Take 5 How to Create Ownership in Your Team with Critical Drivers - - PowerPoint PPT Presentation

Multiple Locations Conference Hugh Chancy, RPh Owner Chancy Drugs

Take 5

How to Create Ownership in Your Team with Critical Drivers

Learning Objective

Discuss two peer-tested ideas that lead to business efficiencies and better patient care.

Disclosure

Hugh Chancy, RPh declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

What, Why, & How

WHAT

• Method for addressing

problem areas in your pharmacy

• Converts team members

from employees to owners

• Simultaneously create ROI

and an incentive program for employees

• Drives consistent, long-

term, positive results

WHY

• Improves financial health
• Increases team

engagement

• Create less stressful

environment

• Frees up time to focus on

important initiatives

• Gives employees a

‘purpose’

HOW

• Identify focus areas
• Define what success looks

like

• Create a monthly

scorecard

• Educate your team about

the ‘WHY’

Critical Driver Benchmarks

Gross profit per script

• 5,000 scripts per month
• Increase profit by $2 per script

5,000 scripts X $2 = $10,000 additional gross profit

• Incentives paid to employees: $1500
• 7 employees: 1 Pharmacist- $500, 3 Techs- $250 each, 2 Clerks- $100 each, Delivery

Driver- $50

$10,000 additional gross profit - $1500 incentives = $8500 net profit

Win Win …. A win for the company and a win for the team!

Questions?

Hugh Chancy, RPh Chancy Drugs hughchancy@chancydrungs.com

Multiple Locations Conference Tom Kelly, RPh Owner and Operator Medicine to Go

Take 5

High-End Supplements and Nutrient Depletion

Disclosure

Tom Kelly, RPh declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

The pharmacist recommends taking GI Flora with this

• product. Take 2 capsules three times a day at least one

hour apart from the Antibiotic. Keep GI Flora in the refrigerator.

Questions?

Tom Kelly, RPh Medicine to Go capsuleman@comcast.net

Multiple Locations Conference March 2, 2019

NCPA’s Wildly Important Goals for Community Pharmacy

Learning objectives

1. Illustrate NCPA’s two wildly important goals for community pharmacy. 2. Discuss at least three current initiatives toward improved change in the community pharmacy marketplace. 3. Outline challenges of medical care organizations and how community- based pharmacies can help meet their needs. 4. Discuss the latest developments in enhanced service networks and best practices for care planning. 5. Describe advanced primary care medical home models that aim to strengthen primary care through multi–payer payment reform and care delivery transformation.

Disclosure

Doug Hoey, RPh declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

Changing the pharmacy payment model

• Why is it necessary?
• Number one issue for NCPA members almost always comes down to

payment

• Payment for products AND payment for services
• The current pharmacy prescription drug payment model?
• Complex
• Costly
• Confusing
• Cumbersome
• Most of all, COVERT
• The whole system is a hot mess!
• A payment model based on simplicity for consumers and taxpayers is

needed.

Changin ing th the pharmacy payment model

• Mega-PBMs are the center of the Rx

drug payment universe—change starts with their model

• U.S. drug costs are the highest in the

world…and the U.S. is the only country that has entrusted PBMs to control drug costs

What does changing the pharmacy payment model mean to you?

1) Practice transformation; embracing being paid differently 2) Transparency, predictability for pharmacies and patients 3) Pharmacy owners are recognized for quality and value (educating plan sponsors) 4) Changing ingredient cost plus professional fee model of today e.g. a standardized payment formula like NADAC + used in Medicaid 5) Implement the WV Medicaid Managed Care model across the country 6) Helping plan sponsors make a different choice about the PBM they hire!

Ch Changin ing th the pharm rmacy payment model 1) Changing the current PBM model to one that is truly transparent and functions as a claims processor rather than healthcare provider is just one step. 2) The entire supply chain must make adjustments—from plan sponsors to patients and everyone in-between.

How will we know progress is being made to change the pharmacy payment model?

NCPA’s unintentional past WIGs

How do we as an organization have the most demonstrable impact on our members? Past WIGs: “NCPA will be a political powerhouse”

• Million dollar PAC

“We must have a Community pharmacy majority in Congress”

• Congressional Pharmacy Caucus
• Pharmacy visits

“Adherence will be a pharmacist core competency by 2015.”

• PAMA-Pharmacists Advancing Medication Adherence
• Simplify My Meds
• Adherence work with pharmacy schools

NCPA WIGs

NCPA’s Wildly Important Goals (our WIGs) are focused in two areas: a) Changing the pharmacy benefit in Medicaid managed care programs b) Practice transformation

Practice Transformation

The Power of National and State Advocacy

Department of Health & Human Services Centers for Medicare & Medicaid Services

Community Pharmacy from Another Lens:

Diary of a Washington Insider

Multiple Locations Conference RADM (ret) Pamela Schweitzer, Pharm.D., BCACP Former Assistant Surgeon General

10th Chief Pharmacist, United States Public Health Service

Disclosure

RADM (ret) Pamela Schweitzer, Pharm.D., BCACP declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

Elevator pitch – HHS/CMS

• Understanding value
• PBM versus health plan
• Separate product from

service

• Collaboration with other

providers

Waiting for the right wave

Product versus service

Product Service Dispensing prescriptions, efficient workflow Time consuming clinical services Consult on Over-the-Counter medications Collaborative practice agreements Delivery of medications, mail-out Medication Therapy Management Dispensing of specialty drugs Relationships to other members of healthcare team Refill reminders Home monitoring, telemedicine/pharmacy Automation Personalized medicine Pharmacy contracts, network agreements Working with healthcare team to clean up medication profile – Rx Cancel, Blue Button Some clinical services - immunizations Patient advocate – patient knows pharmacists’ name

Innovation

• Automation for

filling/dispensing of prescriptions

• Solutions/automation to allow

for aging in place.

• Telepharmacy
• Changing practice of pharmacy
• Team-based care
• Prevention/public health
• Collaboration with

community partners

• Science – new drugs and

delivery systems

Smart medication monitoring and management – technology enabled care

39 Smart Package

• Pill removed
• Date/time log
• Temperature
• Expiration date
• Wireless data transfer

Data flowing back from “Smart” medications are presented in exception management dashboards for review by Care Team members

Smart Patch

• Date/time applied
• Duplicate patch?
• Temperature
• Expiration date
• Wireless data

transfer

2019 advanced Alternative Payment Models (APM)

• Bundled Payments for Care Improvement (BPCI)

Advanced

• Comprehensive ESRD Care (CEC) – Two-Sided Risk
• Comprehensive Primary Care Plus (CPC+)
• Next Generation Accountable Care Organization

(ACO)

• Maryland Total Cost of Care Model (Maryland

Primary Care Program)

CMS Innovation Center (CMMI)

Example – Models (ongoing) that value optimize medication use:

• Part D Enhanced Medication

Therapy Management Model

• Comprehensive Primary Care Plus
• Independence at Home

Demonstration

• Partnership for Patients
• Transforming Clinical Practice

Initiative

https://innovation.cms.gov/index.html

New Part D payment models for 2020

In January 2020, CMMI will begin the Part D Payment Modernization model to test the impact of a revised Part D program design and incentive alignment on overall Part D prescription drug spending and beneficiary out-of-pocket costs.

https://innovation.cms.gov/initiatives/part-d-payment- modernization-model/

2020 - Rewards and incentives

Medicaid expanding scope of pharmacy practice

Reference: CMCS Bulletin, January 17, 2017

CMS legal definition of “furnishing” services

Provider “furnishing” services must: have an NPI on the claim (431.107(b)) be enrolled in Medicaid (431.107(b))

• The service done, not the provider type, is what determines

“furnishing provider”. If a provider “furnishes services” then, on that claim, that provider is the “furnishing provider”.

• Only providers or organizations eligible to enroll in Medicaid may

be furnishing providers.

• Only one provider per service is the furnishing provider.
• How do we determine who/ what provider is the furnishing

provider? See decision tree.

No Yes

Is the provider eligible to enroll in Medicaid? A claim specifies that RN services were

• furnished. An RN

worked directly with the beneficiary, a physician supervised the RN, and both are part of a physician’s group. Which one is the “furnishing” provider? The state billing manual specifies that RN Services are covered as a package of physician services and can be billed by the physician. In this example the RN acted as an agent on behalf of the physician, therefore the physician is the “furnishing provider”. The state billing manual specifies that RN Services are covered as a standalone service and the RN can bill for

• this. In this example the

RN is the “furnishing provider”. The state billing manual specifies that RN Services are only covered as a package of physician services which must be billed by an agency. In this example the RN acted as an agent on behalf of the physician’s group, therefore the physician’s group is the “furnishing provider”. The provider is not a furnishing provider.

Medicaid: Other Licensed Practitioner (OLP)

• Collaborative practice agreement/protocol
• Services provided within scope of practice
• 85-100% of physician services fee schedule
• 1115 waiver opportunities

Reference: https://www.medicaid.gov/state- resource-center/medicaid-state-plan- amendments/index.html

Clinical pharmacy services

• Medication Access Services
• Patient Counseling
• Preventative Care Programs
• Drug Information to Patients
• Medication Reconciliation
• Medication Optimization
• Provider Education
• Retrospective Drug Utilization

Review

• Medication Management

Therapy

• Disease State Management
• Prospective Chart Review and

Provider Consultation

Are clinical services part of your strategic plan?

• Changing relationships with health care providers
• Public health - Leverage access to community pharmacies
• Marketing to patients and healthplans – huge
• New business model – value-based payments
• Improve health care delivery, fill gaps.
• Role of pharmacy technicians, automation

Newer areas

• Precision medicine, genomics
• Connected health, telemedicine
• Health information technology
• Data, population health
• Healthcare finance

48

“If you want to go fast, go alone. If you want to go far, go together.”

RADM (ret) Pamela Schweitzer

Former Assistant Surgeon General 10th Chief Pharmacist, USPHS pamela.schweitzer926@gmail.com

Advocating for a New Pharmacy Payment Model

Multiple Locations Conference

Karry La Violette Advocacy Center Director SVP, Government Affairs

Disclosure

Karry La Violette declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

NCPA members invited to HHS: #AskYourPharmacist

Secretary Alex Azar @SecAzar Thanks to the Trump administration and action from Congress, now you can always ask your pharmacist whether you’re getting the best deal on your prescription drugs. Here are a few tips direct from pharmacists on how to save

• n your prescription drug costs. #AskYourPharmacist

Gag clauses: NCPA-backed legislation became law

Gag clauses: NCPA-backed legislation became law

Pharmacy visit with HHS Secretary Azar

Kevin McCaffery, Co-Owner Spartan Pharmacy; Karry La Violette, NCPA; Secretary Azar; Adam Rice; Co-owner Spartan Pharmacy

Opioids package: NCPA secured a number of pro-pharmacy provisions

HHS Secretary Azar visits 2nd NCPA member within the last four months…

Secretary Azar with Chateau Drug Owner Diane Milano Secretary Azar (center) with Louisiana pharmacists and NCPA’s Ronna Hauser (left)

President’s blueprint and HHS RFI

• Eliminate pharmacy DIR in the Medicare Part D program. In light
• f the president's blueprint and HHS' RFI language to prohibit

pharmacy benefit managers from using rebates in contracts with manufacturers, NCPA is advocating that the administration extend this policy to pharmacy and eliminate pharmacy DIR fees in the Medicare Part D program entirely.

• Eradicate PBM hidden spread amounts by requiring fiduciary

status for PBMs. NCPA is urging the administration to require that PBMs have a fiduciary duty to the entity for whom they manage pharmaceutical benefits. This would shed light on opaque PBM practices, including the PBM's incentive to charge the plan more than the pharmacy is reimbursed and keep the difference as profit.

5/11/18: NCPA member John Kim with Rep. Buddy Carter (R- GA) at White House announcement on Lowering Drug Prices

Drug pricing proposed rule: pharmacy DIR fees efforts

• NCPA coordinating efforts with NACDS and NASP
• Proposed rule released at the end of November that addresses retroactive pharmacy DIR fees:

Comments were due Jan. 25, 2019.

• Asking HHS to ban retroactive DIR fees and require all fees to be captured at point of sale
• NCPA meetings with CMS, HHS, White House Office of Management & Budget (OMB), Small

Business Administration, and White House Domestic Policy Council (DPC),

• This proposal, if finalized, may go into effect as soon as CY 2020.
• Expect a final rule in early April.

Drug pricing proposed rule: success in numbers!

Unprecedented support and assistance from the pharmacy community. ✓3,500 pharmacy comments submitted to CMS ✓200 patient comments submitted to CMS ✓Stakeholder letter with 155 signatures ✓Patient group letter with 24 signatures ✓Multiple Congressional letters of support THANK YOU FOR YOUR HELP!

HHS OIG proposed safe harbor rebate rule

• Publicly released Jan. 31, 2019
• Comments due April 8, 2019
• Excludes rebates paid by mfg to plans under Part D and

Medicaid MCO’s from the discount safe harbor

• Creates a new safe harbor for point of sale price reductions
• Requires 100% of rebates to be passed thru to consumers

starting Jan. 1, 2020

• Pharmacy reimbursement would be subject to chargebacks

from mfg to pharmacy

• Chargeback administrator?

NCPA being heard on Capitol Hill

12/13/17: NCPA CEO Douglas Hoey testifying at House E&C Committee drug supply chain hearing

1/30/18: Pharmacy owner Jake Olson testifying

• n behalf of NCPA at House E&C Subcommittee
• n Health compounding hearing

2/28/18: Pharmacy owner Richard Logan testifying on behalf of NCPA at House E&C Subcommittee on Health opioid crisis hearing

Gag clause hearing

NCPA board member Hugh Chancy testifying on “gag clauses” in

• Sept. 5, 2018 E&C Health Subcommittee hearing

“Gag clause” legislation: signed into law Oct. 10, 2018

New Congress: upcoming activity

• 3 congressional hearings on drug pricing so far with more planned
• Senate Finance Committee on Jan. 29
• House Oversight and Reform Committee on Jan. 29
• House Ways and Means Committee on Feb. 12
• Next up: Pharma CEOs to testify at Senate Finance
• Chairman Grassley announced his intent to discuss a bill on PBM

transparency with the Finance Committee

• Discussion would be based on legislation from last session which required

PBMs to disclose rebates provided by drug manufacturers and the amount

• f rebates passed on to health plans.

Pharmacy DIR fees

• H.R. 803, the Improving Transparency and Accuracy in Medicare

Part D Drug Spending Act

• Sponsored by Reps. Peter Welch (D-VT) & Morgan Griffith (R-VA)
• Increases price transparency by prohibiting retroactive payment

reductions to pharmacies in Medicare Part D

• H.R. 1034, the Phair Pricing Act of 2019
• Sponsored by Reps. Doug Collins (R-GA) & Vicente Gonzalez (D-TX)
• Requires all pharmacy DIR fees to be incorporated at point of sale
• Establishes a working group to develop pharmacy quality measures

2019 projected revenue in BILLIONS: health insurance/PBMs vs. technology

Source: AXIOS Vitals, February 11, 2019

State priorities: momentum in PBM regulation

National Council of Insurance Legislators (NCOIL) adopted a PBM regulation model act: December 2018

• NCPA and our state partners have worked for years to advance model legislation.
• NCPA quarterbacked a coalition of representatives from more than 20 groups, including

state associations, state-based industry groups, and buying groups.

• The odds of success always go up when community pharmacy works together, and this is

Exhibit A. It wasn't easy. PBMs vehemently opposed this model legislation.

• Would give the Insurance Commissioner the authority to license and regulate PBMs.
• Would allow the Commissioner to adopt rules addressing network adequacy, pharmacy

audits, and reimbursements issues.

➢Over half of the states have introduced or plan to introduce legislation to regulate PBM activity in the 2019 State Legislative Calendar.

2019 state legislative priorities

• 1. Medicaid managed care reform (many variations)
• Carve-out
• PBA model/pass through
• Enhanced pharmacy payments/reimbursements
• 2. PBM regulation
• Address MAC price lists
• Post sale claim adjustment/”claw-backs”
• GER
• NCOIL model bill
• 3. Scope of practice and compensation for services

Medicaid managed care pharmacy payment transformation as a WIG

✓ Millions of patients on Medicaid ✓ Managed care in Medicaid is supposed to save the state (e.g. taxpayers) money. It’s not. ✓ Exposure of PBM spread in state MMC pharmacy programs (over $200m just in Ohio!) ✓ Does it help NCPA members get paid appropriately? ✓ Transparency. Accountability. Fairness. for taxpayers and pharmacies

State priorities: reform is needed in Medicaid managed care

• Ohio found PBMs pocket over $224 million in spread
• Louisiana found $42 million billed incorrectly as “medical costs”
• Texas determined that carving pharmacy benefits out of MMC could save up to

$90.3 million

• Pennsylvania Auditor General recently concluded an investigation into PBMs in

MMC program and found taxpayers paid $2.86 billion to PBMs for Medicaid enrollees in 2017, up from $1.41 billion in 2013 (an increase of 100 percent in four years).”

• Recent Kentucky report on spread: $123 million paid to PBMs last year represents a

12.9 percent increase over the previous year

State priorities: beyond the legislature

• Insurance commissioners
• Many laws regulating PBMs are NOT being enforced
• Lack of subject-matter knowledge a huge factor
• NCPA is working with National Association of Insurance

Commissioners (NAIC)

• Comprehensive education program for insurance commissioners
• PBM model legislation similar to NCOIL
• State attorneys general
• Is there proper oversight over those tasked with enforcing

regulations?

State priorities: NCPA assistance and communications to members/partners

• Monthly Calls
• Issue background
• Bill review
• Model language on priority issues
• Letters of support or opposition
• Testimony
• State-specific grassroots calls-to-action to NCPA members
• Consultation on legislative strategy

2019 NCPA Congressional Fly-In

Karry La Violette

Advocacy Center Director SVP, Government Affairs (703) 600-1180 karry.laviolette@ncpanet.org Twitter: @KarryLaViolette

Find more info & resources at www.ncpanet.org/advocacy.

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We are a leading independent, national healthcare research and consulting firm providing technical and analytical services. We specialize in publicly-funded health programs, system reform and public policy. We work with purchasers, providers, policy- makers, program evaluators, investors and others. Our strength is in our people, and the experience they bring to the most complex issues, problems, or

• pportunities.

HMA is fortunate to have on our senior staff a distinguished array of physicians, nurses, advanced practice nurses and behavioral health therapists. These Clinical Services staff members have all practiced direct patient care, and many continue to do so while working at HMA. In addition, they have gained vast experience in former roles as:

Direct caregiver experience makes these colleagues indispensable to healthcare transformation.

Health System Executives

(CMO, CEO, COO)

Medical and Behavioral Health Specialists Health Plan Medical Directors Advanced Practice Nurse Leaders Correctional Health Experts Directors of Academic Departments and Training Programs State Health and Medicaid Clinical Chiefs Clinician Members of Health System, Health Plan and Association Boards

STATE LEVEL EXPERIENCE

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Matt Powers Tom Dehner Izanne Leonard-Haak Pat Casanova Gary Crayton Kathy Gifford Donna Checkett Linda Wiant Joe Moser

Community Pharmacy’s Value Proposition: Opportunities in Managed Medicaid

Multiple Locations Conference Craig Thiele, MD Principal Health Management Associates

Disclosure

Craig Thiele is the Principle of Health Management Associates. The conflict of interest was resolved by peer review of the slide content.

Some things health plans can’t do

• It’s a bit of a secret
• Unbelievable access
• Trusted relationships
• Ability to influence
• You are in their backyard!

Medicaid health plans priorities

• Market share
• Relevance
• Finances
• Outcomes

What health plans want from you

• Performance improvement
• High-risk members
• Savings
• Easy, really easy!
• Scalable!

Value statement

• Access!
• Performance improvement alignment
• High-risk patients
• Transition of care
• State requirements
• Delivery drivers
• Outcomes
• Easy to work with!
• Scalable

How does HMA work with CPESN?

• Value proposition
• Market specific performance objectives
• Plan/market strategies
• Engagement strategies
• New payment models

Craig Thiele

Principal Health Management Associates cthiele@healthmanagement.com

Practice Transformation and Business Opportunities

Multiple Locations Conference Joe Moose, PharmD, Director of Strategy & Luminary Development, CPESN USA Owner, Moose Pharmacies, N.C. ,

Disclosure

Joe Moose, PharmD is the Director of Strategy & Luminary Development with CPESN USA. The conflict of interest was resolved by peer review of the slide content.