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2. welfare
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WellTransitions
Community Partnerships to Reduce Readmissions,
Lower Costs, and Improve Quality
Logo is interchangeable with
ATCO
Agenda
Presenters:
Mark de Jongh, Strategic Account Manager
Ed Cohen, Senior Clinical Director
Susan Singer, Program Manager
• Walgreens: Mission, Community Pharmacy Services
• Medication Adherence Challenges
• WellTransitions – Reducing Preventable Readmissions
Logo is interchangeable with
ATCO
Walgreens Purpose, Vision and Objectives
PURPOSE
Help People Get, Stay and Live Well
VISION
To be the first choice in health and
daily living for everyone in
America…and beyond
STRATEGIC OBJECTIVES
•
Create a Well Experience
•
Transform the Role of Community
Pharmacy
•
Establish an Efficient Global
Platform
©2014 Walgreen Co. All rights reserved.
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Services to Reduce Costs, Improve Clinical Outcomes
and Increase Patient Satisfaction
Diabetes
Specialty
Pharmacy
New-to-Therapy
Interventions
Value-Based Benefit
Design
WellTransitions®
Walgreens offers a broad range of
services that are designed to address
Health Systems
Pharmacy
specific clinical and
patient needs
Specialized
Pharmacies
Innovative Patient
Adherence Programs
Healthcare Clinic
Central Specialty
Retail
Pharmacy
©2014 Walgreen Co. All rights reserved. Confidential and proprietary information.
Infusion
Services
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Walgreens Healthcare Offerings
Medication
Management
Quality
Improvement
Care
Coordination
Primary Care
Extension
o MTM
o Specialized
Pharmacies
o New to Therapy
Interventions
o Adherence
Management
o Specialty Pharmacy
o Gap Closure at Retail
Pharmacies
o Immunizations
o Health Testing
o Site of Service
Optimization
o
o
o
o
o
o HealthCare Clinics
o Infusion and
Respiratory
o Digital Health
Programs
o Patient Messaging
o Patient Outreach
MedGap Analysis®
WellTransitions®
Bedside Delivery
BDM
340(b) Services
Analytics/Reporting
Patient Engagement
Connectivity
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Proprietary & Confidential, Property of Walgreen Co.
Medication Adherence Challenges
©2013 Walgreen Co. All rights reserved.
6
Non-adherence: Nearly 1 in 3 Patients Don’t Fill
100%
50% - 70%
48% - 60%
25% - 30%
15% - 20%
Prescriptions
Brought to
Pharmacy
Picked up
Are Taken
Properly
First Refill
Source: IMS
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A Patient’s Understanding of Health Issues
Hospital discharge teaching
• Less than half of patients can tell you the
diagnosis that they left the hospital with
• Less than half can tell you all the
medications they take
• Fewer than a quarter can tell you the side
effects or how the medication work or
even when to take them
• Patients taking more than 3 prescriptions
medication are more likely to have issues
with medication knowledge
King JL, ShommerJC, WirschingRG. Patients’ King JL, ShommerJC, WirschingRG. Patients’ knowledge of medication care plans after hospital
discharge. Am J Health-Sys Pharm. 1998, 55: 1389-1393
MakaryusAN, Freidman EA. Patients’ understanding of their treatment plan and diagnosis at discharge. Mayo ClinProc. 2005; 80: 983
Reasons for Readmissions in Heart Failure
No follow up
appointment
32%
Diet
noncompliance
21%
Fluid
noncompliance
22%
Medication
noncompliance
25%
Ghali JK, Zmily HD, Shaik I, et al. Facotrs Leading to 30 Day Readmission Following Hospitalization for
Heart Failure. J Am Coll Cardiol. 2010;55(10s1):A144.E1349.
©2012
Walgreen Co. All rights reserved.
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WellTransitions®
Collaboration in Patient Care
WellTransitions Strategic Vision
• Assisting health systems with
avoiding readmission penalties
• Bridging the care gap with
community integration
• Redefining role of the pharmacist
• Intervention based care model
• Collaboration efforts with
interdisciplinary healthcare teams
• Increasing access and extending
care through 8,000 community
locations
Enhanced Pharmacy Functions - Bridging the Gap
Patient Population:
• Target high-risk, complex patients in conjunction with hospital or health
system
• Focus on disease states most commonly associated with readmissions
Clinical Collaboration:
• Conduct patient follow-up after discharge to ensure PCP visit, elevate
medication adherence
• Key point of integration focused on the value of a patient’s relationship
with a community pharmacist
Comprehensive Reporting and Performance Tracking:
• Analyze trends in avoidable readmissions, patient satisfaction and
operational procedures
• Identify gaps in care, collaborate with hospital discharge team for process
improvement
©2013 Walgreen Co. All rights reserved.
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WellTransitions® - Program Overview
Technology Platform
Hospital Treatment
• Data intermediary
custodian ensures HIPAA
compliance
• Determine criteria
• Admission, Discharge and
Transfer (ADT) data
extraction
• Build hospital specific
database including
eligibility triggers
• Eligible patients identified
• Pharmacist education
• Advanced data analytics
upon admission
follow up initiated 48-72
• Real-time access through
• Medication history autohours after discharge
secure web portal
generated
• Pharmacist therapy review
• Readmissions results
• Embedded tech visits
approximately 10 days
measured quarterly
patient: explains program,
post-discharge
•
Monthly program activity
enrolls
• Medication review and
reports
• Fulfillment of discharge
community integration
medications if BSD chosen
approximately day 25
• Medications delivered by
post-discharge
tech, offer of consult via
phone
Clinically Based Post-Discharge Call Interventions
• Tech secures
Discharge Medication
• Focused on medication education and adherence
Instructions of all
• Alerts built into technology for notification of
enrolled patients
Post-Discharge Care
Outcomes Reporting
issues
•
Coordinated care with community providers
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Walgreens WellTransitions® Program for medication adherence has
earned the exclusive endorsement of the American Hospital Association
AHA Solutions, Inc. selected Walgreens
WellTransitions® program for:
• Leadership in assisting hospitals in reducing
readmission rates
• Improving patients’ medication adherence
post-discharge
AHA Solutions awards the AHA endorsement to
a product/service it believes best addresses a
specific challenge for most member hospitals.
Walgreens WellTransitions program
for medication adherence has earned
the exclusive endorsement of the
American Hospital Association.
The American Hospital Association Awards exclusive endorsement to Walgreens WellTransitions ® Program for medication adherence [press release].
Deerfield, IL: Walgreen Co.; September 16, 2013.
©2014 Walgreen Co. All rights reserved.
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WellTransitions – Retrospective Study Methods
•
•
Research examined 744 matched pairs
of WellTransitions patients and nonpatients in a retrospective case
comparison study to evaluate the
effectiveness of the program
Covariate Characteristics
12 month retrospective case
comparison cohort study using
propensity score matching
Minority
Admitted from home
CMS targeted condition (AMI, HF, PN)
Discharged to home
Public Insurance
Number of diagnosis
•
•
Patients enrolled in this pharmacist-led
care transition program were matched
with similar patients in terms of age,
gender, disease state, illness severity,
comorbidities, and other pertinent
predictors of hospital readmission
Length of stay
Age
Unique medication count
Primary outcome variable will be 30-day
hospital readmission rates
Presented at the American Pharmacists Association (APhA) Annual Meeting & Exposition, Orlando, FL, March 28-31, 2014
Research study conducted by Bobby Clark, PhD, MSPharm, MHA, MS, MA
WellTransitions® Impact on Readmissions
WellTransitions® patients were
46% less likely to be readmitted
unexpectedly within 30 days of
hospital discharge.*1
• CMS targeted conditions:
55% less likely to be readmitted
• Age <65: 44% less likely to
be readmitted
• Age ≥65: 48% less likely to
be readmitted
1.0
26%
0.8
Relative risk
• Non-CMS targeted conditions:
26% less likely to be readmitted
Impact of WellTransitions ® on risk of readmissions
46%
55%
44%
48%
0.56
0.52
Age <65
Age ≥65
0.6
0.4
0.74
0.54
0.45
0.2
0
Total
patients
Non-CMS
targeted
conditions
CMS
targeted
conditions
WellTransitions patient sample group
Relative risk
Percent reduction in relative risk
Relative risk = (risk of readmission in WellTransitions cohort)/(risk of readmission in usual care cohort)
Reduction in risk = risk of readmission in usual care cohort – relative risk
Relative risk of 1.0 indicates there is no dif ference in risk between the two groups being compared
*Walgreens study conducted January 2013 through December 2013, with 744 matched pairs selected from four hospitals (744 WellTransitions patients and
744 non-WellTransitions patients).
1. Clark B, Hou J, Cohen E, Kwasigroch D, Singer S. Reducing preventable hospital readmission through a pharmacist-led care transition intervention. Poster
presented at: American Pharmacist Association (APhA) Annual Meeting; March 28-31, 2014; Orlando, FL.
©2014 Walgreen Co. All rights reserved.
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Improve Patient Satisfaction
Walgreens worked with DeKalb
Medical in Atlanta, Georgia to
implement a medication
adherence care transitions
program in January 2011.*1
65%
63%
HCAHPS Score
• Within 90 days, there was
a 26 percent relative increase in
the HCAHPS communication
about medicines domain score2
Improves Patient Satisfaction2
at 65th
percentile
60%
55%
•
50%
50%
50%
at 1st
percentile
45%
0 days
90 days
Time Period
*This program was not the complete WellTransitions program but rather an early intervention collaboration between Walgreens and DeKalb Medical.
1. Duncan I, Healthcare Financial Management Association. DeKalb’s comprehensive medication compliance approach cuts readmissions.
http://www.hfma.org/Content.aspx?id=15964. Published February 28, 2013. Accessed November 18, 2013. 2. Stemphiak M. Bedside delivery: an easier pill to swallow.
Hosp Health Netw. 2012;86(8):16, 25.
©2014 Walgreen Co. All rights reserved.
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Thank You!
Any questions?
Walgreens Local Contact:
Mark de Jongh
Senior Strategic Account Manager – Health Systems
[email protected]
(860) 767-4951
©2014 Walgreen Co. All rights reserved. Confidential and proprietary; should not be re-produced or re-distributed.
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