URAC Specialty Pharmacy v3.0 Accreditatjon: Learn Insider Tips to - - PowerPoint PPT Presentation

URAC Specialty Pharmacy v3.0 Accreditatjon:

Learn Insider Tips to Satjsfy the Latest Patjent Management Requirements

July 11, 2017

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SPEAKERS

CHASE DYE, CPHT

Specialty and Mail Order Pharmacy Operatjons Manager Cleveland Clinic

RUSSEL ALLINSON, RPH, MS

Co-founder, CEO, and CCO Therigy

PAM DEVAUL

Vice President of Quality Therigy

@therigy #Therigy4Specialty

Although this webinar covers URAC Specialty Pharmacy v3.0 Accreditatjon requirements specific to patjent management, it is not sponsored by URAC.

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AGENDA

Navigate the changes in URAC Specialty Pharmacy v3.0 for patient management Apply the new URAC Specialty Pharmacy v3.0 standards for patient management to specialty pharmacy accreditation Plan and implement URAC Specialty Pharmacy v3.0 requirements for patient management Use technology to meet the new patient- and specialty-drug management standards

What You’ll Learn

How to:

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Preparatjon Standards changes Competjtjve advantage Value-based environment Insider knowledge

Why this Webinar?

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Types of Accredited Specialty Pharmacies:

Independent Payer Owned Retail Owned Health System Infusion Pharmacy Physician Practjce

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Mandatory document control New policies and processes New decisions More resources needed Leadership support and coordinatjon across teams Time commitment

What Makes the Accreditatjon Process Challenging?

!

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URAC Specialty Pharmacy v3.0 for Patjent Management

Navigatjng Changes in

$$

Specialty Drug Management (SDrM)

$$

Patjent Management (PM)

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Specialty Drug Management (SDrM)

SAFETY APPROPRIATENESS EFFECTIVENESS

Patjent and prescriber educatjon Access to specialty drugs Cost-effectjve drug management Evidence-based medicine Patjent adherence management Drug Utjlizatjon Review (DUR)

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Patjent Management (PM)

PM 1: PATIENT CENTERED STRATEGY

Writuen overview of services based

• n individual needs

All patjents receiving specialty medicatjons What types of services does your program provide?

Prior authorizatjon

TYPES OF SERVICES PROVIDED

Copay assistance Patjent assistance programs Adherence monitoring Educatjonal materials Patjent educatjon and clinical counseling Availability to clinical staff Qualified staff

$$$

24 7

Policies and Procedures

Clinical practjce guidelines and services Documentatjon in central locatjon Process to communicate with prescribers Evaluatjon of therapeutjc outcomes

Initjal Assessment Reassessment Patjent Educatjon, Counseling, and Resources

Diagnosis Appropriateness Comorbiditjes Medicatjon list Allergies Appropriateness Effectjveness Adverse events Adherence

PM 2-3: PATIENT MANAGEMENT PROGRAM

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PATIENT RECORDS

30

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PM 8: COORDINATION OF CARE

Who What When

Policies and Procedures Care Plan

Statement Strategies Goals Timeframe Resources Patjent desires/motjvatjon

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PATIENT RECORDS

3

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PM 14: DEMONSTRATING PROGRAM VALUE

Clinical Benefits Financial Benefits Quality of Life Patjent Satjsfactjon

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PM 15: PROGRAM EVALUATION OUTCOMES REPORTING

Patjent Satjsfactjon Quality of Life PROJECTED OUTCOMES PAST OUTCOMES Clinical Benefits Financial Benefits

Template letuer Mock reports Technology for reportjng metrics and data

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HOW TECHNOLOGY Can Help Meet Accreditatjon Requirements

Organize workflow Automate evidence-based care plans Document and report clinical interventjons

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OUTCOMES REPORTING

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CLEVELAND CLINIC Case Study

CHASE DYE, CPHT

Specialty and Mail Order Pharmacy Operatjons Manager Cleveland Clinic

Timeline

• Funds Approved
• Director Hired
• Constructjon

Plan

• Constructjon
• Initjal Caregiver

Recruitment

• Opened

Specialty Pharmacy

• URAC In-process
• URAC Desktop

Review

• On-site Visit

Accreditatjon Determinatjon

2013 Q2/Q3 2014 Q4 2014 2015 2016 Q1 2014

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Business Overview

• Funds Approved
• Director Hired

Oral and self-injectable products Disease states Driving unique value propositjons Resettjng service expectatjons Service-line integratjons Integrated data warehouse

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The Obstacles of Delivering Specialty Pharmacy Care

Providers

PATIENT

Specialty Pharmacy Pharma-provided Patjent Services Program Employer / Payer

• Get the patjent on drug fast and keep

them on drug above all costs

• Product of service limitatjons
• Achieve best possible outcomes
• Minimize paperwork and delays
• Overburdened focal point
• Achieve best possible outcomes
• Minimize out-of-pocket costs
• Reduce hassle/delays

Needs help!

• Provide high quality of service to members
• Reduce waste
• Optjmize outcomes
• Define value
• Provide service, cost savings, and

value to the payer

• Incented on dispensing volume

Faxes and phone calls

Cleveland Clinic’s Solutjon

Physician CCF Specialty Pharmacy Pharma-provided Patjent Services Program Employer

PATIENT

Concierge Data Flow Utjlize, but Limit

Electronic links, single point-of-contact, and new opportunitjes for value

EHR Link Follow-up via CarePath

Seeking Accreditatjon

External, independent evaluatjon Quality and structure Patjent safety Metrics Limited distributjon drugs and access to payer networks

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Accreditatjon Process

Sales discussion and review of standards Gap assessment Quality and clinical oversight commituees Contract negotjatjon Policy and procedure development Execute agreement Staff training and mock survey Desktop submission of materials Requests for informatjon in response to desktop submission On-site review Accreditatjon commituee review and decision Consider URAC a part of your team

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On-site Survey

Agenda and checklist Mock surveys Prepare and audit materials in advance Offline staff member Define expectatjons

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INSIDER TIPS

Data reportjng and metrics Contjnue to work with URAC Initjal accreditatjon is a great achievement; maintaining ongoing accreditatjon is demanding

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ADDITIONAL TIPS

Create a project plan Identify gaps, set deadlines Review, modify, and approve all existing policies and procedures Update quality improvement programs and annual reports Organize the evidence in one location or file Ask URAC questions about interpretations Create interview questions Organize all onsite materials

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

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QUESTIONS & ANSWERS

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RUSS ALLINSON russel.allinson@therigy.com PAM DEVAUL pam.devaul@therigy.com

Contact us today.

Patjent-Centered Therapy Management Sofuware for Specialty Pharmacies

@therigy #Therigy4Specialty

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