? I’ve never done this
  • Make it tougher/more complex than needed
  • No payment for this activity
  • Can’t fit it in our workflow
  • Staff not involved/no buy-in
  • Want to be perfect first time and every time
  • It’s not necessary
  • Responses?

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Mark’s Predictions for the Future

  • Increased ease, functionality and in-app guidance
  • Increased inclusion of in-app clinical tools
  • Improved outputs for communication actions
  • More integration with dispensing software
  • More acceptance of plans w/ higher expectations
  • More and improved statistics on impact of care
  • Inclusion of data in larger integrated databases
  • Become 2nd nature in pharmacy practice

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Take Home Messages

  • You can no longer rely on dispensing alone
  • These are the same activities you have always been doing. Document &

get credit for them

  • You have access to patients. Use it!
  • You will not be perfect the 1st time or the 100th time. You will always be

improving

  • Even if you are not currently compensated, make sure staff knows you

see value in this

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More Take Home Messages

  • Find something that happens regularly and commit to charting on that

every time

  • Find or develop cheat sheets
  • Know your outputs, where they are going and where they need to go
  • Use codes whenever possible
  • Book of Screen Shots to train and complete plans
  • When in doubt – Forward!

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Mark McCurdy, RP

Mark’s Pharmacy Cambridge, NE

marksrx@swnebr.net 308-697-3400

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