Evolution of Pharmacy Teams Role in Population Health Management 15 - PowerPoint PPT Presentation

Evolution of Pharmacy Team’s Role in Population Health Management 15 May 2019 Leandra Battisti, PharmD Kanan Shah, PharmD Sonia Alva, PharmD, BCACP

Objectives 1. Describe the skill set of each role within a pharmacy team to support population health initiatives. 2. Illustrate integrated workflows within a pharmacy department to support complex patient needs across the continuum of care. 3. Explain how intradepartmental engagement can result in positive outcomes for disease specific programs. 4. Describe initiatives aimed at improving patient care and reducing total medical expenditures on targeted patients.

Patient care is evolving and we are changing our standard approach to healthcare What is “ Population Health ”? Data  Defined as “the health outcomes of a Integration group of individuals , including the distribution of such outcomes within the group." Patient Performance Stratification Measurement & Intake Components of Population Health • Interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally • Utilizes non-traditional partnerships among different sectors of the community Patient Care Engagement Coordination • An opportunity for health care systems, agencies and organizations to work together in order to improve the health outcomes of the communities they serve Kindig D, Stoddart G . "What is population health?" American Journal of Public Health. 93 (3): 380 – 3, March 2003. 1. 2. Centers for Disease Control and Prevention, Office of Public Health Scientific Services, Center for Surveillance, Epidemiology, and Laboratory Services, Division of Scientific Education and Professional Development

There are three key components to population health management that are the basis of our integrated pharmacy programs Identify Engage Manage • Know your patient • Member engagement • Care management population software • Care management • Patient identification in the • Clinical research Electronic Health Record • Home care (EHR) • Performance improvement • Pharmacy services • Data analytics and • Predictive modeling warehouse • Triage of health related • Registries and scorecards social needs (HRSN) • Quality and regulatory reporting

BMC’s culture and core values reflect our mission of exceptional care without exception Source: https://www.bmc.org/about-us/mission-vision-values

The patients we serve are disproportionately minority and low income More than 70% of our patients identify as minority. More than 50% of our patients have an annual household income below the federal poverty line. More than 20% More than 50% identify as African identify as Hispanic American or Latino. Our patients face an extraordinary number of social, cultural, linguistic, and economic barriers to care when compared to More than 30% of our patients speak a patients at other area primary language other than English. hospitals.

BMC has the highest public payor mix in Massachusetts Massachusetts large hospitals discharges payor mix FY 2017 data, non-340B hospitals excluded 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Medicaid HSN Medicare Other Commercial Source: 2018, CHIA Acute Hospital Utilization Hospital Site databook

BMC Pharmacy Services are truly a health-system pharmacy department spanning across many different areas of focus BMC Health System Pharmacy Department Retail and Specialty and External Inpatient Health Plan Outpatient Ambulatory Partnerships      Centralized and Three retail Clinic-based Medicaid MCO plans External consultancy decentralized model pharmacies ambulatory care for MA and NH relationships pharmacists     Residency program Off-site mail order Clinical and service Specialty pharmacy  pharmacy Specialty Pharmacy support with integrator  Transitions-of-care pharmacists   program Medication refill Patient liaison  center for primary technicians Formulary  Medical reconciliation care management  technicians Prior authorization   Telephonic MTM center Commercial and dual  Investigational eligible programs   Pharmacy Services Adherence Chemotherapy packaging Pharmacy

Timeline of pharmacy department evolution at BMC BMCHP Specialty Transition of Accountable Care Pharmacy Care Services Organization (ACO) Program 2017 2015 2016 2018 2014 2019 Readmission Risk Pharmacy Complex Care HIV HCV Assessment (RRA) Care and Management Pharmacy Pharmacy Program Quality (CCM) Program Program Programs

Our specialty model utilizes the key components of population health to provide comprehensive pharmacy support BMC Specialty Care Management Identification Engagement Management  Identify patients  Rapid prior  Clinical RPh consult authorizations and visits  Letters to patients from  Fast Rx fulfillment and  Phone call support MD delivery to clinics  Outbound calls to  Adherence monitoring  Mail delivery and patients and feedback to MD blister pack offering  In clinic contact In-Clinic Support

The specialty pharmacy team is positioned to provide collaborative support from clinic to pharmacy  21 liaisons and 9 pharmacists embedded in 11 specialty clinics including: Specialty Clinics Heme/Onc, Derm, Neuro, Rheum, GI, ID, Renal/Transplant, Pedi Specialties Clinic Embedded  10 liaisons and 4 pharmacists embedded in primary care clinics across 2 Primary Care Clinics sites  9 liaisons and 3 pharmacists embedded in 4 pharmacies on BMC campus On Site Pharmacies Pharmacy Embedded  12 liaisons and 5 pharmacists located at offsite specialty pharmacy Offsite Specialty Rx  5 liaisons centralized providing PA processing and med access support for 17 Medication Access clinics Centralized  4 pharmacists centralized managing ~10,000 refill requests monthly for 2 Refill Request Mgmt primary care clinics

Dedicated focus in process and performance excellence drive superior clinical outcomes for patients enrolled in our programs … drives superior treatment Process and performance excellence by our specialty team … outcomes for specialty providers 98% 2 95% vs. 60% 1 SVR12 of Hep C treated Medication adherence patients (PDC) 80% vs 33% 3 2 vs. 21 2 HIV viral load Prior authorization suppression turnaround time (days) 76% vs 50% 3 $3M+ CML molecular response Patient assistance rate in oncology dollars secured 1. BMC pharmacy and partner medication adherence measured vs. community averages as exhibited by BMCHP health plan 2. Prior auth time and SVR12 measured via HealthCloud platform; 99% represents those who completed tx outside of lost to follow up. 3. Reflect independent studies done for BMC patients receiving therapy from internal specialty pharmacy vs outside, 2017

Specialty pharmacy’s multidisciplinary staffing model for HCV treatment is a key driver in improving clinical outcomes  Processes prior authorization request and coordinates with pharmacy for Pharmacy prescription processing Patient Liaison  Provides adherence outreach and refill coordination while on HCV treatment  Provides clinical support regarding treatment guidelines, regimen selection, drug interactions, and side effects Clinical Pharmacist  Sees patients for clinical support visits at treatment initiation and throughout treatment course in collaboration with provider  Completes bio-psycho-social intake and addresses barriers to appointment Public Health and med adherence prior to and during HCV treatment Social Worker  Collaborates with patient, provider and pharmacy team for coordination of care

Strong clinical outcomes are maintained in the HCV program despite a psychosocially complex patient population HCV patients in GIM clinic Homeless  Includes 325 patients from 9/2015 to 28% Distribution Measured 12/2018 patient  Past 6 mo. illicit 4 patients did not complete treatment barriers 32% ‒ substance usage 2 due to ADRs, one due to (Health incarceration, 1 lost to follow up Cloud) after 1 month Past 6 mo. heavy 19% ‒ 1 patient who d/ c’ed at 8 weeks still ETOH achieved SVR Treatment 99% completed  *Negative SVR of those tested; 4% lost to follow up Treatment ‒ ITT SVR = 94% Negative SVR at results 98%* 12 weeks post tx completion

Implementing new workflows does not come without its challenges… Challenges Solutions • HR/ hiring support • Employee recruitment and training Development of training protocols and policy / procedures • IT integration • Determination of patient panel and Real time analytics on patients, prescriptions, recruitment / enrollment process reporting • Customer relationship management software • Clinic leadership and staff support and buy in • Integration within specialty and primary care Centralization of non-patient facing staff to clinics provide space for those to engage patients in clinic

Timeline of pharmacy department evolution at BMC Specialty BMCHP Transition of Pharmacy Accountable Care Care Services Program Organization (ACO) 2017 2015 2016 2018 2014 2019 Readmission Risk Pharmacy Complex Care HIV HCV Assessment Care and Management Pharmacy Pharmacy (RRA) Program Quality (CCM) Program Program Programs