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

YOU MT M a nd Me dic a id: Wha t Now? 110115 David M. Angar an, MS, F ASHP, F CCP CPx Communication Prescription LLC

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 4 AM Wor k Out Gr oup  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

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 ounda tion HP, Inc .  Ka ise r F ounda tion HP, of CO  Ca re Plus He a lth Pla ns Inc .  Ka ise r F ounda 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 ounda 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 op 1% : $380,354  T op 5% : $159,619  RPh : $117,000  T op 10% : $113,799  House hold $52,000  T op 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: Ve ntrilo quists  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 Dummy  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

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 45 ve ntions or 40 36% 1.4 Resolution 35 DRP/Patient Rate 30 Re solutions of Inte r 25 20 15 Numbe r 10 5 0 Co st- Me dic a tio E xc e ssive Ga p in Po te ntia l Po te ntia l E ffe c tive n Re late d MI SC Pill Burde n T he ra py Ove ruse Unde ruse Optio n Pro ble m I nte rve ntio ns 8 16 22 36 7 11 39 Re so lutio ns 5 3 4 17 1 6 14

A Clo se r L o o k a t the Disc re pa nc y Da ta 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. Level 1 Drug-Drug Level 2 Drug-Drug PDL Alternatives Gaps in Therapy Lack of Therapy Comorbidities Combination Duplications Medications Interactions Interactions Chronic Therapy Products 1141 676 5 20 96 22 457 9 7 Confirmed (58%) (59%) (23%) (7%) (65%) (13%) (74%) (64%) (58%) 441 16 220 27 140 117 2 5 (42 Eliminated 41 (4%) (22%) (73%) (77%) (18%) (85%) (19%) (14%) %) 380 422 45 24 43 3 New 1 (5%) 2 (1%) 0 (0%) (19%) (37%) (16%) (16%) (7%) (21%) Total 1962 1139 22 285 147 164 617 14 12 Discrepancy 42% 41% 77% 93% 35% 87% 26% 36% 42%

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? T he Go o d T he Ba d Dra ft Ke y Que stions: T he se que stions we re a va ila ble fo r public 2013 AHRQ  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  Othe r se r vic e s  Pha rma c ist  Dise ase manage me nt  Physic ia n re la tionship  Ca se Ma na g e r s  Pa tie nt re la tionship  F or mula r y  Pa ye r  Pra c tic e mode l  PDP: Rx spe nd only  E xpe rtise  Cr e dit for savings  Da ta Ac c e ss  Star r atings/ Bonus  Re fill Rx only  Pe r for manc e Me asur e  Pa tie nt popula tion  Org a niza tion  SE S  Ca pita te d/ Risk  Insur e r  ACO, HMO,  Cultur a l  Busine ss pla n

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 ove 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 ovide d.  T he r e was substantial var iation in outc ome s.  T he be st-pe r for ming impr ove 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 om 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 ospe 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 o 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 o 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 olle 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 o 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 We saw a [Medicare Advantage] plan last year lose 40% of its membership when [the star ratings came out and] the low-quality membership when [the star ratings came out and] the low-quality rating letter got sent from CMS to the members. Forty percent rating letter got sent from CMS to the members. Forty percent walked when they saw the hate mail from CMS saying you are walked when they saw the hate mail from CMS saying you are enrolled in a crappy plan.” enrolled in a crappy plan.” — John Gorman, executive chairman of Gorman Health Group, — John Gorman, executive chairman of Gorman Health Group, LLC, told AIS’s Health Plan Week . LLC, told AIS’s Health Plan Week . " T oo 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 obse r ve d. "My br othe 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 Par tic ipation  76 Pha rma c ists  L e ve l 1 $50  10 RPh did 90%  L e ve l 2 $76  6% e ligible patie nts  L e ve l 3 $100  18 pa tie nt/ RPh / ye a r  L e ve l 4 $124  $86.00/ Cla im  L  $2,800/ RPh/ yr e ve l 5 $148 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