Webinar August 18, 2017 Whos who Matt Gallagher Associate, Network - - PowerPoint PPT Presentation

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Webinar August 18, 2017 Whos who Matt Gallagher Associate, Network - - PowerPoint PPT Presentation

Oct 23, 2023 135 likes •462 views

Health Partners Provider Webinar August 18, 2017 Whos who Matt Gallagher Associate, Network Performance Jackie Shine Resident, Clinical Services Lauren Adair Senior Associate, Network Performance Agenda The Objective About

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Health Partners Provider Webinar

August 18, 2017

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Who’s who

  • Matt Gallagher

Associate, Network Performance

  • Jackie Shine

Resident, Clinical Services

  • Lauren Adair

Senior Associate, Network Performance

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Agenda

The Objective About OutcomesMTM About the Health Partners Program Who Participates (Pharmacy network) Interaction with Providers & Patients Types of Recommendations Benefits to All Q&A

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The Objective

Understand the Health Partners Medication Therapy Management Program Utilize understanding for collaboration and patient care

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Experience:

  • One of the first MTM companies
  • Has worked with Medicare, Medicaid, Commercial, employer groups

and other payers

Approach:

Leverage personal relationships in communities combined with innovative, user-friendly technology to impact patient outcomes and improve healthcare

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Patient Relationships - Impacting Adherence

Connectedness with a pharmacy and its staff is the single strongest individual predictor of prescription medication adherence

  • NCPA (2013) Medication Adherence In America
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MTM and Quality Measures

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Medicare Star Ratings

  • Annual ratings of Medicare plans made available on

Medicare Plan Finder and CMS Website (beginning in 2008)

  • 2 year data lag – e.g. 2017 Ratings represent 2015

performance

  • Ratings are displayed as 1 to 5 stars
  • Stars calculated for each measure, then rolled up into

domain, summary and overall

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Part D Star Measures

  • Patient-Safety Measures
  • Display Measures
  • Statin Use in Patients with Diabetes (SUPD)
  • High Risk Medications (HRM)
  • Drug-Drug Interactions
  • Adherence to Antiretroviral Therapy
  • Excessive doses of oral diabetes medications

Measure Weighting Medication Adherence for Diabetes Medications (non-insulin) 3 Medication Adherence for Hypertension (RAS Antagonists) 3 Medication Adherence for Cholesterol (Statin) 3 MTM Program Completion Rate for CMRs 1

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HEDIS Measures

  • Measures all plans
  • 81 individual measures across 5 domains
  • Routine health screenings and immunizations
  • Customer satisfaction surveys
  • Call answer timeliness
  • Drug therapy: CAD, Hypertension, Diabetes, COPD
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HEDIS Measures

  • OutcomesMTM Impact
  • Assessments and Comprehensive Care
  • Assessment of High Risk Medications
  • Comprehensive Diabetes Care
  • Management of Common Disease States
  • Adherence
  • Filling gaps in care
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Interactions with Provider and Patient

Types of Interventions

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Pharmacy to Prescriber Communication

  • Fax or phone
  • OutcomesMTM

provides fax forms

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Prescriber and Patient Acceptance - Medicare

16% 11% 15% 28% 79% 84% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 2015 2016 2017 Prescriber Patient

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Prescriber and Patient Acceptance - Medicaid

15% 15% 10% 24% 79% 84% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 2015 2016 2017 Prescriber Patient

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Top Interventions - Medicare**

4,742 2,600 3,344 1,522 478 4,909 1,175 2,246 1,574 326 Adherence check-ins (+ 90 day) Adherence Monitoring CMR Needs patient education Needs Drug Therapy 2016 2017

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Top Interventions – Medicaid**

25,852 4,777 6,514 1,294 512 18,117 4,295 2,936 992 461 Adherence check-ins Needs Patient Education CMRs Needs Drug Therapy Suboptimal Drug 2016 2017

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Closing the loop

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Pharmacist Prevented Additional Healthcare Costs

Personal Pharmacist™ Jodi Miguel, 5 Star Pharmacy & Medical Supply, Southampton, PA

Jodi initiated a claim following a CMR after identifying a patient was taking both the long-acting and short-acting formulations of their medication for diabetes. Jodi recognized that both therapies were not necessary to treat the patient’s diabetes. Jodi contacted the patient’s prescriber and confirmed the patient should be taking the immediate release formulation. In follow-up, Jodi deactivated the prescription for the long-acting formulation and counseled the patient on the appropriate medication to continue. Thanks to Jodi’s intervention, prevented additional healthcare costs. Great work, Jodi!

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Q&A

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