10/18/19 1 Disclosure There are no relevant financial relationships with ACCME- defined commercial interests for anyone who was in control of the content of the activity. 2 1
10/18/19 Community Health Worker: The Staff Position You Never Knew You Needed NCPA Annual Convention 2019 Richard Logan, Jr, PharmD Michelle Pattengill, CPhT, CHW L&S Pharmacy 3 Pharmacist and Pharmacy Technician Learning Objectives • Identify which pharmacy personnel might make good Community Health Workers • Describe how training pharmacy staff as CHWs can improve patient care • Explain why CHWs provide value to your pharmacy practice 4 2
10/18/19 Who are you? / Why are you here? • Richard Logan, Jr., PharmD • L & S Pharmacy, Charleston, MO • Medical Arts Pharmacy, Sikeston, MO • VP Marketing/Strategic Alliances ESPhA • Partner MedHere Today Consulting • GFT5 5 Who are you? / Why are you here? • Michelle Pattengill, CPhT, CHW CPhT and CHW L & S Pharmacy, Charleston, Mo 6 3
10/18/19 What we’re really going to talk about • Local healthcare • SDOH and barriers to care • Improving health by improving communication with the help of a CHW • Show how embedding a CHW in your practice can improve patient care, reduce healthcare costs, and (possibly) enhance pharmacy revenue 7 Let’s Define a CHW • Just what is a Community Health Worker? • What does a CHW do? 8 4
10/18/19 Defining a CHW “Community Health Workers (CHWs) are frontline public health workers who are trusted members of and /or have an unusually close understanding of the community served . This trusting relationship enables CHWs to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.” Community Health Worker Definition; American Public Health Association Policy Statement 20091, Support for Community Health Workers to Increase Health Access and to Reduce Health Inequities; 2009 9 CHW is LOCAL ….are trusted members of and /or have an unusually close understanding of the community served . This trusting relationship… 10 5
10/18/19 CHW is LOCAL ….are trusted members of and /or have an unusually close understanding of the community served . This trusting relationship… 11 CHWs Pharmacy and Local Care Management • Many similar duties to current Pharmacy Techs • Expands the Pharmacy’s touch outside the 4 walls of the Pharmacy and into the patient home 12 6
10/18/19 CHWs Pharmacy and Local Care Management Community Health Workers act on the patient’s behalf Healthcare translators Navigators Facilitators Referral source Data collectors/reporters 13 CHWs addressing SDOH/SDH Social Determinants of Health “The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” World Health Organization (WHO) https://www.who.int/social_determinants/sdh_definition/en 14 7
10/18/19 Community Pharmacy Every community is unique Every community has unique challenges Every community has unique resources Every community pharmacy has a unique patient mix with unique problems (SDOH) This Photo by Unknown Author is licensed under CC BY 15 Why is LOCAL so important? The greatest barrier to effective healthcare is poor communication 16 8
10/18/19 Communication Barriers—Let me demonstrate Yetyet 17 Communication Barriers—Let me demonstrate Yetyet Have you eaten recently? 18 9
10/18/19 Communication Barriers—Let me demonstrate Chikatawl? 19 Communication Barriers—Let me demonstrate Chikatawl? Would you like me to examine the fluid levels in the vehicle you brought in? 20 10
10/18/19 Next Step: Putting it in practice in your pharmacy • CHW • TRUSTED RELATIONSHIPS • ABILITY TO COMMUNICATE WITH PATIENTS 21 Next Step: Putting it in practice in your pharmacy • CHW • TRUSTED Efficient RELATIONSHIPS local care • ABILITY TO management COMMUNICATE WITH PATIENTS 22 11
10/18/19 Why should Pharmacists be interested in Care Management? What’s that got to do with me? CARE MANAGEMENT 23 Why should Pharmacists be interested in Care Management? What’s that got to do with me? ACCESSIBLE/LONGITUDINAL/LOCAL PATIENT CARE 24 12
10/18/19 Why should Pharmacists be interested in Care Management? What’s that got to do with me? Medicaid Programs & Health Plans often spend more on CARE MANAGEMENT (medical side) than on PRESCRIPTION DRUGS (pharmacy side) --North Carolina Medicaid and NC Health Choice Annual Report for State Fiscal year 2018July 1, 2017 – June 30, 2018 -- Missouri Department of Social Services 2017 Annual Report; https://dss.mo.gov/re/pdf/2017-dss-annual- report.pdf 25 And this is what it often SOUNDS like Telephonic Care Management 26 13
10/18/19 And this is what it often looks like “Hi my name is ‘XXXXX’ calling on behalf of ‘Health Plan’, I have a patient on the line. ‘Patient Name and Date of Birth’. I have a question about a prescription for lisinopril 10 mg pharmacist and if is a with that can I please verify the last time that prescription was last filled please thank you.” 27 And this is what it often looks like “Hi my name is ‘XXXXX’ calling on Transcription: behalf of ‘Health Plan’, I have a patient on the line. ‘Patient Name and Date of L&S Pharmacy Birth’. I have a question about a Message; Saturday prescription for lisinopril 10 mg February 2 nd , 2019; pharmacist and if is a with that can I please verify the last time that 1:59pm Central prescription was last filled please thank you.” 28 14
10/18/19 We can do better! As Missouri moves to statewide Managed Care for family Medicaid (parents, kids and pregnant women), MHD has taken the opportunity to use the new Managed Care contract as a vehicle to strengthen care management requirements and improve performance outcomes ¬ Contracted Managed Care Organizations (MCOs) are required to implement patient health responsibility incentive programs such as pay-for- performance payment methodologies with providers and Local Community Care Coordination (LCCC) ¬ The LCCC is a form of accountable care organization where local community providers are paid and accountable for face-to-face care management and coordination that was previously done by the MCO anonymously using mail and telephone communication 29 We can do better! strengthen care management As Missouri moves to statewide Managed Care for family Medicaid (parents, kids and pregnant women), The LCCC is a form of accountable MHD has taken the opportunity to use the new Managed Care contract as a vehicle to strengthen care care organization where local management requirements and improve performance community providers are paid and outcomes ¬ Contracted Managed Care Organizations (MCOs) are required to implement patient health accountable for face-to-face care responsibility incentive programs such as pay-for- performance payment methodologies with providers management and coordination that and Local Community Care Coordination (LCCC) ¬ The LCCC is a form of accountable care organization where was previously done by the MCO local community providers are paid and accountable anonymously using mail and for face-to-face care management and coordination that was previously done by the MCO anonymously telephone communication using mail and telephone communication ¬ Local Community Care Coordination (LCCC) ¬ 30 15
10/18/19 We can do better! 31 Ou Our P r Patien ent Ca Care St e Strateg egy 32 16
10/18/19 Ou Our P r Patien ent Ca Care St e Strateg egy 33 We jump into the CHW pool We began initially by sending 4 Pharmacy Technicians to CHW Training 34 17
10/18/19 We jump into the CHW pool • Help patients and their families navigate the health care system, access LOCAL community services & non-local resources, as well as promote the adoption of healthy behaviors • Facilitate a LOCAL and ACCESSABLE destination for soft handoffs for patients in transition and/or in need of services beyond standard prescription dispensing • Serve as a LOCAL liaison for payer and provider partners and become a conduit for information flow and service delivery 35 Local Care Management This is what Local Care Management Looks Like 36 18
10/18/19 Services Case presentation 1 CHW Within Pharmacy Walls 37 The CHW within the Pharmacy Walls I’ve got to sell my truck! Patient presents to Pharmacy Insurance coverage/copays Tech handoff to CHW 38 19
10/18/19 From Pharmacy to Hospital to Home Case presentation 2 39 Case: Bariatric Patient • Delivery driver picked up on acute concern via standard screening, engaged pharmacist, emergency services dispatched • Patient admitted for blood clots, resolved, then discharged on opioids – resulting in access issue due to high MMEs • Dispatched CHW for ongoing peer-peer engagement (MI, etc) • Hospital bed broke 2 times, trouble breathing, developed bed sores, experienced increases in pain, frustration, and isolation 40 20
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