10/18/19 1 Care Planning: Keys to Surviving and Thriving Mark McCurdy, RPh Mark’s Pharmacy Cambridge, NE 2 1
10/18/19 Disclosure There are no relevant financial relationships with ACCME- defined commercial interests for anyone who was in control of the content of the activity. 3 Pharmacist and Pharmacy Technician Learning Objectives • Define the elements of a care plan that are needed to document patient care interactions. • Describe strategies for implementing care planning into pharmacy workflow. • Identify various types of interventions that should be documented in a care plan. 4 2
10/18/19 TH THIS SESSION WILL BE E UTI UTILIZING G AUD UDIEN ENCE E PO POLLING G SOFTW TWARE Pl Please se go to ME MEET.PS/CAREPLA LANNING to to answer poll que questi tions ns 5 Why is Care Planning Important? 6 3
10/18/19 Why is Care Planning Important? • Designed to improve patient care through documentation and communication • We all provide patient care every day, but who knows about it? • Coordination and follow-up of a patient’s care with the patient, provider or other entities • Improves internal & external workflow efficiency • Tracks goals, both personal and therapeutic • This documentation is on the “medical side” 7 Why is Care Planning Important? • If you don’t document it, it didn’t happen! 8 4
10/18/19 Why is Care Planning Important? • Care Planning is a growing opportunity to increase income through increased patient care activities • Who thinks they can survive on dispensing alone? • Examples of income from increased care activities • Direct Care Contracts • Select Networks • Improved customer loyalty 9 Why is Care Planning Important? • Reimbursement for our medical care services REQUIRES that we document our activities … • The Care Plan 10 5
10/18/19 Why is Care Planning Important? • In medicine, it’s all about Value Based Reimbursement – highest value for monetary investment. • Complex patients visit their pharmacy 35 times per year vs 4 for their MD • We need to show these contact points are worth something by documenting how we are contributing to patient medical care and not just dispensing medications. 11 Why is Care Planning Important? • Payers want a network with providers ready to go (ex. NE Medicaid Smoking Cessation) • Helps payers see we are doing more than dispensing. Proof that we are doing it • Scalability of services – will they listen to me or we? • Prepares pharmacies to be ready when paying opportunities come 12 6
10/18/19 Why Pharmacy is Prepared to Succeed 13 Why Pharmacy is Prepared to Succeed • Cost, Quality, Access – The Key Considerations in Health Care 14 7
10/18/19 Why Pharmacy is Prepared to Succeed • Cost – what services can and do we provide that are cheaper than: • MD visit • ER visit • Ambulance transport • Delay in LTC placement • Readmission • Many others 15 Why Pharmacy is Prepared to Succeed • Access – Patients see us more than any other health care provider (35 to 4) • Patients come to us at their convenience and our availability. We are highly accessible. • Deliveries – who makes house calls anymore? It is a point of contact where care can be provided. 16 8
10/18/19 Why Pharmacy is Prepared to Succeed • Quality – We have been trained for and have the scope within our licenses to provide this care • We were all trained in “Clinical Pharmacy”. The long-held promise is coming true. 17 Why Pharmacy is Prepared to Succeed • We currently provide a large amount of medical care that is not compensated. • By taking the time to document that care, the uncompensated can become compensated. • Need to convert from Care activity to Care and Documentation activity. Get credit for what you do! 18 9
10/18/19 Please go to MEET.PS/CAREPLANNING to answer poll questions! 19 20 10
10/18/19 22 Mark’s Pharmacy 24 11
10/18/19 25 What’s so special about Mark’s? • Nothing really. Typical community pharmacy providing a lot of uncompensated care, except: • We adopted a community wellness mentality • Advice from Clarence • Staff meeting: “Patient care is the way things are headed. We may as well get started.” Buy-in! • “Am I the one that needs to be doing this?” • When things bog down, “FORWARD!” 26 12
10/18/19 27 Introducing Care Planning to You and Your Staff 28 13
10/18/19 Basic Definitions and Concepts • eCare Plan vs Care Plan • Required Components of a Care Plan • Currently Available Platforms • SNOMED codes • 90/10 concept of health care spend • Time to set up patients vs care data entry • Rule of thumb – care time vs care documentation 29 Care Plan Components Pharmacist Care Plan Traditional Care Plan • Health Concerns • Health Concerns • Add documentation of medication therapy • Identified health or risk concerns such as problems problems, allergies, or social issue, etc. • Interventions • Interventions • Add more medication history • Includes active medication list, medication • Prescription fill history may be added administered, and planner medications • Goals • Goals • Emphasis on goals of therapy • Includes patient goals • Health Status Evaluation & Outcomes • Emphasis on sections related to medications • Health Status Evaluation & Outcomes • Laboratory Results and Vitals • Includes disposition and outcomes • Payer Section • Laboratory Results and Vitals 30 14
10/18/19 www.ecareplaninitiative.com 31 Reviewing, Adopting and Implementing a Care Plan Platform • What are your needs? • Inputs • Outputs • Vendors making changes based on user needs • Try to record care by SNOMED whenever possible • Platforms are changing rapidly. Your first may not be your last 32 15
10/18/19 Please go to MEET.PS/CAREPLANNING to answer poll questions! 33 34 16
10/18/19 36 Examples of What Pharmacists and Staff are Documenting 38 17
10/18/19 Current Care Plan Activities • Daily Activities by a pharmacist “On the Fly” • Adverse reaction to medication • Allergy to medication • Dosing / Dosing changes • Medication education • Disease education • If you think every single event is documented, you are mistaken. 39 Current Care Plan Activities • Med Sync calls and contacts • These are medication reconciliations • Use call script • No questions or changes? Technician • Questions or changes? Pharmacist 40 18
10/18/19 Current Care Plan Activities • Visiting Pain Specialist • Access PDMP and perform med reconciliation for each monthly visit • Next step: mid-month call for pain assessment, medication compliance and medication tolerance and efficacy. 41 Current Care Plan Activities • Blood Pressure Service • Portable, downloadable meters sent home with patients • Meters are brought in monthly by patients or picked up on deliveries • Pharmacist reviews results . “Reportable” results are forwarded to providers with comments from pharmacist • “Acceptable” results are forwarded to providers with care plan completed by technicians 42 19
10/18/19 Other Care Plan Considerations • Where do students fit in? 43 Other Care Plan Considerations • The Book of Screenshots – How-to Guide to Document Routine Care Plans (a.k.a. Teaching how to fish.) • Screen shots with descriptions on where data needs to be entered into your care platform. • Can be vendor generated – see CPESN workflow Wednesdays for online videos from vendors • Other outside examples – ex. Flip The Pharmacy • Self-generated – ex. Snap Tool on Windows machines for personal use 44 20
10/18/19 Mark’s Pharmacy – Changes in Workflow 45 Changes in Workflow • “At first I tried to fit the clinical flow into my dispensing flow. Now I’m thinking the other way around.” 46 21
10/18/19 Changes in Workflow • Adoption of med sync and compliance packaging – controlling the demand. 47 Changes in Workflow • Two questions have been and are still key to us • Do I/We need to be doing this? • Am I the one that needs to be doing this? • Automation of Processes • Vendors to help manage processes – cost vs benefit • Self generated & managed? Use the 2 questions 48 22
10/18/19 Changes in Workflow • Use of scrap sheets and crib sheets to record data for later entry • We use this frequently but there is a limited time window for entry before they are lost in flow. 49 Changes in Workflow • Get your staff involved! 50 23
10/18/19 Changes in Workflow In case I wasn’t clear ... • Get your staff involved! 51 Impacts of Care Plans on Medical Providers, Support Staff and Patients 52 24
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