Disclosure There are no relevant financial relationships with ACCME- - - PDF document

10/18/19 1

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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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Community Health Worker:

The Staff Position You Never Knew You Needed

NCPA Annual Convention 2019 Richard Logan, Jr, PharmD Michelle Pattengill, CPhT, CHW

L&S Pharmacy

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Pharmacist and Pharmacy Technician Learning Objectives

• Identify which pharmacy personnel might make good

Community Health Workers

• Describe how training pharmacy staff as CHWs can improve

patient care

• Explain why CHWs provide value to your pharmacy practice

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Who are you? / Why are you here?

• Richard Logan, Jr., PharmD
• L & S Pharmacy, Charleston, MO
• Medical Arts Pharmacy, Sikeston, MO
• VP Marketing/Strategic Alliances ESPhA
• Partner MedHere Today Consulting
• GFT5

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Who are you? / Why are you here?

• Michelle Pattengill, CPhT, CHW

CPhT and CHW L & S Pharmacy, Charleston, Mo

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What we’re really going to talk about

• Local healthcare
• SDOH and barriers to care
• Improving health by improving communication with the help
• f a CHW
• Show how embedding a CHW in your practice can improve

patient care, reduce healthcare costs, and (possibly) enhance pharmacy revenue

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Let’s Define a CHW

• Just what is a

Community Health Worker?

• What does a CHW do?

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Defining a CHW

“Community Health Workers (CHWs) are frontline public health workers who are trusted members of and /or have an unusually close understanding of the community served. This trusting relationship enables CHWs to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as

• utreach, community education, informal counseling, social support and

advocacy.”

Community Health Worker Definition; American Public Health Association Policy Statement 20091, Support for Community Health Workers to Increase Health Access and to Reduce Health Inequities; 2009

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CHW is LOCAL ….are trusted members of and /or have an unusually close understanding of the community

• served. This trusting relationship…

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CHW is LOCAL ….are trusted members of and /or have an unusually close understanding of the community

• served. This trusting relationship…

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CHWs Pharmacy and Local Care Management

• Many similar duties to

current Pharmacy Techs

• Expands the Pharmacy’s

touch outside the 4 walls of the Pharmacy and into the patient home

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CHWs Pharmacy and Local Care Management

Community Health Workers act on the patient’s behalf Healthcare translators Navigators Facilitators Referral source Data collectors/reporters

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CHWs addressing SDOH/SDH

Social Determinants of Health

“The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

World Health Organization (WHO) https://www.who.int/social_determinants/sdh_definition/en

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Community Pharmacy

This Photo by Unknown Author is licensed under CC BY

Every community is unique Every community has unique challenges Every community has unique resources Every community pharmacy has a unique patient mix with unique problems (SDOH)

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Why is LOCAL so important?

The greatest barrier to effective healthcare is poor communication

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Communication Barriers—Let me demonstrate

Yetyet

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Communication Barriers—Let me demonstrate

Yetyet Have you eaten recently?

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Communication Barriers—Let me demonstrate

Chikatawl?

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Communication Barriers—Let me demonstrate

Chikatawl?

Would you like me to examine the fluid levels in the vehicle you brought in?

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Next Step: Putting it in practice in your pharmacy

• CHW
• TRUSTED

RELATIONSHIPS

• ABILITY TO

COMMUNICATE WITH PATIENTS

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Next Step: Putting it in practice in your pharmacy

• CHW
• TRUSTED

RELATIONSHIPS

• ABILITY TO

COMMUNICATE WITH PATIENTS

Efficient local care management

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Why should Pharmacists be interested in Care Management? What’s that got to do with me?

CARE MANAGEMENT

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Why should Pharmacists be interested in Care Management? What’s that got to do with me?

ACCESSIBLE/LONGITUDINAL/LOCAL PATIENT CARE

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Why should Pharmacists be interested in Care Management? What’s that got to do with me?

Medicaid Programs & Health Plans often spend more on CARE MANAGEMENT (medical

side) than on PRESCRIPTION

DRUGS (pharmacy side)

• -North Carolina Medicaid and NC Health Choice Annual Report for State Fiscal year 2018July 1, 2017 – June 30, 2018
• - Missouri Department of Social Services 2017 Annual Report; https://dss.mo.gov/re/pdf/2017-dss-annual-

report.pdf

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And this is what it often SOUNDS like

Telephonic Care Management

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And this is what it often looks like

“Hi my name is ‘XXXXX’ calling on behalf of ‘Health Plan’, I have a patient

• n the line. ‘Patient Name and Date of

Birth’. I have a question about a prescription for lisinopril 10 mg pharmacist and if is a with that can I please verify the last time that prescription was last filled please thank you.”

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And this is what it often looks like

“Hi my name is ‘XXXXX’ calling on behalf of ‘Health Plan’, I have a patient

• n the line. ‘Patient Name and Date of

Birth’. I have a question about a prescription for lisinopril 10 mg pharmacist and if is a with that can I please verify the last time that prescription was last filled please thank you.”

Transcription: L&S Pharmacy Message; Saturday February 2nd, 2019; 1:59pm Central

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We can do better!

As Missouri moves to statewide Managed Care for family Medicaid (parents, kids and pregnant women), MHD has taken the opportunity to use the new Managed Care contract as a vehicle to strengthen care management requirements and improve performance outcomes ¬ Contracted Managed Care Organizations (MCOs) are required to implement patient health responsibility incentive programs such as pay-for- performance payment methodologies with providers and Local Community Care Coordination (LCCC) ¬ The LCCC is a form of accountable care organization where local community providers are paid and accountable for face-to-face care management and coordination that was previously done by the MCO anonymously using mail and telephone communication 29

We can do better!

As Missouri moves to statewide Managed Care for family Medicaid (parents, kids and pregnant women), MHD has taken the opportunity to use the new Managed Care contract as a vehicle to strengthen care management requirements and improve performance

• utcomes ¬ Contracted Managed Care Organizations

(MCOs) are required to implement patient health responsibility incentive programs such as pay-for- performance payment methodologies with providers and Local Community Care Coordination (LCCC) ¬ The LCCC is a form of accountable care organization where local community providers are paid and accountable for face-to-face care management and coordination that was previously done by the MCO anonymously using mail and telephone communication ¬

strengthen care management

Local Community Care Coordination (LCCC) ¬ The LCCC is a form of accountable care organization where local community providers are paid and accountable for face-to-face care management and coordination that was previously done by the MCO anonymously using mail and telephone communication

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We can do better!

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Ou Our P r Patien ent Ca Care St e Strateg egy

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Ou Our P r Patien ent Ca Care St e Strateg egy

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We jump into the CHW pool

We began initially by sending 4 Pharmacy Technicians to CHW Training

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We jump into the CHW pool

• Help patients and their families navigate the health

care system, access LOCAL community services & non-local resources, as well as promote the adoption of healthy behaviors

• Facilitate a LOCAL and ACCESSABLE destination for

soft handoffs for patients in transition and/or in need of services beyond standard prescription dispensing

• Serve as a LOCAL liaison for payer and provider

partners and become a conduit for information flow and service delivery

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Local Care Management This is what Local Care Management Looks Like

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Services

Case presentation 1

CHW Within Pharmacy Walls

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The CHW within the Pharmacy Walls

I’ve got to sell my truck!

Patient presents to Pharmacy Insurance coverage/copays Tech handoff to CHW

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From Pharmacy to Hospital to Home

Case presentation 2

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Case: Bariatric Patient

• Delivery driver picked up on acute concern via standard

screening, engaged pharmacist, emergency services dispatched

• Patient admitted for blood clots, resolved, then discharged on
• pioids – resulting in access issue due to high MMEs
• Dispatched CHW for ongoing peer-peer engagement (MI, etc)
• Hospital bed broke 2 times, trouble breathing, developed bed

sores, experienced increases in pain, frustration, and isolation

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Case: Bariatric Patient

• Transit wouldn’t pick her up for PT due to prior approval (coverage gap).
• Transit logistics service didn’t pick her up for pulmonology follow up or PCP visits. PCP was to discuss
• ptions for PT as an alternative to pain medication during visit. Patient had no way to get to this or any
• ther office visit.
• Experienced increasing leg pain from inability to move & increases in weight.
• Patient developed bed sores from immobility, further intensifying pain.
• CHWs find new transit service equipped to transfer bariatric patients.
• CHW coordinates with PCP office, who stays open late to see the patient for assessment, care planning,

& to discuss PT options.

• CHWs coordinate appt with pulmonologist using new transit service.

Patient now feels sense of hope, thus creating a path to reduce opioid use, increase exercise, & improve health.

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CHWs Local Referral Sources

• Pharmacy embedded CHWs have:
• Patient Access
• Community Knowledge
• Ability to communicate
• Most Importantly – Patient Trust

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But THE Question is

Is it sustainable?

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Our CHW Project

• Grant Funded
• CHW Training – Cost reimbursed by grant
• Another grant opportunity (Diabetes and HTN) as a direct

result of having CHW

• Another grant opportunity (Asthma) just because

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CMS Addressing SDOH

CMS has developed ICD 10 Codes that address SDOH

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Statewide Efforts (Missouri) Coalition for Sustainability

• Interested stakeholders
• Across the state
• Dedicated to sustained

funding for CHWs MO CHW Sustainability Collaborative

Local community orgs Associations/collaboratives CHWs Managed Care Organizations State Departments

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State Medicaid

As yet unpublished study from Missouri HealthNet

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Presented at the 1st Annual Meeting of the National Association of Community Health Workers (NACHW), April 2019

*unpublished*

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Presented at the 1st Annual Meeting of the National Association of Community Health Workers (NACHW), April 2019

*unpublished*

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Our Results

As yet unpublished study from L & S Pharmacy

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Ea Early CHW Results (Q1Q2-2019) 2019) * *unpublished*

• > 1400 Delivery Driver Home Assessments
• > 275 Unique Sites
• > 200 CHW referrals from Drivers, Pharmacist, Staff, & Other
• Medication Optimization review led to > $75 PMPM out of

pocket savings (CHW à PharmD)

• > $87,000 in estimated annual out of pocket Rx savings
• Converted 10+ patients to medication packaging
• Connected patients to ongoing transit services for multiple office

visits

Hundreds of unique, patient centric engagements

Update: This project continues with home monitoring of patients with diabetes, hypertension, & heart failure with regular follow up. We have also expanded our CHW initiative with a county wide pediatric asthma initiative across multiple school districts, clinics, PCPs, pulmonologists, service providers, and pharmacies.

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Who Sees The Value?

• CMS
• State Medicaid/MCO
• Patients
• PCPs
• Health Systems

PHARMACY

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Sustainability

• Is it there yet?

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Sustainability

• Is it there yet?

N O P E

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Sustainability

• Is it coming?

Y O U B E T C H A

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Where do we want to be positioned?

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Our Experiences in Practical Application

• Regulatory Issues (Boards of Pharmacy)-

Separating CHW from Tech

• Choosing your CHW
• Pharmacy Philosophy
• Delivery Driver Assessments
• What services does CHW refer to the pharmacy?
• CHW Training

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Resources

Delivery Driver Assessment

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Resources – Examples of CHW Encounter

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Resources

Good articles on Zcodes https://www.ama-assn.org/practice- management/digital/new-icd-10-codes-will-help-physicians- tackle-social-barriers-care https://www.aapc.com/blog/46424-new-icd-10-cm-codes- will-allow-you-to-report-social-determinants-of-health/

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Resources

Good article on SDOH https://www.mhanet.com/mhai mages/Policy_Briefs/PolicyBrief_ SDOH.pdf

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Resources

CPESN/NCPA Online CE (3HR CE)

(CPESN only access – currently) https://www.ncpalearn.org/activity/6722580/detail.aspx

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Resources https://nachw.org/

National Association of Community Health Workers

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Take-Aways

• Community Health Workers (CHWs) are frontline public health workers who

are trusted members of and /or have an unusually close understanding of the community served

• The greatest barrier to effective healthcare is poor communication
• Medicaid Programs & Health Plans often spend more on CARE

MANAGEMENT (medical side) than on PRESCRIPTION DRUGS (pharmacy side)

• CHWs are a growing influence and there is a large movement to get them

involved in patient care and make them sustainable.

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EXTRA CREDIT – Communication Skills

FYRTYR

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EXTRA CREDIT

FYRTYR

U.S. FORESTRY SERVICE OBSERVATION TOWER

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Questions and Contact Info

Richard Logan, Jr., PharmD rlogan@semorx.com

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