CPx Communication Prescription LLC Ob je c tive s Will NOT solve - - PowerPoint PPT Presentation

David M. Angar an, MS, F ASHP, F CCP

CPx

Communication Prescription LLC

MT M a nd Me dic a id: Wha t Now? 110115

YOU

Ob je c tive s

Will NOT

solve your proble ms

De sc ribe the va ria tions in MT

M prog ra ms

De sc ribe the role of Sta r me a sure s in

dr iving pr a c tic e

Disc uss why MT

M is not Holly Gra il

De sc ribe the c urre nt sta tus of MT

M pa yme nt

My Me dic a tio n Histo ry, Pe rfo rma nc e Me a sure s a nd T e le he a lth E xpe rie nc e

 F

ir st Me dic a tion Histor y: 1968

 Ag e nda for

Cha ng e JCAHO 1989

 Hig h Risk Me dic a tions:

1995

 T

e le phone Me d Hx: 1997

 T

e le me dic ine / T e le phar mac y: 1998

 e Pha r

ma c y 1999

 Spe c ia lty Pha rma c y

2000

 AlzOnline : Me d Histor

y 2005

 UF

MT MCCC 2010

 Communic ation Pr

e sc r iption 2015

4 AM Wor k Out Gr

• up

Culture , Co -o pe ra tio n, Co ntinuity, Co nse nsus a nd sha re d c o mmitme nt.



5- Sta r MA Pre sc ription Drug Cove ra g e



Ka ise r F

• unda tion HP, Inc .



Ka ise r F

• unda tion HP, of CO



Ca re Plus He a lth Pla ns Inc .



Ka ise r F

• unda tion HP, Inc .



Ka ise r F NDN HP Mid- Atla ntic Sta te s



Group He a lth Coope ra tive



Gunde rse n He a lth Pla n



Ma rtin's Point Ge ne ra tions, L L C



He a lthspa n Inte g ra te d Ca re



Ka ise r F

• unda tion HP of the NW



Provide nc e He a lth Pla n

T he 9% Culture

How E xpe nsive is to be poor; Blow, C NY time s, Ja nua ry 19, 2015

 T

• p 1% : $380,354

 T

• p 5% : $159,619

 RPh

: $117,000

 T

• p 10% : $113,799

 House hold $52,000  T

• p 50% : >$33,048

 Me dic a re Me dia n:

 White $24,800  Bla c k: $15,250  Hispa nic $13,800

 Dua l E

lig ible $10,000

UF MT M Co mmunic a tio n a nd Ca re Ce nte r

Our Se lf- F unde d Busine ss Mode l inc lude s:

 A Busine ss c onne c te d to

a c a de mia

 5 F

T E

• 90 F

T E 5 ye a rs

 Ac ade mic - Re se ar

c h mission

 E

xpe r tise a nd E xpe r ie nc e

 Me dic a r

e a nd Me dic a id

 >15,000 MT

M

 35,000 Quar

te r ly Re vie ws Pe r Ye a r

 > 800,000 a dhe re nc e c a lls in

2015

Ve ntrilo quists

Dummy

Curre nt Me dic a id UF MT MCCC

Dual E

ligible

F

L DOH Me dic a id: MT M 2011- c urre nt

Community He a lthc a re Worke rs a nd MT

M: In prog re ss

 Me dic aid Manage d Car

e : Un- c oordina te d c a re a nd MT M

Me dic a id Adhe re nc e

Me dic a id Re so lutio ns 2011-12

Co st- E ffe c tive Optio n E xc e ssive Pill Burde n Ga p in T he ra py Me dic a tio n Re late d Pro ble m MI SC Po te ntia l Ove ruse Po te ntia l Unde ruse I nte rve ntio ns 8 16 22 36 7 11 39 Re so lutio ns 5 3 4 17 1 6 14

5 10 15 20 25 30 35 40 45

Numbe r

• f Inte r

ve ntions or Re solutions

36% Resolution Rate

1.4 DRP/Patient

A Clo se r L

• o k a t the

Disc re pa nc y Da ta

Medications Chronic Comorbidities Level 1 Drug-Drug Interactions Level 2 Drug-Drug Interactions Gaps in Therapy Therapy Duplications Lack of Therapy PDL Alternatives Combination Products

Confirmed 1141 (58%) 676 (59%) 5 (23%) 20 (7%) 96 (65%) 22 (13%) 457 (74%) 9 (64%) 7 (58%) Eliminated 441 (22%) 41 (4%) 16 (73%) 220 (77%) 27 (18%) 140 (85%) 117 (19%) 2 (14%) 5 (42 %) New 380 (19%) 422 (37%) 1 (5%) 45 (16%) 24 (16%) 2 (1%) 43 (7%) 3 (21%) 0 (0%)

Total 1962 1139 22 285 147 164 617 14 12 Discrepancy 42% 41% 77% 93% 35% 87% 26% 36% 42%

T he value o f the te le pho nic inte rac tio n.

MT M se rvic e s with patie nt inte rac tio n are vital in inde ntifying info rmatio n that be tte r allo ws fo r appro priate de c isio n making.

Na po le o n Bo na pa rte a nd the Me dic a l/ Me dic a tio n Histo ry

Na pole on Bona pa r te “History is a se t of lie s a g re e d upon.”

MT M: An infor

mation silo?

Dra ft Ke y Que stions: T he se que stions we re a va ila ble fo r public 2013 AHRQ

T he Go o d T he Ba d

 Car

e F r agme ntation

 Pa tie nt

 Confusion  De c isiona l Conflic t  Anxie ty  Dissa tisfa c tion

 Pre sc ribe r

 Unre que ste d c onsult  Confusion  Dissa tisfa c tion  Compe tition

11

Ho w MT M pro g ra ms Diffe r

 Pha rma c ist  Physic ia n re la tionship  Pa tie nt re la tionship  Pra c tic e mode l  E

xpe rtise

 Da ta Ac c e ss  Re fill Rx only  Org a niza tion  Ca pita te d/ Risk  ACO, HMO,  Busine ss pla n

 Othe r

se r vic e s

 Dise ase manage me nt  Ca se Ma na g e r

s

 F

• r

mula r y

 Pa ye r  PDP: Rx spe nd only  Cr

e dit for savings

 Star

r atings/ Bonus

 Pe r

for manc e Me asur e

 Pa tie nt popula tion  SE

S

 Insur

e r

 Cultur

a l

Ac ume n CMS MT M F ina l Re po rt

http:/ / inno va tio n.c ms.g o v/ F ile s/ re po rts/ MT M_F inal_Re po rt.pdf

 Impr

• ve d me dic ation adhe r

e nc e and quality of pr e sc r ibing for CHF , COPD and diabe te s patie nts, par tic ular ly whe n CMR s we r e pr

• vide d.

 T

he r e was substantial var iation in outc ome s.

 T

he be st-pe r for ming impr

• ve d me dic ation adhe r

e nc e , pr e sc r ibing, ke e ping he alth c ar e c osts (inc luding dr ugs) fr

• m r

ising.

Me dic a tion T he ra py Ma na g e me nt Inte rve ntions in Outpa tie nt Se tting s AHRQ #138

T he Pa rt D E nha nc e d MT M Mode l

http:/ / he althaffair s.or g/ blog/ 2015/ 09/ 28/ r e aligning - me dic a re - part- d- inc e ntive s- a - ne w- mode l- for- me dic a tion- the ra py- ma na g e me nt/

 CMMI

is la unc hing the Par

t D E nhanc e d MT M Mode l in 2017

r

e g ula tor y fle xibilitie s

pr

• spe c tive pa yme nt

pe r

for ma nc e pa yme nt

Da ta Colle c tion And Qua lity Indic a tors Improving Ca re Coordina tion

Sho uld be mo re surprise d whe n MT M wo rks o r no t wo rks?

Me dic a id: Va lue Ba se d/ Pa y F

• r Pe rfo rma nc e

 Initial Cor

e Se t: Ba c kg ro und o n the I

nitia l Co re Se t c a n be fo und a t:

http:/ / www.me dic aid.g o v/ Me dic aid-CHI P-Pro g ram-I nfo rmatio n/ By-T

• pic s/ Quality-o f-Care / Quality-o f-Care -%E

2%80%93PM-Adult-He alth- Care -Quality-Me asure s.html.



Core Se t of He a lth Ca re Qua lity Me a sur e s for Adults E nr

• lle d in Me dic aid

(Me dic a id Adult Cor e Se t):

 T

e c hnic a l Spe c ific a tions a nd Re sour c e Ma nua l for

 Ce nte r

for Me dic a id a nd CHIP Se r vic e s

 Ce nte rs for Me dic a re & Me dic a id Se rvic e s

Ho w a re Pla ns Pe rfo rming : Na tio na l Ave ra g e s F

• r Pa rt D

Me a sure s a nd Cut-Po ints fo r CMR Co mple tio n Ra te s

Cut Points for Me a sure : D- 15 - MT M Prog ra m Comple tion Ra te for CMR:

Sta r Ra ting s

https:/ / www.c ms.gov/ me dic ar e / he alth- pla ns/ me dic are advtg spe c rate sta ts/ downloa ds/ advanc e 2016.pdf

CMS’ Star Ratings data must be accurate and reliable. Lose 1 Star bad data.

Sta r Me a sure s: Ca rro t a nd Stic k

We saw a [Medicare Advantage] plan last year lose 40% of its membership when [the star ratings came out and] the low-quality rating letter got sent from CMS to the members. Forty percent walked when they saw the hate mail from CMS saying you are enrolled in a crappy plan.” — John Gorman, executive chairman of Gorman Health Group, LLC, told AIS’s Health Plan Week. We saw a [Medicare Advantage] plan last year lose 40% of its membership when [the star ratings came out and] the low-quality rating letter got sent from CMS to the members. Forty percent walked when they saw the hate mail from CMS saying you are enrolled in a crappy plan.” — John Gorman, executive chairman of Gorman Health Group, LLC, told AIS’s Health Plan Week.

"T

• o ofte n physic ia ns se e m to think

that nonc omplianc e is e qual to de fia nc e ," a fa mily doc tor

• bse r

ve d. "My br

• the r

wa s a c op. His nonc ompliant subje c ts we r e 'ta se d.' Should we do the sa me ?“

Physic ians Are T a lking : Why Punish Do c s fo r Pa tie nt Ac tio ns? Ne il Che sa no w De c e mbe r 15, 2014 Me dsc a pe Busine ss Why Should Your

Nonc omplia nc e Ha r m My Inc ome ?

Minne so ta MT M Me dic a id Pro je c t

J Am Pharm Asso c . 2013;53:254–260

Pa yme nt

L

e ve l 1 $50

L

e ve l 2 $76

L

e ve l 3 $100

L

e ve l 4 $124

L

e ve l 5 $148

Par tic ipation 76 Pha rma c ists 10 RPh did 90% 6% e ligible patie nts 18 pa tie nt/ RPh / ye a r $86.00/ Cla im $2,800/ RPh/ yr

21

“It is not the strong e st of the spe c ie s tha t survive s, nor the most inte llig e nt tha t sur vive s. It is the one tha t is the most a da pta ble to c ha ng e .”

Cha rle s Da rwin quote s