Presentation PDF
Pharmacy Track Expanding Pharmacy Practice Presenter: Dr. Dave Harlow BS, Pharm D, Assistant Vice President for Professional Services,Clinical Pharmacy, Clinical Imaging, Clinical Laboratory and Disease Management, Martin Health System FACULTY(DISCLOSURE( The(faculty(reported(the(following(financial(relaAonships(or( relaAonships(to(products(or(devices(they(or(their(spouse/life( partner(have(with(commercial(interests(related(to(the(content(of( this(CE(acAvity:(( ( Dr.(Dave(Harlow(BS,(Pharm(D,(Assistant(Vice(President(for( Professional(Services,Clinical(Pharmacy,(Clinical(Imaging,(Clinical( Laboratory(and(Disease(Management,(( MarAn(Health(System( ( –(No(financial(interest/relaAonship(relaAng(to(the(topic(of(this( acAvity( The Martin Health System Comprehensive Medication Management Strategy Dr.$Dave$Harlow$BS,$Pharm$D,$ $Assistant$Vice$President$for$Professional$ Services$ Clinical$Pharmacy,$Clinical$Imaging,$Clinical$ Laboratory$and$Disease$Management$ Our(Staff( Shanna$Klingsporn,$CMA$–Comprehensive( Health(Management(Facilitator(( Heather$Robertson,$PharmD$–(( Comprehensive(Health(Management( Pharmacist(( Debra$Antoon,$R.Ph.,$C.Ph.$–(( Corporate(Manager(Ambulatory(Pharmacy( Services( LeR(to(Right:(Heather(Robertson(S(Chronic(Disease(Management(Pharmacist( Shanna(Klingsporn(S(Chronic(Disease(Management(Facilitator,(Maribelle(S(Palm(Beach(AtlanAc( Pharmacy(Student(,(Jordan(S(Palm(Beach(AtlanAc(Pharmacy(Student( Jacintha(Cauffield(S(Palm(Beach(AtlanAc(Faculty,(Andrea(S(Palm(Beach(AtlanAc(Pharmacy(Student,(Kim( Fleming(S(Clinical(Pharmacist,(Sheri(Arndt(S(Palm(Beach(AtlanAc(Faculty,(Debra(Ann(Antoon(S(Corporate( Manager(Ambulatory(Pharmacy(Services(( Strategy( • PATIENT(CENTERED(CARE(for(the(most(complex(paAents!(( ( • MHS(AdministraAve(Support(and(Visionary(approach.( – Movement(from(“Fee(for(Service”(to(“Payment(for(Quality(Outcomes”( mentality!( • Chronic(Disease(Management(( – “The(Heart(and(Soul(of(PopulaAon(Health(Management”( ( • MISSION:(MHS:$(To#provide#excep,onal#health#care,#hope#and# compassion#to#every#pa,ent,#every#,me.# • MISSION:(CHaMP(Service:(“Align#with#Physician#Prac,ces#and#the# Complex#Pa,ents#they#serve#to#Keep#them#Healthy#at#Home”# ( Keeping(the(loop(connected!( PE(&(“LEAN”(FoundaAon( A3SRoot(Cause(Analysis( Workflow( Mapping( Huddle(Board( Physician(Rapport( • Elbow(to(Elbow(TEAM(approach(( • EnAre(Team(working(at(the(top(of(their(license!( – Increased(PaAent(SaAsfacAon( – Increased(PaAent(Throughput( – Increased(MD(saAsfacAon( – And(Decreased(Hospital(admissions( • We(are(engaging(Physicians(that(want(to(adopt(this(new(mentality!( • Physician(Champions!( Started(with(1(MD( • Started(in(1(office……..( • Built(Rapport(with(Physician,(worked(out(kinks(in( workflow( • Built(usable(tools(to(tracking(visits,(demographics,( intervenAons(and(outcomes( • Interest(was(created(in(other(MMG(offices(( • **Currently(in(5(offices(( ( (SReceiving(referrals(from(16(different(Physicians(( Care(Maps( • Evidenced(Based(Care(Maps:( – Diabetes ( ( (( – CHF( ( ( (( – HTN( ( ( (Future&“Maps”&in&the&Works:( – Dyslipidemia ( ( (CKD( – COPD ( ( ( (Depression( – Asthma( MarkeAng(Support( • Our(Service(:(Comprehensive(Health(Management(Service(:(( – ((aka(“CHaMP”$Service( • Flyers(Developed(for(Providers(and(PaAents!( ( KPI’s( • • • • Key&Performance&Indicators& MedicaAon((ReconciliaAon(Tracking( Number(of(Office(Visits(Monthly( Number(of(Physicians(Referring( Number(of(Offices(Served( Total;Completed;Visits Jun$14 Jul$14 Aug$14 Sep$14 Oct$14 Nov$14 Dec$14 Jan$15 Feb$15 Mar$15 Total&Number&Of& Completed&Visits 14 20 27 48 74 54 64 73 85 87 Goal; 32 32 32 32 60 60 60 60 90 90 Apr$15 90 Monthly;Visit;Goals 100 90 90 85 90 87 80 74 73 70 60 60 64 60 60 DecA14 JanA15 60 54 50 48 40 30 32 32 32 32 27 20 20 14 10 0 JunA14 JulA14 AugA14 SepA14 OctA14 NovA14 Total&Number&Of&Completed&Visits ( Goal FebA15 MarA15 StaGsGcs$FY$2015$$$$$$$$$$$$$$$$$$October$2014$P$March$2015$$$$ OctS14( NovS14( DecS14( JanS15( FebS15( MarS15( 289( 268( 258( 232( 188( 162( 74( 54( 65( 73( 85(87( 34(31(28(33(35(33( Referrals(to(Service( 18(17( Total(Number(Of( Completed(Visits( 25(20(23( 15( NEW(paAents(seen(( 22(24( 33(37( 44(42( 6( 5( 5( 5( 5( 5( Follow(Up( Total(Number(Of( COMPREHENSIVE( Telephone(Contacts(( visits( Offices(served( 14(10(12(10(14(13( Provider's(referring( to(Service((((((current( month)(in(EPIC(( StaAsAcs(and(Report(Building( ( Current(Payor(Mix:(68%( Medicare( 28%(Commercial( ((5%(Self((Meritain)( ( ( PaAent(Complexity(Reports( Disease States Number of Patients with Disease State Diabetes CHF Hyperlipidemia/CAD Hypertension COPD ASTHMA 105 18 36 108 31 18 Disease State How many patients… 1 Disease State 2 Disease States 3 Disease States 4 Disease States 5 Disease States >5 Disease States 14 29 54 14 8 1 Total Patients 120 65%: 3 or more complex disease states* FY 2014 Resident Project Results: Medication Related Problems Problem$Types$and$Frequency$ $$Unnecessary$Drug$Therapy$ (((((((No(valid(indicaAon$ (((((((TherapeuAc(duplicaAon( (((((((Nondrug(therapy(needed( ( $$IneffecGve$Drug$ (((((((Dose(too(low(to(produce(desired(response$ (((((((Drug(is(not(effecAve(for(condiAon( (((((((Other((dosage(form,(drug(interacAon,(etc.)( $ Noncompliance$ (((((Did(not(understand(instrucAons$ (((((Prefers(not(to(take(the(medicaAon((((( (((((Forgets(to(take(the(medicaAon( (((((Too(expensive(( (((((Other((administraAon(or(pick(up(issues)( ( Needs$immunizaGon$or$lab$ 55$ 35( 18( 2( Needs$AddiGonal$Drug$Therapy$ (((((IniAaAon(of(drug(therapy(required$ (((((PreventaAve(therapy(required( (((((AddiAonal(drug(required(for(addiAve((((((( ((((((((((effects( 104$ ( 56( $$Adverse$Drug$ReacGon$ 39( (((((((Drug(causes(non(doseSrelated(reacAon((((((( 9( (((((((Safer(drug(required(due(to(risk(factors( (((((((Drug(interacAon(causes(reacAon( 252$ ( 136( MedicaGon$ReconciliaGon$ 44( (((((Omission(( 36( (((((Incorrect(dose( 24( (((((MedicaAon(paAent(is(not(taking( 12( (((((DuplicaAon( (((((Incorrect(instrucAons( 83$ (((((Other((dosage(form,(duraAon)( ( 80$ 49( 21( 10( 67$ 36( 21( 10( 277$ 82( 66( 63( 29( 25( 12( FY 2014 Resident Project Results:( Pharmacist(IntervenAons( IntervenGon$Types$and$Frequency$ MedicaGon$IntervenGon$ DisconAnue(drug( Add(drug( Increase(dose( Change(drug(to(another(Rx( Change(Aming(of(dose( IniAaAon(of(monitoring( Change(in(monitoring( Decrease(dose( Change(drug(to(OTC( Refill(drug( Cost(TherapeuAc(Switch(S(PAP( Change(dosage(form( 399$ EducaGon$IntervenGon$ 91( Ed.(PrescripAon(drug( 67( Ed.(Disease(state( 50( Ed.(Adherence( 46( Ed.(Lifestyle(factors( 33( Ed.(PreventaAve(care( 30( Ed.(OverStheScounter(medicaAon( 25( EducaAon(Other( 24( ( 10( MedicaGon$ReconciliaGon$IntervenGon$ 10( Deleted(medicaAon(paAent(not(taking( 8( Added(medicaAon(paAent(is(taking( 5( Changed(dose( ( Changed(dosage(form( Other( ( 1358$ 406( 261( 223( 209( 118( 104( 37( 311( 109( 88( 62( 3( 49( OUTCOMES( • FOCUSED(1st(year(on(DiabeAc(OutcomesS( – Why?!88%(of(our(paAents(are(DiabeAcs( – Complex(Disease(Management(SStep(wise(approach(( ( • LimitaAons(for(outcome(accuracy( – First(6(months(spent(building(EMR(and(Workflow( • Inconsistent(data(collecAon(for(first(6S8(months( • Hand(tally(of(data(from(progress(note(review(for(first(7(months( – Building(new(relaAonships(with(MD’s( – Defining(appropriate(paAents(for(Service.( – Limited(follow(up(Ame(for(repeat(A1c(( FY14(Study(Results:(( A1c(in(Detail( • Average'A1c'decreased'from'9.0'to'7.8' ' • 18'patients'reached'the'goal'of'A1c'<'8.0'during'pharmacist' intervention,'and'15'patients'remained'at'that'goal' ' • For'the'20'patients'who'remained'>'8.0'at'the'end'of'data' collection:' – Average'followCup'was'6.3'months'(range'3.5'to'10.0)' – Percent'improvement'from'baseline'was'5%'(range'C11'%'to'23%)' – For'the'13'patients'who'improved,'the'average'improvement'was'1.3' Conclusion FY 2014 Resident Project :( Diabetes(Outcomes(Study( • Over'the'Lirst'12'months'of'the'CHaMP'Service,' pharmacists'saw'153'patients,'identiLied' numerous'problems'and'provided'a'variety'of' medication'and'educational'interventions' ' • These'interventions'led'to'47%'of'patients'above' goal'at'baseline'reaching'the'goal'of'A1c'<'8.0' CBISA( • WHY(Report(as(Community(Benefit?( – Currently(we(charge(NO(FEE(for(Service(and(WHY( – Face(to(Face(AND(Telephone(Call(intervenAons.( FY14:(JanuarySSeptember(2014:(Total(191.6(Staff(hours,(a(CB(expense(of($39,926( touching(653(people*((although&we&know&a&lot&less&went&through&the&program&we&take& into&account&every&encounter&with&each&personAthis&number&counts&each&unique&visit)& (( FY15:(October(2014S(January(2015(S(Total(thus(far((4(months):(348.7(staff(hours( auributed,(for(a(total(of($67,992(of(community(benefit(dollars(touching(1108(people*.(( (( Total(Program(Summary((through(January(2015):((540.4(Staff(Hours:(( Total(Community(Benefit(Dollars(of($107,918.((Total(paAent(encounters(1761( ( *although&we&know&fewer&actual&paFents&went&through&the&programA&we&take&into&account&every&encounter&with&each& personAthis&number&counts&each&unique&visit& ( ( PaAent(Case(#1(( • $ $ • AGE:$83$y.o.$$ • IniGal$Date$Seen:$1.23.14$ • Past$Medical$History:$$ • HTN/DM/(A(fib(/1st(degree(AV(Block( • Hyperlipidemia/(CAD/DiabeAc(Neuropathy/CHF( • • • • • • ( 15$MedicaGons$ 9$Changes$needed$on$1st$visit$ Health$Literate$ MedicaGon$Adherent$ Pleasant$PaGent$WANTS$to$get$beaer!$ Helped$Develop$the$Service$ IniGal*$&$$$$$$$$ $REPEAT$LABS: 1/29/2014* 4/9/2014 2/5/2015 % decrease HgA1c$(((((((((((((((((((((((((((((((( Goal(<8.0 9.2 7.7 6.8 26% Total$Cholesterol$$$$$$$$$$$$$$$$ Goal<180 140 117 107 24% LDL$$$(((((((((((((((((((((((((((Goal<70 83 59 60 28% Triglycerides$$((((((((((((((((((((( Goal(<150 111 46 42 62% 44/2.3 40/1.6 48/1.6 34 48 48 BUN/Cr Estimated CrCl (ml/min) PaAent(Case(#2( • • • • AGE:$53y.o.$ IniGal$Date$Seen:$6/9/14$$ Past$Medical$History:$$ Fibromyalgia,(Type(II(Diabetes( • • • • IniGal$Vital$Signs$Labs:$ $ $ $ $ $$ BP:134/75(mm(Hg(( ( ( ( ( (Previous$12$months:( HgA1c$10.2$$$$LDL(177mg/dl(((TC(276mg/dl(((((((TG((259((((((FBS(372(((((((((((ER$visit$:$10$ SMBG:$$$>200$$P300$rouGnely $ $ $ $Urgent$Care$Visits:$4$ • • REPEAT(Labs:(September#2014###A1c$8.2,((TC(201,((HDL(48,((LDL(124,((TG(145( NO$ADMISSIONS$NOR$ER$VISITS$AFTER$SERVICE$VISITS*$ $( • PaGent$Goals$of$Therapy: ( – • ( ( (( Glucose(and(A1c(control((( Screens:$Health$Literacy:$8$(literate);$Ask$12P$adherent;$PHQ9P$severe$depressed;$Readiness$RulerP$6$=~Ready$to$change$ PaAent(Case(#3( • AGE:$85y.o.$$ • IniGal$Date$Seen:$3.4.14$ • Past$Medical$History:$$ • HTN/DM/Hyperlipidemia/COPD( (((((((CAD/DiabeAc(Neuropathy/CKD( ( • 16$Chronic$MedicaGons$ • 6$Changes$needed$on$1st$visit$ • • • • $ ( ( NOT$Health$Literate$ MedicaGon$NONP$Adherent$ MD$unable$to$make$progress$ Pleasant$PaGent$WANTS$to$get$beaer!$ IniGal*$&$$$$$$$$ $REPEAT$LABS: HgA1c$(((((((((((((((((((((((((((((((( Goal(<8.0 Total$Cholesterol$$$$$$$$$$$$$$$$ Goal<180 LDL$$$(((((((((((((((((((((((((((Goal<70 Triglycerides$$((((((((((((((((((((( Goal(<150 BUN/Cr 11/8/13 6/11/14 2/2/15 % decrease 11.2 8.4 6.7 40% 127 135 151 +18% ( N/A( ( N/A( N/A N/A 326 244 333 - 59/2.6 34/2.03 42/2.04 20% Office(Outcomes( Palm(City( Patient Initial)HgA1c 1st)repeat 2nd)repeat ( 1 2 3 6.2 6 11.8 9.2 10.1 8.5 6.9 11.2 6.3 6 7.7 3 22 16 46 %,decrease 4 5 7 8 9 6.5 10.2 6.5 8.2 6 10 6.8 7.3 6.7 6.9 6.4 12.4 6.7 7.3 32 5 41 0 20 10 11 13 14 15 16 17 18 19 20 6.4 10.8 5.8 9.1 12 8.7 7.3 9.6 7.7 6 5.8 9.2 7.7 6.8 6.1 6.1 5.9 6.1 6.4 9.5 7 16 20 3 26 0 9 16 26 Palm,City,Family,Care9 CHaMP's9 Diabetic,Patients,w/,HgA1c,Repeat,labs 14 12 ( ( ( ( 12.4 11.8 11.2 10.2 10.1 10 10.8 10 9.6 9.2 8 8.5 6.2 6 9.1 6.9 7.3 8.2 7.7 6.3 6 9.5 9.2 8.7 6.5 6 6.8 6.5 6.9 6.7 6.4 6.7 7.3 6.4 7.3 7.7 7.7 6 5.8 6.8 5.8 Initial)HgA1c 6.1 5.9 6.1 6.4 6.1 18 19 7 2nd)repeat 4 2 0 1 2 #)Patients #w/decreases #)w/increases Average)decrease 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1st)repeat 20 20 17 17/20='85%' 3 (ALL)3)still)below)Goal)of)8) 18% )),,,*RANGE,,,,0%,9,46% Desktop/CHaMP.documents/PC.FC.DM.A1c.data.3.2015 Results:(PaAent(SaAsfacAon( PaAents(evaluate(each(quesAon(from(1((strongly(disagree)(to(5((strongly( agree)(following(the(iniAal(visit:( 1. 2. 3. 4. 5. If(you(had(to(schedule(an(appointment(with(the(Clinical(Pharmacist(was( your(appointment(scheduled(to(your(convenience?(((( Did(the(visit(today(with(the(Clinical(Pharmacist(help(you(feel(beuer(about( your(future?(( Did(the(Clinical(Pharmacist(listen(to(you(and(answer(all(of(your(quesAons( and(concerns(to(your(saAsfacAon?( Do(you(feel(like(another(visit(with(the(Clinical(Pharmacist(would(be( helpful(to(you?( (( Would(you(recommend(this(program(to(family(and(friends?( ( Average(Score:(4.6(/(5( PaAent(AuriAon(( • Purged(paAents(in(November(( – paFents&that&were¬&“appropriate”&but&&were&acquired&into&system&as& we&grew&and&trialed&systems& • Currently&120&paFents&AcFve&in&our&System&of&the&194& idenFfied& – 38&have&been&dismissed&for&“non&interest”/&non&compliance&&(~20%)& – Others&idenFfied:& • Dialysis/End&of&Life/SNF/&Oncology&paFents& • as&MD&requested&paFent&intervenFons:& – MedicaFon&ReconciliaFon&Needs&of&a&paFent¬&meeFng&Criteria& – Hospital&Follow&Up&&Visit&assistance&Requested&by&MD& • Developed(Standard(Work(defining:( • PaAent(status(idenAficaAon( • Criteria(to(idenAfy(proper(paAent(populaAon( ( StaAsAcs(for(Financials( • STAT(build(uAlizing(Visit(Types(weighted(to( assess(producAvity.( • Value(not(Aed(to(revenue(but(ROI(captured(in( decreased(hospital(admissions,(increased( paAent(saAsfacAon,(increased(Physician(Ame( available(for(urgent(paAent(visits.( Lessons(Learned( • Choose(the(BEST(partners(and(staff!( • Align(with(the(ENTIRE(Healthcare(TEAM!( • Be(Flexible(and(Accept(CriAcism(graciously( • Create(Standard(Work(&(Reassess(Regularly( • Be(PaAent!(( • Tedious(work(DOES(pay(off!( Future(Goals( • CollaboraAve(PracAce(Agreements( • Full(Time(Staffing(at(each(PCP(Office(and(a(presence(in( Specialists(Offices( • Sharing(our(experience(uAlizing(Pharmacists(as(part(of((the( Ambulatory(Healthcare(Team(with(EVERYONE!( ( • Having(paAents(more(involved(in(their(health(care!( (( ****Keeping#our#pa,ents#Healthy#at#Home!****# Thank(You( Pharmacy Track Improving Patient Care and Enhancing Revenue Streams Through Specialty Pharmacy Presenters: Annette Karageanes, MS, RPh Contract Portfolio Director, Pharmacy Services Beaumont Health Scott Sterrett, PharmD Manager, Specialty Pharmacy Beaumont Hospital, Royal Oak FACULTY(DISCLOSURE( The(faculty(reported(the(following(financial(relaAonships(or( relaAonships(to(products(or(devices(they(or(their(spouse/life(partner( have(with(commercial(interests(related(to(the(content(of(this(CE( acAvity:(( ( Anneue(Karageanes,(MS,(RPh,(Contract(Poryolio(Director,(Pharmacy( Services,(Beaumont(Health(( ( Scou(Sterreu,(PharmD,(Manager,(Specialty(Pharmacy,(Beaumont( Hospital,(Royal(Oak( ( –(No(financial(interest/relaAonship(relaAng(to(the(topic(of(this(acAvity( ObjecAves( 1. Analyze(and(idenAfy(the(components(of(a( successful(specialty(pharmacy(program.(( 2. Discuss(the(posiAve(impacts(that(such(a( program(can(have(on(paAent(care(and( revenue(cycle.(( 3. Review(the(process(used(to(develop(and( implement(specialty(pharmacy(programs.(( Part(1( OVERVIEW$AND$SIGNIFICANCE$ What(Are(Specialty(Drugs?( • • • • • • • High(cost( Treatment(requires(special(monitoring( Treats(orphan,(uncommon,(or(rare(disease( Special(handling,(storage,(or(distribuAon( Limited(distribuAon(from(manufacturer( Treats(disease(already(classified(as(specialty( Requires(paAent(administraAon(training( EMD(Serono(Specialty(Digest:(10th(EdiAon((2014)( Why(Are(They(Important?( ( ( • • • • Cost( Growth(( Complexity( Profitability( JMCP(2013;19(4):336( Cost( $36,000( $120,000( MercedesSBenz(CLAS250( 4(year(Bachelor’s(degree( $225,000( House(in(Royal(Oak,(MI( $$ $ TradiGonal$Pharmacy$ Type$of$CondiGon$ U.S$PaGent$PopulaGon$ Acute( Millions( DuraGon$of$Therapy$ Short(term( Cost$of$Therapy$ $ Chronic( Millions( $ Specialty$Pharmacy$ Complex(Chronic( Hundreds(of( Thousands( Rare(Disease( Affects(<200K( Ongoing( (maintenance)( Lifelong( Lifelong( ~$100/episode( $1,000’s(/year( $10,000+/year( $100,000+/year( PaGent$Monitoring/ EducaGon$ Minimal(( Average(( High(level(( Very(high(( Product$Requirements$ No(special( requirements( No(special( requirements( RefrigeraAon,(selfS administered( injecAon(training.( Limited$distribuGon$ channels$ RefrigeraAon/( mixings/(pumps/( med(port(training.( Limited$distribuGon$ channels$ Typical$DistribuGon$ Channel$ Retail( Retail(or(mail(order( Specialty(pharmacy,( infusion(clinics,( doctor’s(office,(home( infusion(services( ( Specialty(pharmacy,( infusion(clinics,( doctor’s(office,(home( infusion(services( Growth( $500(( $470(( Category(Spend(($Billion)( $450(( $398(( $400(( $350(( $300(( $250(( $307(( $334(( $235(( $179(( $92(( $127(( $215(( $207(( $219(( $235(( 2012( 2014( 2016( 2018( $200(( $150(( $100(( $50(( $0(( TradiAonal(Rx( Year( Specialty(Rx( Total(Rx( CVS(Caremark.(Insights&2014.( Express(Scripts.(2014&Drug&Trend&Report.( Complexity( JMCP(2013;19(4):334S42.& Profitability( • New(revenue(stream( • UHC(survey:(( – 7(insAtuAons(analyzed( – PotenAal(annual(gross(revenue(>$220M((( • • • • Drug(margin(6S8%( Significant(340B(opportunity( Easy(to(implement( Low(iniAal(investment( UHC,(University(HealthSystem(ConsorAum( Part(2( BEAUMONT$SPECIALTY$PHARMACY$ CASE$STUDY$ Beaumont(Health(Overview( • • • • • • 8(hospitals;(3,351(beds(( 30(outpaAent(centers( 7,400(physicians( 168,000(admissions( 2.9M(OP(visits( $3.8B(revenue( Components(of(a(Successful(SP( • • • • • • • • • Benefits(invesAgaAon( Prior(authorizaAon(services( Denial(appeals( Financial(assistance( Clinical(appropriateness(review( Comprehensive(clinical(management( Call(center(with(24/7(support( Refill(reminders( Free(delivery( Resources(Needed(to(Start(Program( • • • • • Opportunity(Assessment( Capability(to(fill(outpaAent(prescripAons( CollaboraAon(and(team(work( Program(Manager( Prior(AuthorizaAon(Technicians(( ( Program(Development(and( ImplementaAon( Nov 13 - Jan 14 Consultant Engagement Aug 13 Initial interest & UHC Collaborative Apr 14 HCV Clinic Aug 13 - Dec 13 Background research Program Development Aug 2013 9/13 10/13 11/13 12/13 May 14 Discharge Program Initiation Feb 14 - Mar 14 Initial Personnel Hired (3 FTE) 1/14 Sep 14 Beaumont Health SP Work Group Formed Sep 14 Rheumatology Clinic Jul 14 Pediatric Subspecialty Clinic Expansion Initial Implementation 2/14 3/14 4/14 5/14 6/14 7/14 8/14 9/14 10/14 11/14 12/14 Dec 2014 Low(Cost(to(Implement( Salary(Expense((annualized)( (((((Manager( (((((2(Prior(AuthorizaAon(Technicians( $( 190,000( Consultant(Fees( Travel(and(Training( Computers(and(Equipment( TOTAL$INVESTMENT$ $( $( $( $$ ((((30,000( ((((((5,000( ((((((5,000( $$230,000$ Outcomes(of(a(Successful(SP( • Access(to(medicaAons( • Adherence(to(therapy( • Improved(outcomes( • Improved(financial(performance( • Customer(saAsfacAon( The(Challenge( 1/3(Never( Taken(or( Not(Filled( 1/3(Taken( Incorrectly( 1/3(UAlized( Correctly( Specialty&Pharmacy&Times(2014;5(6):S3.( Access( • OneSthird(of(prescripAons(never(filled(or(not( taken( – Insurance(authorizaAon(process( – Copay(or(coSinsurance( • Beaumont(HepaAAs(C(clinic((232(paAents)( – 51%(receive(some(form(of(financial(assistance( – 22%(receive(free(drug(( – Financial(assistance:(>$2.5M(to(date( – >99%$of$paGents$start$their$treatments$ Adherence( • OneSthird(of(prescripAons(taken(incorrectly( ( • MulAple(studies(show(adherence(is(beuer(for( paAents(who(use(specialty(pharmacies(and(those( with(access(to(copay(assistance( • Beaumont(HepaAAs(C(clinic((232(paAents)( – PaAent(outreach(at(2,(4,(8,(and(12(weeks( – Assess(for(missed(doses,(side(effects,(interacAons( – >89%$of$prescripGons$refilled$on$Gme$ ( Health&Affairs(2014;33(10):1761S9.( Adv&Ther(2010;27(8):523S32.& Outcomes( • OneSthird(of(prescripAons(uAlized(correctly( • TradiAonal(raAonale( – ↑(adherence(=(↑(outcomes(( • HealthSsystem(specialty(pharmacies(are(uniquely( posiAoned(to:(( – Improve(access( – Improve(adherence( – Study(relaAonship(between(adherence(and(outcomes( JMCP(2014;20(12):1227S34.& Financial(Performance( Financial(Growth(( ($2,000,000(( ($160,000(( ($1,800,000(( ($140,000(( ($1,600,000(( Net(Revenue( ($100,000(( ($1,200,000(( ($1,000,000(( ($80,000(( ($800,000(( ($60,000(( ($600,000(( ($40,000(( ($400,000(( ($20,000(( ($200,000(( ($S(((( MayS14( JunS14( JulS14( AugS14( SepS14( OctS14( NovS14( DecS14( Net(Revenue( Net(Income( JanS15( FebS15( MarS15( ($S(((( Net(Income( ($120,000(( ($1,400,000(( Performance(by(Class( May$2014$–$April$2015$ ((((Net(Revenue( ((((((((((((((($((10,912,886(( ((((Drug(Expense( ((((((((((((((($((((9,874,853( ((((Net(OperaAng(Income( ((((((((((((((($(((((((829,958(( Drug(Margin(by(Disease(State( ($199,826(( HepaAAs(C( ($5,576(( Gastroenterology(&( Rheumatology( Discharge( 57( ($831,521(( Why&can&a&healthAsystem&pharmacy& provide&more&comprehensive&care& than&an&outside&pharmacy?&& Oncology(Clinic(Example( ESPrescripAon( Review(notes(and(labs( Pharmacy(care(( notes(available( EMR Hospital Clinic Pharmacy(care(( notes(available( Document(in(( pharmacy(note( Progress(( note( Physician(sees(( paAent(in(clinic( Specialty4 Pharmacy Contact(prescriber( for(clarificaAon( Physician Customer(SaAsfacAon( “How(does(one(adequately(describe(how(someone(can( give(you(hope(again?(You’re(taking(someone(who(has( cirrhosis(and(giving(them(a(chance(to(live!”( # # #HHepa,,s#C#Pa,ent# “I(wanted(to(send(you(another(message(to(tell(you(how( grateful(I(am.(Everyone(is(super(helpful(and(make(things( a(million(Ames(easier.(Thank(you(all(so(much,(you're( doing(an(amazing(job!”( # #HClinic#Staff( # “By(far(the(best(customer(service(I(have(EVER(received!”( # #HRheumatoid#Arthri,s#Pa,ent# SelfSAssessment(QuesAon(1( Which$of$the$following$are$requirements$for$a$ successful$specialty$pharmacy?$ a) b) c) d) Prior(authorizaAon(and(financial(assistance( PaAent(monitoring(and(counseling( Access(to(a(pharmacist(24/7( All(of(the(above( SelfSAssessment(QuesAon(2( Which$of$the$following$statements$about$ implemenGng$a$specialty$pharmacy$is$TRUE?$ a) Every(aspect(of(the(program(should(be(perfect( before(it(is(implemented( b) CollaboraAon(with(mulAple(departments(is(crucial( to(be(successful( c) Expenses(will(always(exceed(drug(margin(during(the( first(year(of(a(new(specialty(pharmacy( SelfSAssessment(QuesAon(3( How$can$specialty$pharmacies$increase$the$ quality$of$paGent$care?( a) RestricAng(access(to(certain(medicaAons( b) Providing(programs(and(services(to(increase( medicaAon(adherence( c) Offering(services(to(only(clinics(that(are(340BS eligible( d) All(of(the(above( Contact Information Annette Karageanes, MS, RPh Contract Portfolio Director, Pharmacy Services Beaumont Health [email protected] Scott Sterrett, PharmD Manager, Specialty Pharmacy Beaumont Hospital, Royal Oak [email protected]
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