Anthony P. Morreale, Pharm.D., MBA, BCPS, Assistant Chief Consultant for Clinical Pharmacy Services and Healthcare Delivery Services Research of the Department of Veterans Affairs. 1
12:03 – 12:08pm – Introductions 12:08 – 12:20pm – Overview of PCPCC’s Medication Management Guide 12:20 – 1:05pm - Integration of Clinical Pharmacists into the Medical Home: Measuring Clinical Impact 1:05 – 1:25pm – Audience Q&A 1:25 – 1:30pm – Closing Remarks
Introduction by: Te Terry rry Mc McInn nnis is, MD, MPH, FACOEM, President and Founder of Blue Thorn Inc. Guest Speaker: Anthony ny P. Morre real ale, Pharm.D., MBA, BCPS, Assistant Chief Consultant for Clinical Pharmacy Services and Healthcare Delivery Services Research of the Department of Veterans Affairs. Moderator: Edwin win Webb, PharmD, MPH, Associate Executive Director & Director of Government and Professional Affairs, American College of Clinical Pharmacy
The PCPCC Guide Defines comprehensive medication management in the patient centered medical home AHRQ Innovation Center- Quality Toolkit 2 nd Revision with Appendix A- “Guidelines for Practice and Guidelines for Documentation PCPCC Resource Guide- Integrating Comprehensive Medication Management to Optimize Patient Outcomes http://www.pcpcc.org/guide/patient-health-through-medication-management
Describe the VA version of the Medical Home Model called Patient Aligned Care Teams (PACT) and share data on improvements in care that have been demonstrated to date Discuss the integration of the Clinical Pharmacist in the PACT focusing on the top of the license collaborative practice in Chronic Disease & Medication Management. Describe data systems that have been created to document the interventions and outcomes associated with clinical pharmacist care. Discuss the outcomes being demonstrated by Clinical Pharmacists and the implications to cost benefit and cost effectiveness through validated modeling techniques.
VA Average Percent (1) HEDIS 2011 (2) 2011 Commercial Medicare Medicaid Clinical Indicator 2012 (6) 2010 (6) (6) (7) (7) (7) 87 85 87 71 69 50 Breast Cancer Screening 93 93 94 77 n/a 67 Cervical Cancer Screening Cholesterol Management for Patients with Cardiovascular 70 71 69 59 57 42 :LDL-C Control (<100 mg/dL) Cholesterol Management for Patients with Cardiovascular Conditions: 96 96 96 88 89 82 LDL-C Screening 82 82 82 62 60 n/a Colorectal Cancer Screening 80 81 82 66 63 61 Comprehensive Diabetes Care - Blood Pressure Control (<140/90) 90 90 91 57 66 53 Comprehensive Diabetes Care - Eye Exams 98 99 90 91 83 Comprehensive Diabetes Care - HbA1c Testing 68 69 70 48 53 35 Comprehensive Diabetes Care - LDL-C Controlled (LDL-C<100 mg/dL) 97 97 97 85 88 75 Comprehensive Diabetes Care - LDL-C Screening 95 95 96 84 90 78 Comprehensive Diabetes Care - Medical Attention for Nephropathy 19 17 15 28 27 43 Comprehensive Diabetes Care - Poor HbA1c Control (8) 77 78 79 65 64 57 Controlling High Blood Pressure - Total 96 97 97 77 n/a 76 Medical Assistance with Smoking Cessation - Advising Smokers To Quit 3 94 94 94 53 n/a 44 Medical Assistance with Smoking Cessation - Discussing Medications 3 96 97 97 48 n/a 40 Medical Assistance with Smoking Cessation - Discussing Strategies 3 65 65 71 53 na n/a Flu Shots for Adults (50-64) 3 76 79 82 n/a 69 n/a Flu Shots for Adults (65 and older) 3, 4, 5 93 94 95 n/a 69 n/a Immunizations: Pneumococcal 3,4, 5 SOURCE: Office of Analytics and Business Intelligence Updated 11/28/2012
Team Members work Patient Centered and at top of their Same Day Access Team Based license, training and competency Population Focus on Preventive management of High Evidence Based Care Risk Patients Lower Cost through reductions in ER visits and hospitalizations
Other Team Members For each parent facility Other Team Health Promotion Disease Prevention Clinical Pharmacy Program Manager:1 FTE Specialist: ± 3 panels Members Health Behavior Coordinator: 1 FTE Clinical Pharmacy My Health e Vet Coordinator: 1 FTE anticoagulation: ± 5 panels Teamlet: assigned to 1 Social Work: ± 2 panels panel (±1200 patients) Nutrition: ± 5 panels Case Managers • Provider: 1 FTE Trainees Integrated Behavioral Health • RN Care Mgr: 1 FTE Psychologist ± 3 panels • Clinical Associate Social Worker ± 5 (LPN, MA, or Health panels Care Manager ± 5 Tech): 1 FTE panels • Clerk: 1 FTE Psychiatrist ± 10 panels Patient Caregiver
Patient ient provid ider encou ounte nters have ve increased d 12 perce cent nt Encounters unters with Veterans rans has increased reased 50 perce cent nt mostly ly due to telehe heal alth, th, teleph phone one and group p enco counters. unters. 65 perce cent t of Veterans rans request uestin ing g a sa same day primar ary y care appointment ntment with h their ir personal nal provid ider are accommodate ommodated 78 percen cent t of Veterans erans are able to se see their r own primary ry care provider der for an appoin intment tment on the date they y desire re Veteran ran acce cess to primary ary care during ng extend tended d hours (non- busines ness hours) ) has increased ased 75 perce cent t since Januar uary y 2013. 13. Source: VA Press Release April 30, 2014
Over r 72 perce cent t of all Veteran terans discharge harged d from VA a are contacte tacted within in two days. . Mental tal healt lth se servi vice ces s offered ered in VA A primary ry care e clinics ics increased d 18 perce cent nt. . 33 perce cent t decrease in primary ry care patient ients urge gent t care visits. ts. 12 perce cent t decrease and acute te hospit ital al admissio ions ns. Veterans rans strongl ngly y endor orse VA he heal alth th care, , with h 91 perce cent nt offerin ing g positive ive assessments ments of inpatient ient care and 92 percent nt for outpat atient ient care. Source: VA Press Release April 30, 2014
Under der Feder deral al law 38 8 USC C 740 402(b), 2(b), the Depart artmen ment of Veter teran ans s Aff ffairs irs (VA) is auth thori rized zed to to: establ ablish ish profes fessio ional nal practice ctice elements ements such ch as licensu ensure e requiremen uirements, s, qualificati lifications, ons, and sco copes pes of practice ctice for the employmen ployment of VA pharmac rmacist sts VHA Direct ectiv ive e 200 009-014: 014: grant nted ed Pharma armacist cist medicati ication on prescribi scribing ng & monitori nitoring ng privilege leges s based ed on a locall ally- defined fined scope ope of f practice ctice Compreh mprehensiv ensive e medic icatio ation managemen nagement is performed formed autonomous tonomously ly but collabor llaborati tivel ely y by the CPS
Clinical Pharmacy Model Vision: Bridging the Gap Between Primary Care and Specialty Care P a t i e n t C o m p l e x i t y , H e a l t h S t a t u s , N e e d s Speci cialt lty y Care Patient ent Al Aligne ned Care e Team Clinical Pharmacy Specialist st Coordination tion of Care Disease/Cohort Management Manag agemen ment of C Care 14
Role PACT CPS Acc ccess ss Practi tice e Care Manag agement ment & Coordina nati tion on Redesig design Improve PC access Cost avoidance ce Disea ease se state te managemen ent Improve e Speci cial alty ty access Increased sed safety ty Clinical perfor formance e measure re improvem vement ent Med reconc oncili iliati ation Provi vider der educati tion on Walk-in n prescr cript iptio ion n Dual Care Innova vative tive avenues es renewa newal clinic for management t Antico coagu gulatio tion Clinic High risk k patient t managemen ent t Patient Centeredness: Mindset and Tools Improvement: Systems Redesign Resources: Technology, Staff, Space, Community 15
VH VHA has approxi oxima matel tely y 7,050 Pharma macists cists Pharmac rmacis ists ts wit ith Sc Scope of Practice ice exceeds eds 2,93 2, 935 5 (42 42%) Of These e 2,935 Reside Re denc ncy BPS Ot Other r Re Residency dency &/ &/or r Certification ification Certification ification = 64 64% Certification ification = 38 38% = 15 15% = 76 76%
3,100 3,10 2,965 965 2,900 2,90 2,853 853 2,716 716 2,700 2,70 2,654 654 2,500 2,50 2,473 473 2,300 2,30 2,284 284 46% 46% 2,100 2,10 2,087 087 1,945 945 1,900 1,90 1,70 1,700 Data ta Sour urce: e: CPP PPO Scop ope of Practi tice ce Share rePo Point nt Data tabase e
1237 1237 876 876 621 621 478 478 406 406 405 405 288 329 329 288 279 279 246 246 167 210 210 209 209 195 195 157 172 167 172 157 122 122 100 100 58 70 70 68 68 58 21 21
1,37 1,375 1,175 1,17 97 975 An Antic ticoag oag Lipids Li pids 775 77 Diabe Di betes tes Hy Hyper perten tension sion 575 Glob Gl obal 37 375 175 17 11 ul-11 -11 Sep-11 -11 ov-11 -12 Jan-12 r-12 12 y-12 12 ul-12 -12 Sep-12 -12 ov-12 Jan-13 -13 13 Mar-13 -13 13 ul-13 Sep-13 -13 ov-13 -13 Jan-14 -14 Mar-14 14 May-1 May-1 Mar- Mar- Mar- Jul Sep Nov Jul Sep Nov May Jul Sep Nov Ma Ma Data Source: CPPO Scope of Practice SharePoint Database
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