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Partners in Care Foundation Sandy Atkins VP Institute for Change
Dennee Frey PharmD Program Consultant
Adaptable Evidence-based Medication Safety Improvement Intervention
Opening the door to CBO-Healthcare Partnerships
Agenda
bull Introduce Partners in Care amp HomeMeds
bull Contribution community agencies can make to medication safety using HomeMeds
bull The evidence base and the intervention
bull The software
bull User experiences amp innovative applications
bull Getting started with HomeMeds
bull Q amp A
Partners in Care Foundation Who We Are bull Partners in Care serves as a catalyst for
shaping a new vision of healthcare by partnering with organizations families and community leaders in the work of changing healthcare systems changing communities and changing livesmdashfocusing on home and community care
bull We evolved from the VNA of Los Angeles to be a nimble force for change
The Problem
bullMedication Errors are
ndash Serious Over 700000 people go to ED each year for adverse drug events
ndash Costly Drug-related morbiditymortality gt $170 billion (ER hospitalreadmissions SNF use etc)
ndash Common Up to 48 of community-dwelling elders have medication-related problems
ndash Preventable At least 25 of all harmful adverse drug events are preventable
The Solution HomeMeds
bull HomeMeds is designed to enable community agencies to keep people at home amp out of hospital by addressing medication safety
bull Practice change with workforcessettings that already go to the home ndash more cost effective use of existing effort
bull Focus on potential adverse effects (falls vitals confusion) hellip then determine if medications may be part of the cause
HOMEMEDS BRIDGE FROM HOME TO HEALTHCARE
ldquoAny symptom in an elderly patient should be considered a drug side effect until proved otherwiserdquo (Gurwitz et al 1995)
Why should non-healthcare agencies work on medication safety
bull To thrive CBOs need to play a new role connecting the home with the healthcare system
ndash Medications are a huge factor in readmissions
ndash Home provides unique perspective otherwise unavailable to healthcare providers
ndash New focus on population health ndash identifying and proactively addressing health for high-risk patients
ndash Quality measures for health plans and providers relate to issues such as medication use and fall prevention
ndash Home medication reconciliation is a national patient-safety goal
Medications amp Care Transitions
from Mary Andrawis PharmD CMMI presentation to Drug Safety Panel May 10 2011 (cite Forster et al Annals of Internal Medicine 2003 128 161-167 CMAJ FEB 3 2004 170 (3)
Home visit uncovers many ldquosecretsrdquohellip that prescribers may not know about
bull OTCs ndash Over-the-counter medications
bull Prescriptions from other other providers
bull Adverse effects such as falls dizziness confusion
bull Adherence issues
bull Out of system meds Drugs from other countries borrowed Wal-Mart $4
Quality Measures Now Tied to $$$
bull Star Ratings ndash Medicare Advantage ndash Yearly review of all medications and supplements being taken
ndash Yearly pain screening or pain management plan
ndash Controlling blood pressure
ndash Reducing risk of falling
ndash Readmission to a hospital within 30 days of being discharged
bull HEDIS for physicians ndash Percentage of Medicare members 66+ who received at least
one high-risk medication
ndash Fall Risk Management Discussion amp Management
ndash Potentially Harmful Drug-Disease Interactions
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Agenda
bull Introduce Partners in Care amp HomeMeds
bull Contribution community agencies can make to medication safety using HomeMeds
bull The evidence base and the intervention
bull The software
bull User experiences amp innovative applications
bull Getting started with HomeMeds
bull Q amp A
Partners in Care Foundation Who We Are bull Partners in Care serves as a catalyst for
shaping a new vision of healthcare by partnering with organizations families and community leaders in the work of changing healthcare systems changing communities and changing livesmdashfocusing on home and community care
bull We evolved from the VNA of Los Angeles to be a nimble force for change
The Problem
bullMedication Errors are
ndash Serious Over 700000 people go to ED each year for adverse drug events
ndash Costly Drug-related morbiditymortality gt $170 billion (ER hospitalreadmissions SNF use etc)
ndash Common Up to 48 of community-dwelling elders have medication-related problems
ndash Preventable At least 25 of all harmful adverse drug events are preventable
The Solution HomeMeds
bull HomeMeds is designed to enable community agencies to keep people at home amp out of hospital by addressing medication safety
bull Practice change with workforcessettings that already go to the home ndash more cost effective use of existing effort
bull Focus on potential adverse effects (falls vitals confusion) hellip then determine if medications may be part of the cause
HOMEMEDS BRIDGE FROM HOME TO HEALTHCARE
ldquoAny symptom in an elderly patient should be considered a drug side effect until proved otherwiserdquo (Gurwitz et al 1995)
Why should non-healthcare agencies work on medication safety
bull To thrive CBOs need to play a new role connecting the home with the healthcare system
ndash Medications are a huge factor in readmissions
ndash Home provides unique perspective otherwise unavailable to healthcare providers
ndash New focus on population health ndash identifying and proactively addressing health for high-risk patients
ndash Quality measures for health plans and providers relate to issues such as medication use and fall prevention
ndash Home medication reconciliation is a national patient-safety goal
Medications amp Care Transitions
from Mary Andrawis PharmD CMMI presentation to Drug Safety Panel May 10 2011 (cite Forster et al Annals of Internal Medicine 2003 128 161-167 CMAJ FEB 3 2004 170 (3)
Home visit uncovers many ldquosecretsrdquohellip that prescribers may not know about
bull OTCs ndash Over-the-counter medications
bull Prescriptions from other other providers
bull Adverse effects such as falls dizziness confusion
bull Adherence issues
bull Out of system meds Drugs from other countries borrowed Wal-Mart $4
Quality Measures Now Tied to $$$
bull Star Ratings ndash Medicare Advantage ndash Yearly review of all medications and supplements being taken
ndash Yearly pain screening or pain management plan
ndash Controlling blood pressure
ndash Reducing risk of falling
ndash Readmission to a hospital within 30 days of being discharged
bull HEDIS for physicians ndash Percentage of Medicare members 66+ who received at least
one high-risk medication
ndash Fall Risk Management Discussion amp Management
ndash Potentially Harmful Drug-Disease Interactions
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Partners in Care Foundation Who We Are bull Partners in Care serves as a catalyst for
shaping a new vision of healthcare by partnering with organizations families and community leaders in the work of changing healthcare systems changing communities and changing livesmdashfocusing on home and community care
bull We evolved from the VNA of Los Angeles to be a nimble force for change
The Problem
bullMedication Errors are
ndash Serious Over 700000 people go to ED each year for adverse drug events
ndash Costly Drug-related morbiditymortality gt $170 billion (ER hospitalreadmissions SNF use etc)
ndash Common Up to 48 of community-dwelling elders have medication-related problems
ndash Preventable At least 25 of all harmful adverse drug events are preventable
The Solution HomeMeds
bull HomeMeds is designed to enable community agencies to keep people at home amp out of hospital by addressing medication safety
bull Practice change with workforcessettings that already go to the home ndash more cost effective use of existing effort
bull Focus on potential adverse effects (falls vitals confusion) hellip then determine if medications may be part of the cause
HOMEMEDS BRIDGE FROM HOME TO HEALTHCARE
ldquoAny symptom in an elderly patient should be considered a drug side effect until proved otherwiserdquo (Gurwitz et al 1995)
Why should non-healthcare agencies work on medication safety
bull To thrive CBOs need to play a new role connecting the home with the healthcare system
ndash Medications are a huge factor in readmissions
ndash Home provides unique perspective otherwise unavailable to healthcare providers
ndash New focus on population health ndash identifying and proactively addressing health for high-risk patients
ndash Quality measures for health plans and providers relate to issues such as medication use and fall prevention
ndash Home medication reconciliation is a national patient-safety goal
Medications amp Care Transitions
from Mary Andrawis PharmD CMMI presentation to Drug Safety Panel May 10 2011 (cite Forster et al Annals of Internal Medicine 2003 128 161-167 CMAJ FEB 3 2004 170 (3)
Home visit uncovers many ldquosecretsrdquohellip that prescribers may not know about
bull OTCs ndash Over-the-counter medications
bull Prescriptions from other other providers
bull Adverse effects such as falls dizziness confusion
bull Adherence issues
bull Out of system meds Drugs from other countries borrowed Wal-Mart $4
Quality Measures Now Tied to $$$
bull Star Ratings ndash Medicare Advantage ndash Yearly review of all medications and supplements being taken
ndash Yearly pain screening or pain management plan
ndash Controlling blood pressure
ndash Reducing risk of falling
ndash Readmission to a hospital within 30 days of being discharged
bull HEDIS for physicians ndash Percentage of Medicare members 66+ who received at least
one high-risk medication
ndash Fall Risk Management Discussion amp Management
ndash Potentially Harmful Drug-Disease Interactions
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
The Problem
bullMedication Errors are
ndash Serious Over 700000 people go to ED each year for adverse drug events
ndash Costly Drug-related morbiditymortality gt $170 billion (ER hospitalreadmissions SNF use etc)
ndash Common Up to 48 of community-dwelling elders have medication-related problems
ndash Preventable At least 25 of all harmful adverse drug events are preventable
The Solution HomeMeds
bull HomeMeds is designed to enable community agencies to keep people at home amp out of hospital by addressing medication safety
bull Practice change with workforcessettings that already go to the home ndash more cost effective use of existing effort
bull Focus on potential adverse effects (falls vitals confusion) hellip then determine if medications may be part of the cause
HOMEMEDS BRIDGE FROM HOME TO HEALTHCARE
ldquoAny symptom in an elderly patient should be considered a drug side effect until proved otherwiserdquo (Gurwitz et al 1995)
Why should non-healthcare agencies work on medication safety
bull To thrive CBOs need to play a new role connecting the home with the healthcare system
ndash Medications are a huge factor in readmissions
ndash Home provides unique perspective otherwise unavailable to healthcare providers
ndash New focus on population health ndash identifying and proactively addressing health for high-risk patients
ndash Quality measures for health plans and providers relate to issues such as medication use and fall prevention
ndash Home medication reconciliation is a national patient-safety goal
Medications amp Care Transitions
from Mary Andrawis PharmD CMMI presentation to Drug Safety Panel May 10 2011 (cite Forster et al Annals of Internal Medicine 2003 128 161-167 CMAJ FEB 3 2004 170 (3)
Home visit uncovers many ldquosecretsrdquohellip that prescribers may not know about
bull OTCs ndash Over-the-counter medications
bull Prescriptions from other other providers
bull Adverse effects such as falls dizziness confusion
bull Adherence issues
bull Out of system meds Drugs from other countries borrowed Wal-Mart $4
Quality Measures Now Tied to $$$
bull Star Ratings ndash Medicare Advantage ndash Yearly review of all medications and supplements being taken
ndash Yearly pain screening or pain management plan
ndash Controlling blood pressure
ndash Reducing risk of falling
ndash Readmission to a hospital within 30 days of being discharged
bull HEDIS for physicians ndash Percentage of Medicare members 66+ who received at least
one high-risk medication
ndash Fall Risk Management Discussion amp Management
ndash Potentially Harmful Drug-Disease Interactions
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
The Solution HomeMeds
bull HomeMeds is designed to enable community agencies to keep people at home amp out of hospital by addressing medication safety
bull Practice change with workforcessettings that already go to the home ndash more cost effective use of existing effort
bull Focus on potential adverse effects (falls vitals confusion) hellip then determine if medications may be part of the cause
HOMEMEDS BRIDGE FROM HOME TO HEALTHCARE
ldquoAny symptom in an elderly patient should be considered a drug side effect until proved otherwiserdquo (Gurwitz et al 1995)
Why should non-healthcare agencies work on medication safety
bull To thrive CBOs need to play a new role connecting the home with the healthcare system
ndash Medications are a huge factor in readmissions
ndash Home provides unique perspective otherwise unavailable to healthcare providers
ndash New focus on population health ndash identifying and proactively addressing health for high-risk patients
ndash Quality measures for health plans and providers relate to issues such as medication use and fall prevention
ndash Home medication reconciliation is a national patient-safety goal
Medications amp Care Transitions
from Mary Andrawis PharmD CMMI presentation to Drug Safety Panel May 10 2011 (cite Forster et al Annals of Internal Medicine 2003 128 161-167 CMAJ FEB 3 2004 170 (3)
Home visit uncovers many ldquosecretsrdquohellip that prescribers may not know about
bull OTCs ndash Over-the-counter medications
bull Prescriptions from other other providers
bull Adverse effects such as falls dizziness confusion
bull Adherence issues
bull Out of system meds Drugs from other countries borrowed Wal-Mart $4
Quality Measures Now Tied to $$$
bull Star Ratings ndash Medicare Advantage ndash Yearly review of all medications and supplements being taken
ndash Yearly pain screening or pain management plan
ndash Controlling blood pressure
ndash Reducing risk of falling
ndash Readmission to a hospital within 30 days of being discharged
bull HEDIS for physicians ndash Percentage of Medicare members 66+ who received at least
one high-risk medication
ndash Fall Risk Management Discussion amp Management
ndash Potentially Harmful Drug-Disease Interactions
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HOMEMEDS BRIDGE FROM HOME TO HEALTHCARE
ldquoAny symptom in an elderly patient should be considered a drug side effect until proved otherwiserdquo (Gurwitz et al 1995)
Why should non-healthcare agencies work on medication safety
bull To thrive CBOs need to play a new role connecting the home with the healthcare system
ndash Medications are a huge factor in readmissions
ndash Home provides unique perspective otherwise unavailable to healthcare providers
ndash New focus on population health ndash identifying and proactively addressing health for high-risk patients
ndash Quality measures for health plans and providers relate to issues such as medication use and fall prevention
ndash Home medication reconciliation is a national patient-safety goal
Medications amp Care Transitions
from Mary Andrawis PharmD CMMI presentation to Drug Safety Panel May 10 2011 (cite Forster et al Annals of Internal Medicine 2003 128 161-167 CMAJ FEB 3 2004 170 (3)
Home visit uncovers many ldquosecretsrdquohellip that prescribers may not know about
bull OTCs ndash Over-the-counter medications
bull Prescriptions from other other providers
bull Adverse effects such as falls dizziness confusion
bull Adherence issues
bull Out of system meds Drugs from other countries borrowed Wal-Mart $4
Quality Measures Now Tied to $$$
bull Star Ratings ndash Medicare Advantage ndash Yearly review of all medications and supplements being taken
ndash Yearly pain screening or pain management plan
ndash Controlling blood pressure
ndash Reducing risk of falling
ndash Readmission to a hospital within 30 days of being discharged
bull HEDIS for physicians ndash Percentage of Medicare members 66+ who received at least
one high-risk medication
ndash Fall Risk Management Discussion amp Management
ndash Potentially Harmful Drug-Disease Interactions
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Why should non-healthcare agencies work on medication safety
bull To thrive CBOs need to play a new role connecting the home with the healthcare system
ndash Medications are a huge factor in readmissions
ndash Home provides unique perspective otherwise unavailable to healthcare providers
ndash New focus on population health ndash identifying and proactively addressing health for high-risk patients
ndash Quality measures for health plans and providers relate to issues such as medication use and fall prevention
ndash Home medication reconciliation is a national patient-safety goal
Medications amp Care Transitions
from Mary Andrawis PharmD CMMI presentation to Drug Safety Panel May 10 2011 (cite Forster et al Annals of Internal Medicine 2003 128 161-167 CMAJ FEB 3 2004 170 (3)
Home visit uncovers many ldquosecretsrdquohellip that prescribers may not know about
bull OTCs ndash Over-the-counter medications
bull Prescriptions from other other providers
bull Adverse effects such as falls dizziness confusion
bull Adherence issues
bull Out of system meds Drugs from other countries borrowed Wal-Mart $4
Quality Measures Now Tied to $$$
bull Star Ratings ndash Medicare Advantage ndash Yearly review of all medications and supplements being taken
ndash Yearly pain screening or pain management plan
ndash Controlling blood pressure
ndash Reducing risk of falling
ndash Readmission to a hospital within 30 days of being discharged
bull HEDIS for physicians ndash Percentage of Medicare members 66+ who received at least
one high-risk medication
ndash Fall Risk Management Discussion amp Management
ndash Potentially Harmful Drug-Disease Interactions
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Medications amp Care Transitions
from Mary Andrawis PharmD CMMI presentation to Drug Safety Panel May 10 2011 (cite Forster et al Annals of Internal Medicine 2003 128 161-167 CMAJ FEB 3 2004 170 (3)
Home visit uncovers many ldquosecretsrdquohellip that prescribers may not know about
bull OTCs ndash Over-the-counter medications
bull Prescriptions from other other providers
bull Adverse effects such as falls dizziness confusion
bull Adherence issues
bull Out of system meds Drugs from other countries borrowed Wal-Mart $4
Quality Measures Now Tied to $$$
bull Star Ratings ndash Medicare Advantage ndash Yearly review of all medications and supplements being taken
ndash Yearly pain screening or pain management plan
ndash Controlling blood pressure
ndash Reducing risk of falling
ndash Readmission to a hospital within 30 days of being discharged
bull HEDIS for physicians ndash Percentage of Medicare members 66+ who received at least
one high-risk medication
ndash Fall Risk Management Discussion amp Management
ndash Potentially Harmful Drug-Disease Interactions
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Home visit uncovers many ldquosecretsrdquohellip that prescribers may not know about
bull OTCs ndash Over-the-counter medications
bull Prescriptions from other other providers
bull Adverse effects such as falls dizziness confusion
bull Adherence issues
bull Out of system meds Drugs from other countries borrowed Wal-Mart $4
Quality Measures Now Tied to $$$
bull Star Ratings ndash Medicare Advantage ndash Yearly review of all medications and supplements being taken
ndash Yearly pain screening or pain management plan
ndash Controlling blood pressure
ndash Reducing risk of falling
ndash Readmission to a hospital within 30 days of being discharged
bull HEDIS for physicians ndash Percentage of Medicare members 66+ who received at least
one high-risk medication
ndash Fall Risk Management Discussion amp Management
ndash Potentially Harmful Drug-Disease Interactions
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Quality Measures Now Tied to $$$
bull Star Ratings ndash Medicare Advantage ndash Yearly review of all medications and supplements being taken
ndash Yearly pain screening or pain management plan
ndash Controlling blood pressure
ndash Reducing risk of falling
ndash Readmission to a hospital within 30 days of being discharged
bull HEDIS for physicians ndash Percentage of Medicare members 66+ who received at least
one high-risk medication
ndash Fall Risk Management Discussion amp Management
ndash Potentially Harmful Drug-Disease Interactions
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HomeMeds Saves Money Saves Lives
bull Falls and other adverse effects improved through collaboration between pharmacists and members of the care team
bull 467 of older adults screened in 14 sites from 2007 to 2010 had risk for medication-related injury
bull Estimated Savings from 7000 Screenings up to $15 million
HRSA 2010 wwwhrsagovpatientsafety
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
ROI for MTM Medication Therapy Management
bull Five core components of MTM 121 ROI Highly targeted MTM in Medicaid Health Plan
ndash General MTM has ROI of 151 to 41
ndash Cost $240 per patient
ndash Savings $3235 per patient (net of admin cost copays etc) in decreased utilization (facilities professional services and prescriptions)
Clinical and economic outcomes of medication therapy management services the Minnesota experience Isetts BJ Schondelmeyer SW Artz MB Lenarz LA Heaton AH Wadd WB Brown LM Cipolle RJ J Am Pharm Assoc 2008 Mar-Apr48(2)203-11
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Expected Results
Lower Cost
Fewer falls improved BP control less confusion etc
Improved medication use
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
WHATrsquoS IT ALL ABOUT Dennee Frey PharmD
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Evidence-Based Origins
bull Vanderbilt University ndash John A Hartford Foundation Funds ndash RCT proved efficacy in home health
ndash Based on a pharmacist-nurse collaboration to identify amp resolve errors
ndash Results bull 19 had potential medication problems
bull Medication use improved in 50 of patients (compared to 38 of controls) when pharmacist collaborated with home health staff
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HomeMeds Further Evidence
AoA Funds and USC Evaluation
bull In Medicaid Waiver for Dual Eligibles (nursing-home eligible living at home)
ndash Social workers amp nurses collected data
bull Resultssup1sup2 49 had potential medication problems
ndash After pharmacist review 29 of all waiver clients required physician intervention
bull Medication use improved in 61 of clients 1 Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid Waiver Services Alkema GE Wilber KW Enguidanos
SM and Frey D The Annals of Pharmacotherapy December 2007 Volume 41 2 The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults Receiving Medicaid Waiver Services Alkema G
Enguidanos S Wilber K Trufasiu M and Frey D The Consultant Pharmacist Feb-2009 V24 No 2
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HomeMeds Evidence-based Recognition
bull AoA recognition as an evidence-based prevention program ndash Highest Level of Evidence
bull National Registry of Evidence-based Programs and Practices (httpnreppsamhsagov) (soon to be published)
bull Quality of research 324 bull Readiness for dissemination 44
bull US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
bull Strong evidence rating
httpwwwinnovationsahrqgovcontentaspxid=2841)
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Risk-Screening Protocols bull Identified by national expert consensus panel sup1
bull Targets problems that can be identified and resolved in the home ndash Positive response by prescribers
ndash Minimize ldquoalert overloadrdquo based on signssymptoms
1 Unnecessary therapeutic duplication
2 Use of psychotropic drugs in patients with a reported recent fall andor confusion
3 Use of non-steroidal anti-inflammatory drugs (NSAID) in patients at risk of peptic ulcergastrointestinal bleeding
4 Cardiovascular medication problems
bull High BP low pulse orthostasis and low systolic BP
bull Limited to only these medication-related problems sup1A model for improving medication use in home health care patients Brown N J Griffin M R Ray W A Meredith S Beers M H Marren J
Robles M Stergachis A Wood A J amp Avorn J (1998) Journal of the American Pharmaceutical Association 38 (6) 696-702
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Fidelity to Core Components
bull Comprehensive medication inventory amp assessment
bull Collect data on falls dizziness confusion vitals
bull Risk screening per protocols
bull Review of alerts amp clinical signs by a pharmacist
bull Written recommendations from pharmacist to prescribers
bull Follow through with MD andor clientfamily
bull Documentation of all actions and results
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HomeMeds Intervention Process
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
ldquoWersquore not a medical programhelliprdquo ldquohellipbut yoursquore in the homerdquo
bull Already visit home and collect medication and
other assessment information
bull Coordination amp communication role
bull Trust of clients
bull Focused on delaying institutionalization
bull Funding ndash Title III-D amp Waiver purchase of
service
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Roles of the pharmacist
bull Screen alerts to confirm problems
bull Communicate with prescribers
bull Consult with care manager
bull Identify problems beyond protocols
bull Assist with complex cases
bull Educate staff about medicationsrisks
bull Avg 30 minclient
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Case presentation A 76 year old woman with several chronic conditions recently
admitted to waiver program reported taking six medications and experiencing dizziness over the past several months
Screening 2 alerts therapeutic duplication and dizziness 2 beta blockers atenolol 50 mg and metoprolol 100 mg Pharmacist Reviewconsultation recommended that the case
manager verify that the client was taking both beta blockers regularly
Confirmation RNCM confirmed the duplication and contacted the primary care physician to report the duplication and medication-related dizziness and requested one of the beta-blockers be discontinued
Follow-up The care manager then followed-up with the client to assure the MD orders were carried out and that the client understood how to take her medications correctly
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HOMEMEDS BRINGING IT HOME WITH STORIES OF SUCCESS
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Consumer Feedbackhellip
Mr Johnson went from 20 meds to just 8
ldquoYou have saved us money on monthly refills and my life We cannot thank you enoughrdquo
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Clinician Feedback I called the MDs office and Dr A actually answered the phone He was very concerned about the client and definitely wants to follow-up with her He really appreciated knowing about the falls especially given aspirin amp Advil use because of the potential for bleeding wfalls - Pharmacist consultant found that PA was refilling Valium wo MD awareness
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Agency Feedback ldquoAvoiding a potential train wreckhelliprdquo
bull ldquoJust thought you would like to know about our first alert (Three blood thinners from three different physicians amongst other problems)rdquo ndash Pharmacist consultant (School of Pharmacy)
ldquoWersquove had one case so far and itrsquos proven to be a good learninghellipWe were communicating with who we thought was the primary physician last week based on the name on the prescriptions It turned out that the initial physician hasnrsquot seen the patient in over a year ndash not goodrdquo
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
User Feedback Implementation and Impact bull Pharmacist time for med reviews 15-45 min
bull Seniors living at home without supports received the greatest benefit
bull Positive feedback on having a comprehensive med list
bull Hospitals Health Plans amp community providers recognize the problem and understand value of this service
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
AAA in Tarrant County TX
bull Caregivers have positive response
ndash Beneficial to gain better understanding of their loved onesrsquo medications and provides confidence when accompanying them to doctors visits
bull Don Smith Director Tarrant County AAA ldquoHomeMeds is the easiest of all evidence-based programs to implement We can see results - decrease in number of medications decrease in falls pre amp postrdquo
29
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HOMEMEDS RISK-SCREENING SOFTWARE ASK FOR A DEMO
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HomeMeds Software Demo
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HomeMeds Software Dashboard
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HomeMeds Software Risk Assessment
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HomeMeds Software Medications
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HomeMeds Software Alerts
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HOMEMEDS INNOVATIVE ADAPTATIONS amp SUSTAINABILITY
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Whorsquos Implementing HomeMeds
bull Medicaid 1915(c) Waiver programs for Dual Eligibles
bull Care Transition programs
bull CBO under contract with medical groups
bull Area Agencies on Aging amp Senior Centers
bull Meals on Wheels
bull Home HealthHomecare Agencies
bull Assisted Living amp Affordable Housing
bull Native American Tribal Community
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Innovative Applications ndash Partners in Care Los Angeles bull Contract with at-risk medical group
bull Targeted one-time home visit by social worker
bull HomeMeds screening and general safety assessment (ADLs environment cognitive status caregiverfamily support PHQ-29)
bull HomeMeds pharmacist intervention
bull Reports to Case Manager PCP EHR system
bull Care plan and referrals
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Targeting Criteria for a Home Visit
1Age 65+ and 2EDhospital use in past year plus
a) Five or more prescribed meds or
b) Warfarinantiplatelet or insulindiabetes meds or
c) Dx CHF COPD depression anxiety bipolar psychosis or
d) Mild cognitive impairment or
e) Recent treatment for fall or confusion or
f) Age 80+ or
g) Any patient there is a concern about
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
bull MOW target 1500 clients
ndash Pharm Tech doing data entry
ndash 80 had alerts
ndash 180400 had at least one fall in last 3 months and a number had dizziness related to the fall
bull Local Fall Prevention Coalition ndash Fire Dept mapped frequent fallers
ndash Target MOB classes and HomeMeds outreach
ndash Provide alternative to 911
40
HomeMeds in Tarrant County TX
ldquoHomeMeds integrates really well with CDSMP and MOB Each has a module on medication management and HomeMeds reinforces this and integrates and is easy to refer people tordquo
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
The Future for HomeMeds bull Make HomeMeds a standard of care for
home-based services care transitions etc
bull All home visit programs ndash health amp social service
bull Enhance technology (and policy) for ease of use
bull SAMHSA alcohol and prescription drug use screening amp additional clinical protocols
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
GETTING STARTED ndash THE NITTY GRITTY
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Our Process Planning amp Decisions
bull Readiness Assessment (online SurveyMonkey)
ndash Executives show higher readiness than supervisors and those who must implement
bull Choose Protocols
ndash At times vital signs not available due to scope of practice concerns
bull Data entry variations
ndash Real-time data entry or person who collected data best
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Planning for Challenges
bull Fear of liability by agency staff
ndash Social work role is in-home information gathering and communication
bull Individual consents from care management clients
ndash Review amp update contracts
ndash Avoid a separate consent if possible
ndash Provide an opt-out rather than an opt-in choice
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
What does it cost bull Planning setup consultation support
bull $3000 one-time fee
bull Software license
bull From $200month for up to 50 new clients createdmo
bull Negotiate shared licenses for smaller sites
bull Training
bull $5000 on-site plus travel (shared multisite OK)
bull $250 per refresher webinar (after year 1)
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Covering the cost bull Software Startup amp Pharmacist
ndash Older Americans Act Title III-D
bull Pharmacist coverage alternatives
ndash Pharmacy School ndash students amp supervision
ndash Waiver purchase-of-service dollars
ndash Volunteer community pharmacist
ndash Medicare MTM Medication Therapy Management (through local pharmacy or patientrsquos Part D plan
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
Conclusion
HomeMeds is a proven tool for improved medication safety health and well-being for older adults
It is an affordable evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230
HomeMeds Call us or email us
Email us at HomeMedspicforg
HomeMeds Website wwwHomeMedsorg
HomeMeds Information Packet
httpwwwhomemedsorglanding_pages143html
Partners in Care Website wwwpicforg
June Simmons CEO jsimmonspicforg
Sandy Atkins VP satkinspicforg
Dennee Frey PharmD dfreypicforg
Phone 8188373775
Join us at ASA Tuesday 312 at 1230