Utilizing Care Coordination to Address Medication Management Stuart Beatty, PharmD, BCACP, CDE, FAPhA Associate Professor of Clinical Pharmacy The Ohio State University College of Pharmacy Neeraj Tayal MD Director, Division of General Internal Medicine and Geriatrics The Ohio State University Wexner Medical Center
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Setting Value-Based Payment Goals – HHS Efforts to Improve US Health Care Sylvia M. Burwell
“The Department of Health and Human Services now intends to focus its energies on augmenting reform in three… ways. 1. Use incentives to motivate higher value care, by increasingly tying payments to value through alternative payment models. 2. Changing the way care is delivered through greater teamwork and integration, more effective coordination of providers across settings, and greater attention by providers to population health 3. Harnessing the power of information to improve care for patients.” http://www.nejm.org/doi/pdf/10.1056/NEJMp1500445
Comprehensive Primary Care Plus
Care team:PCP Staffing ratio
• PCMH Summit convened Society for General Internal Medicine 2011 • What is the appropriate staffing infrastructure for PCMH? • Reviewed published data, interviewed nine high functioning PCMHs • Proposed PCMH staffing ratio with associated cost The American Journal of Managed Care Vol 19 No 6
Care Coordination by Clinical Pharmacists • Chronic disease management (DM, HTN, Anticoag, CHF, Depression) • Transitional calls after hospital and ER encounters • Population health with registries • ASCVD risk reduction • Immunization • Drug monitoring
• Self management training (insulin, inhalers) • Barriers to attaining medications (cost, handling)
Transitional Care Management
Inpatient Team
AVS Complete
Report symptoms Review medications Self-management Follow-up appointment
Patient & Family
Primary Care Team (PharmD)
Previous Workflow (2013-2016)
Contact patient
Follow TC Smartphrase
Route note to PCP
Yes Primary Care Physician
Review AVS (determine if high risk)
High risk
No
Nothing further
Ensure office visit
Smartphrase (Hospital Discharge)
Transitional Call Volumes (20152017)
Inpatient and ER Team
Report symptoms Review medications Self-management Follow-up appointment
Patient & Family
Primary Care Team (PharmD and Nurse)
Primary Care Physician
New CPC Workflow (2017 - ***)
AVS Complete
Reporting Workbench
Review AVS
Contact Pt (Outreach Encounter)
Follow TC Smartphrase
Route note to PCP
Ensure office visit
Reporting Workbench
Reporting Workbench
Smartphrase (Hosp and ED Discharge)
Population Health Management
Practice-based PHM Process Define population
Generate Report
Implement Intervention Engage Patients
Measure and Track Outcomes
OSU GIM Population Health Management Metformin Herpes zoster 2010
vaccinations
CKD and renal 2011 medication dosing Bisphosphonate use
2013
monitoring
2014 Controlled substance
monitoring
2012
2016 ASCVD risk reduction
Transitional 2013 Care Management
2017
Otsuka S, et al. Am J Med. 2013 126(9):832.e1-6 Barnes KD, et al. Pharmacotherapy. 2014; 34(12): 1330-5. Matthews DE, et al. Ann Pharmcother. 2016; 50(10): 840-6.
PPI Deprescribing
ASCVD Risk Reduction Define population
All Patients of GIM Physicians with the OSU Health Plan
Generate report
Problem List, Medication List Most recent lipid panel values Parameters needed to calculate ASCVD Risk
Implement Intervention Engage Patients
ACC/AHA Guideline for the treatment of blood cholesterol to reduce ASCVD risk in adults
Track and Manage Outcomes
EMR Updated
ASCVD Risk Reduction
6,460 OSUHP patients identified Presence of ASCVD evaluated and/or ASCVD risk calculated if applicable 1,905 patients had recommendation to reduce ASCVD risk
888 recommendations to start or change statin
122 patients started statin/change in statin dose
1,017 patients with recommendation to obtain lipid panel or had not been seen by PCP ≼ 2 years 201 patients had wrong PCP listed by OSUHP
Lessons learned • Place pharmacists in close proximity to physicians • Introduce to your patients as highly trained professionals • Provide up to date hardware/software needs • Start with discrete duties (anticoagulation) • Broaden scope as team culture develops • Perform professional development together • Physicians recognize benefits of partnership rapidly
Next steps – consult agreements • Pharmacist Consult Agreements with Physicians (House bill 188) • Authorize pharmacist under a consult agreement with physician to manage patient drug therapy for specified diagnosis or disease and order and evaluate blood and urine tests • Creates single process for establishing consult agreement • Grants certain immunities for civil liability to pharmacists and physicians practicing under consult agreement
Questions?