6/27/2016 1 Healthcare Trends and Changes – Creating Connectedness and Leveraging Medication Synchronization to Influence Patient Behavior and Drive Adherence Alabama Pharmacy Association Annual Convention June 13, 2016 Assess the power of creating a relationship between the pharmacist and patient through timely, relevant communications Understand how appointment based medication synchronization is changing not only patient behavior, but the way community pharmacies are practicing OBJECTIVES Examine evidence that demonstrates how community pharmacy is impacting adherence and Star ratings through the implementation of these solutions List current healthcare trends that are influencing change within pharmacy practice. Evaluate value-based payment models and quality measures and how they impact community pharmacy practice
Transcript
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Healthcare Trends and Changes –Creating Connectedness and Leveraging Medication
Synchronization to Influence Patient Behavior and Drive Adherence
Alabama Pharmacy Association Annual ConventionJune 13, 2016
Assess the power of creating a relationship between the pharmacist and patient through timely, relevant communications
Understand how appointment based medication synchronization is changing not only patient behavior, but the way community pharmacies are practicing
OBJECTIVES
Examine evidence that demonstrates how community pharmacy is impacting adherence and Star ratings through the implementation of these solutions
List current healthcare trends that are influencing change within pharmacy practice.
Evaluate value-based payment models and quality measures and how they impact community pharmacy practice
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FEE FOR SERVICE REIMBURSEMENTS
HEALTHCARE TREND #1
Troy Trygstad, Making Your Case: Integrating Pharmacists Into New Care Delivery Models, APhA 2016 presentation
Fee-for-service (FFS) reimbursements are subject to downward pressure from the public payer and the continuation of narrowing networks
Troy Trygstad, Making Your Case: Integrating Pharmacists Into New Care Delivery Models, APhA 2016 presentation
Providers are becoming payers, but payers are losing their appetite to become providers, therefore everyone consolidates.
• Health systems – 1 IN 5 will become payers by 2018:• 34% of health systems own health plans• 21% plan on launching a health insurance plan by 2018• Tuffs – Minuteman Health• Piedmont Healthcare and WellStar Health System (Atlanta) - MA
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Examples:• Humana – Medicare Advantage – owned 22 medical centers at the end of
2014 (Florida) staff by PCP and some specialists of which 10,600 PCP “ownership” relationships in 2014 compared to 8,400 in 2013
• UnitedHealth Optum unit that handles medical operations has direct relationship with 17,000 physicians (owns or helps with contracting)
• Anthem purchased CareMore – physician based medical group• Optum absorbed Monarch HealthCare – large physician practice in
California• Highmark (BSBC) bought West Penn Allegheny Health System in Pittsburg,
creating a hospital, physician and health plan network
Consolidation
PAYERS BY 2018
CONSUMERISM
HEALTHCARE TREND #3
Troy Trygstad, Making Your Case: Integrating Pharmacists Into New Care Delivery Models, APhA 2016 presentation
Consumerism will play an increasing role in how we are paid for pharmacy services because health savings accounts have significantly grown.
The consumer will become more in control of how they spend their own dollars on health care. As a result, control shifts from the health plan to the consumer. Consumer choice will be driven by high quality, low cost. 35.3% under age 65 enrolled in HDHP (employer based), half HSA 53.7% under age 65 in HDHP (exchanges)
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Pharma entering into the risk, reward, and outcomes
HEALTHCARE TREND #4
Troy Trygstad, Making Your Case: Integrating Pharmacists Into New Care Delivery Models, APhA 2016 presentation
• ACOs will increasingly look for risk sharing to become part of standard contracting agreements with manufacturers in the near future.
• According to input from 100 accountable care organizations, “8% of Medicare ACOs and 4% of Commercial ACOs already have active risk-sharing programs with manufacturers. The risk-sharing models vary across ACOs, but the message is clear in that the organizations expect manufacturers to have a stake in patient outcomes.” (Kelly, 2014)
• Health care payers and pharmaceutical manufacturers agree to link coverage and reimbursement levels to a drug’s effectiveness and/or how frequently it is utilized.
Increasing Pressure on PBMs to Evolve beyond Drug Cost
HEALTHCARE TREND #5
Troy Trygstad, Making Your Case: Integrating Pharmacists Into New Care Delivery Models, APhA 2016 presentation
Part D Enhanced Medication Therapy Management (“MTM”) Model demonstration
o Medication risk based – risk stratify patientso Expansion of serviceso MTM encounter data – MTM-specific code set – ONCo Prospective funding for enhanced benefits/services that could include
pharmacy or beneficiary incentives - PMPM
Bonus performance payment (via increased premium subsidy)o Achieve 2% reduction in expected FFS expenditureso Request Part A & B claims and ACO alignmento $2 PM increase in gov subsidy to plan premium – lower premium
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NEW PAYMENT MODELS
HEALTHCARE TREND #6
Troy Trygstad, Making Your Case: Integrating Pharmacists Into New Care Delivery Models, APhA 2016 presentation
New payment models are growing rapidly, both in diversity and volume
Health Reform is here…
Sylvia Mathews Burwell, HHS Secretary
“First, is that 30% of all Medicare provider payments will move to alternative payment models in 2016 that are tied to how well providers care for their patients and will get to 50% by 2018.”
“The second goal would be to tie all Medicare fee‐for‐service (FFS) payments to quality and value, achieving at least 85% in 2016 and 90% in 2018.”
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ALTERNATE PAYMENT MODELS
2016 2018
100% 100%
85%90%
30%
50%
Target percentage of Medicare FFS payments linked to quality and alternative payment models in 2016 and 2018
All Medicare FFS (categories 1‐4) FFS linked to quality Alternative payment models (categories 3,4)
ALTERNATE PAYMENT MODELSExamples:
1. Accountable Care Organizations‐MSSP, Next Gen
2. Patient Centered Medical Home3. Bundled Payments4. Integrated care demonstrations for Medicaid/Medicare enrollees (i.e. MLS regs)
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with Medicare Access & CHIP Reauthorization Act - MACRA (2015)
QUALITY FOCUS
Reference: Sam Stolpe, PharmD, Quality Metrics and Value‐based Payments, NASPA 2016
Paying physicians – the “old” way- Medicare Physician Fee Schedule (MPFS)- Sustainable growth rate (SGR) formula- Ensure that Medicare increases did no exceed growth in GDP
‐Resulted in frequent “doc fixes” by Congress
New method: Merit-based Incentive Payment (MIPS)- Consolidates the current Medicare FFS incentive
programs into one system under MACRA - Adds a new clinical practice improvement measure
Reference: Sam Stolpe, PharmD, Quality Metrics and Value‐based Payments, NASPA 2016
Physician given a publicity report score of 1-100- Quality measures (PQRS)- Efficiency measures/Resource use (Value-based Modifier)- Meaningful use of electronic health rescores (MU)- Clinical practice improvement activities
Physician performance rewarded or penalized- Thresholds established based on mean performance composites- Providers scoring below threshold subject to payment reductions
- -4% in 2018, -5% in 2020, -7% in 2021, -9% in 2022- Providers scoring above threshold receive bonuses (funded by penalties)
- +12% in 2019, +15% in 2020, +21% in 2021, +27% in 2022- $500M bonus pool for “best of best”
Providers in alternative models may opt out
MERIT-BASED (MIPS)
INCENTIVE PAYMENTS
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The Star Rating now affects payment to Medicare Advantage plans in which higher-rated plans get higher payment
MEDICARE INCENTIVES
Quality Bonus Payments (QBPs) are being awarded on a sliding scale according to the Star Ratings
Sam Stolpe, PharmD, Quality Metrics and Value‐based Payments,, NASPA 2016
2016 payments will be based on 2015 ratings which are based on 2013 and 2014 data
QBP opportunity for many large MA-PDs exceed $100 million
QUALITY BONUS PAYMENTS
Annual ratings of Medicare plans that are made available on Medicare Plan Finder and CMS website
• Ratings are displayed as 1 to 5 Stars• Stars are calculated for each measure, as well as each domain, summary and overall • Part C Stars include 32 measures of quality and Part D include 15 measures of quality
MEDICARE C & DSTAR RATINGS
Two –year lag between “year of service” and reporting year for Star ratings
• 2014 drug claims are used for 2016 Star Ratings• 2016 Star Ratings were released in October 2015 to inform beneficiaries who were
enrolling for 2016
Sam Stolpe, PharmD, Quality Metrics and Value‐based Payments,, NASPA 2016
Worst Performers for Part D• Several Medicare contracts received a “low performer icon” which means that they
have consistently been below 3 stars• Over 100 contracts had 2 Star or lower on all PQA adherence measures
Sam Stolpe, PharmD, Quality Metrics and Value‐based Payments,, NASPA 2016
Removal from Medicare for continued poor overall performance (<3 Stars for 3 years in a row)
Medicare drug plans receive an overall rating on quality assurance domain scores (32 measures total in 2016)
STAR RATINGSPART C
Pharmacists can affect Part C measures in several ways:1. C03 Annual Flu Vaccine2. C05 Improving or Maintaining Mental Health 3. C12 Osteoporosis Management in Women who had a 4. C17 Rheumatoid Arthritis Management 5. C14 Diabetes Care , C15 Diabetes Care x36. C16 Controlling Blood Pressure Chronic Management Services x37. C04 Improving or Maintaining Physical Health, C06 Monitoring Physical Activity, 8. C07 Adult BMI Assessment – provide BMI/Biometric screenings9. C11 Care for Older Adults – Pain Assessment Pain management and opioid use10. C09 Care for Older Adults – Medication Review, 11. C10 Care for Older Adults – Functional Status Assessment C18 Reducing the Risk of C19 Plan All‐
Cause Readmissions Transitional Care Services
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Medicare drug plans receive an overall rating on quality assurance domain scores (15 measures total in 2016)
STAR RATINGSPART D
Domain on safety contains 5 measures:1. D11 High Risk Medication X32. D12 Medication Adherence for Diabetes X33. D13 Medication Adherence for Hypertension (RAS antagonists) X34. D14 Medication Adherence for Cholesterol (Statins) X35. D15 MTM Program Completion Rate for CMR X1*Part D Display Measure ‐ Statin Use in Person with Diabetes
Due to the higher weighting of clinically relevant measures, the PQA medications use measures account for 43% of Part D Star ratings for 2016
National Report Card on Medication Adherenceidentified the six key predictors of medication adherence
NCPA. (2013). Medication Adherence in America A National Report Card . Washington, D.C.: Langer Research Associates.
The extent to which their medication causes unpleasant side effects06
How well informed they feel about their health
How important patients feel it is to take their medication exactly as prescribed
The level of continuity they have in their health care
How easy it is for them to afford their medications
Patients’ personal connection with a pharmacist or pharmacy staff
0504030201
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HOW DO WE ADDRESS THESE REASONS
NON-ADHERENCE
NCPA. (2013). Medication Adherence in America A National Report Card . Washington, D.C.: Langer Research Associates.
DRIVE PATIENT RELATIONSHIP
HELP THEM REMEMBER
PHARMACY
CONNECTEDNESSPatients who obtain their medication by mail are significantly less likely than others to feel that someone at their prescription provider knows them pretty well
Connectedness peaks among those who use an independent neighborhood pharmacy
NCPA. (2013). Medication Adherence in America A National Report Card . Washington, D.C.: Langer Research Associates.
36%MAIL
ORDER
67%CHAINPHARM
89%NEIGHBOR PHARM
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NEW PATIENTWELCOME
HAPPYBIRTHDAY
WILL CALL BINMANAGEMENT
QUARTERLYEVENTS
ON-DEMANDCAMPAIGNS
CLINICAL REFILL REMINDERS
AUTOMATED, DIGITAL
COMMUNICATIONS
Voice of the PharmacistRecord messages to be sent to patients,
helping providers deliver timely information with a personal feel without
hiring any additional staff.
Relevant MessagingEasily deliver messages which are
important and relevant to the patient:Clinical Refill Reminders, Birthday, Will
Call Bin, Special Events etc.
Pharmacy Loyalty Results High Touch
Utilize behavior analytics, selective segmentation and market-tested
campaigns to improve adherence and loyalty.
CRAFTING A
COMMUNICATIONConduct needs analysis
Write the message
Beta-test the message
Patient“Pre-Condition”
Patient“Post-Condition”
Communication
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ARE SHRINKING
ATTENTION SPANS
Data: Grove Microlearning Infographic
12 sec 8 sec
2000 2013
How can we communicate with patients clearly and concisely?
Use short sentences
CDC Resource: Everyday Words for Public Communication
Assessment
PLAIN LANGUAGE
Chronic
test
life-long
Individuals you
More effective works better
Use the active voice
Use everyday words
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WRITING THE
MESSAGE
20%0 sec 35 sec10%35%35%
Establish Voice of Authority Contact Information
Personal Closing
Key Take Away
Use Short Sentences Use the Active Voice Use Everyday Words
OUTCOMES
Clinical Refill Reminder calls have cut days late by 50%.
Flu Campaigns have increased immunizations by up to 500% year-over-year.
Will Call Bin Management campaigns have seen a 30% reduction in return-to-stock.
New patients who receive a Welcome Call are 22% more likely to bring their next fill to that pharmacy.
HERE ARE THE
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MED SYNCAPPOINTMENT BASED
More than synchronizing patient’s medications so they come due on the same day of the month
Changing the way pharmacies are practicing – from reactive to proactive engagement with their patients
Should become the standard of care for pharmacies in the future
Why Med Sync?Adherence
Schedule an appointment with patientOpportunity for additional patient interventions
Adherence Star MeasuresDiabetes, Hypertension and Cholesterol for targeted patient populations
Today 6,000+ Pharmacies are Performing Med Sync
4.5M Medicare patients out of 132k total patients are synched
APPOINTMENT-BASEDMEDICATION SYNCHRONIZATION
Identify Recruit Conduct Sustain
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Med Sync patients were over 2.5 times more likely
to be adherent to medications.
79%Patients who received ABMS services were
79% more likely to continue their prescription drug regimen.
MED SYNCTHE IMPACT OF
RESULTS TELL THE STORYOUTCOMS
32%INCREASE
FACTSJUST THE
One 1,000+ member PSAO increased its overall Star Ratings from 3.1 to 4.1 in the first year of working with PW 4%
IN 4 MONTHS
One 30+ store pilot group increased its overall Star Ratings from 3.9 to 4.1 in just the first 4 months of working with PW
2.5TIMES
One 80+ store pilot group using PW proved patients were 2.5 times more adherent than the control group of patients using the same pharmacy
2.7MILLION
One 500+ member GPO showed an increase of 2.7 Million fills year over year while working with PW
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Immunizations
Clinical Tests,
Biometrics
Disease StateManagement
ComprensiveMedication
Review, Med Rec, TOC
APPOINTMENTAdditional Services Centered around the
COMPREHENSIVE PHARMACY CARE MANAGEMENT
COMMON TYPES OF PHARMACY RATES AND CONCESSIONS CAPTURED AS *DIR
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