Paving the Way for the ‘One Team’ Approach: Pioneer ACO MTM Program Update

Pharmacy Support Meeting

Open Discussion

November 14, 2013

Partners and Funding• Partners:

• Trinity Pioneer ACO• The University of Iowa• OutcomesMTM• Iowa Pharmacy Association• Community Pharmacies in ACO Service Area

• Funding Acknowledgements• National Association of Chain Drug Stores (NACDS)

Foundation• Community Pharmacy Foundation• McKesson

Objectives• Assess the effects of an integrated MTM program for ACO

patients on all-cause hospitalization rates

• Assess the 30-day hospital readmission rates for the ACO patients

• Evaluate the impact of an integrated MTM program on the incidence of adverse drug events that result in an emergency department visit for ACO patients

• Assess the effect of an integrated MTM program on per capita Part A and Part B Medicare costs for ACO patients

• Characterize the types and frequencies of drug-related problems identified and resolved by the pharmacist-delivered MTM services for ACO patients

Research Methods: Overview • 2-year study overall

• Will operate integrated MTM program for at least 12 months

• Will compare integrated MTM program in Pioneer ACO (Fort Dodge area) to usual care under Medicare Shared Savings Program (Waterloo area)

• Encompasses all ACO patients, though focus on high-risk patients

• Will track effects of the MTM program via Medicare claims and MTM claims data• Quality indicators• Utilization and costs

MyNurse Nurses complete a 24 hr post-discharge telephone evaluation on all hospitalized patients. Refer patients with med issues to the MTM Pharmacists(unable to teach back; complicated regimens; high risk medications).

Trinity Pharmacists Identify patients on high-risk medications or fit criteria for needing post-discharge follow-up.

MTM Referral Process – Trinity ACOHigh Risk Transition

of Care PatientsHigh Risk Chronic Care

Patients

Population Management PharmacistHigh risk patients identified by review of claims data (high risk medications; multiple prescribers; high medication costs).

Iowa Health ACO Pharmacists

(Triage High-risk Patients)

MTM-Trained Community Pharmacist Providers

Primary Activities

• Create linkages with case management & analytics• Identify and triage high risk MTM patients• Solve medication issues telephonically, if able• Send referrals to MTM-Trained Community

Pharmacists via OutcomesMTM platform

• Complete MTM activities for all referred patients• Assist with transition of care patients (medication

reconciliation).• Communicate with PCP/home care as needed• Assist with monitoring and follow-up for pts started on

high risk med (ex: insulin, steroids, antiplatelets, warfarin).

• Assist with adherence monitoring and adherence tools• Document activities in OutcomesMTM platform

CommunicationPrimary Activities

OutcomesMTM

Referral

Integrated MTM Program: Screening and Assigning• Screening

• High Risk Transition of Care Patients• Internal risk assessment prior to discharge- Trinity Pharmacists• MyNurse follow-up

• High Risk Chronic Care Patients • Analysis of utilization & clinical data within ACO• Analysis of drug claims data by OutcomesMTM

• Assigning• OutcomesMTM will assign at-risk, targeted patients to receive services from

either ACO pharmacy personnel or community pharmacists• ACO pharmacists can provide immediate services prior to discharge• Community pharmacists provide MTM services when patient transitions to

home

Integrated MTM Program: MTM Care• Will follow OutcomesMTM standard set of covered services

• Comprehensive Medication Review (CMR)• Prescriber Consultation• Patient Adherence Consultation• Patient Education & Monitoring

• For discharged patients, CMRs can include a medication reconciliation to compare post-discharge medications with those prior to hospitalization

• BEST PRACTICE: Share current medication list with prescriber

• After service delivery, the pharmacist will file MTM claim using OutcomesMTM web platform for reimbursement

Current MTM Program Timeline • Summer 2013

• Communication to patients, prescribers, and pharmacies

• October 17th – Pilot Begins with 2 Clinics• UnityPoint Clinic in Fort Dodge: Dr. Birkett• Humboldt Family Practice: Dr. Dvorak

• November 8th – Full Implementation• Fax/E-mail blast announces official rollout

• Nov 2013 – Oct 2014• Community pharmacy MTM services delivered to ACO patients

• Nov/Dec 2014• Claims run-out and data collection

• 2015• Data analyses and report writing

• Throughout• Regular meetings with UnityPoint and project planners

MTM Care Referral Form

Feedback & Discussion• Communication Amongst Prescribers & Pharmacists

• Fax process• SOAP format• Communication between all parties• Barriers

• Communication with Patients• Privacy issues• Cognitive impairment situations

• Overall Program• Clinical Interventions• Workload concerns

Additional Resources:• ACO Phone Numbers

• MTM Help Line for Patients: 515.574.6385• UnityPoint Hospitalist Line: 515.574.6332

• Patient Brochure includes:• What is the Trinity Pioneer ACO? MTM?• Benefits of a Medication Review• Frequently Asked Questions

• Provider Communication Forms• Medication Therapy Management Concern Form• Information Request Form

• DRAW Tool• TIMER Tool

Pharmacy Education and Support Update

• Pharmacy Support Meetings• Thursday, February 27th at 6:00pm in Fort Dodge

• MTM and ACO Quality Measures• Accredited for Pharmacists & Pharmacy Technicians

• On-Demand Health Coaching Series (2 x 1 hr of CPE)• Engaging Patient Through Health Coaching• Health Coaching Tools for Pharmacists• Register on www. GoToCEI.org with the code “ACO13”

• Complimentary IPA Membership for Technicians ($65 value)• Register at www.iarx.org, Click Membership, then Join/Renew• Use code “IPAACO”

Questions

• Bill Doucette, U of I• William-Doucette@uiowa.edu

• Jessica Frank, OutcomesMTM• jfrank@outcomesmtm.com

• Justin Riesberg, OutcomesMTM• jriesberg@outcomesmtm.com

• Chris Donner-Tiernan, Hy-Vee• csdonner@yahoo.com

• Jennifer Kownacki, UnityPoint• Jennifer.Kownacki@unitypoint.org

• Scott Leigh, Trinity Hospital• Scott.Leigh@unitypoint.org

• Craig Logemann, UnityPoint• Craig.Logemann@unitypoint.org

• Anthony Pudlo, IPA• apudlo@iarx.org

THANK YOU!