URAC Specialty Pharmacy v3.0 Accreditatjon: Learn Insider Tips to Satjsfy the Latest Patjent Management Requirements July 11, 2017
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Automate, Standardize, and Scale Your Patient Management Programs with Evidence-Based Care Plans Across 20 Disease States TherigySTM™ is the patient-centered therapy management software used by 60% of URAC-accredited health-system specialty pharmacies. htup://info.therigy.com/stm htup://info.therigy.com/stm Learn more htup://info.therigy.com/stm htup://info.therigy.com/stm Patjent-Centered Therapy Management Sofuware for Specialty Pharmacies
SPEAKERS RUSSEL ALLINSON, RPH, MS CHASE DYE, CPHT PAM DEVAUL Co-founder, CEO, and CCO Specialty and Mail Order Pharmacy Vice President of Quality Therigy Operatjons Manager Therigy Cleveland Clinic @therigy #Therigy4Specialty Although this webinar covers URAC Specialty Pharmacy v3.0 Accreditatjon requirements specific to patjent management, it is not sponsored by URAC. www.therigy.com
AGENDA What You’ll Learn How to: Navigate the changes in URAC Specialty Pharmacy v3.0 for patient management Apply the new URAC Specialty Pharmacy v3.0 standards for patient management to specialty pharmacy accreditation Plan and implement URAC Specialty Pharmacy v3.0 requirements for patient management Use technology to meet the new patient- and specialty-drug management standards www.therigy.com
Why this Webinar ? Preparatjon Standards changes Competjtjve advantage Value-based environment Insider knowledge www.therigy.com
Types of Accredited Specialty Pharmacies: Health Payer Physician System Owned Practjce Retail Infusion Independent Owned Pharmacy www.therigy.com
Mandatory document control ! What Makes the New policies and processes Accreditatjon Process New decisions Challenging? More resources needed Leadership support and coordinatjon across teams Time commitment www.therigy.com
Navigatjng Changes in URAC Specialty Pharmacy v3.0 for Patjent Management 50 40 30 20 $$ 10 $$ 0 Specialty Drug Management Patjent Management (SDrM) (PM) www.therigy.com
Specialty Drug Management (SDrM) SAFETY APPROPRIATENESS EFFECTIVENESS Patjent and Cost-effectjve drug Patjent adherence prescriber educatjon management management Access to specialty Evidence-based Drug Utjlizatjon Review drugs medicine (DUR) www.therigy.com
$$$ Patjent Management (PM) Patjent Prior Copay assistance authorizatjon assistance programs PM 1: PATIENT CENTERED STRATEGY TYPES Writuen overview of services based OF SERVICES on individual needs PROVIDED Adherence Educatjonal monitoring materials All patjents receiving specialty medicatjons What types of services does 24 7 your program provide? Patjent Availability Qualified educatjon to clinical staff and clinical staff counseling
PM 2-3: PATIENT MANAGEMENT PROGRAM Policies and Clinical practjce Documentatjon in Process to communicate Evaluatjon of Procedures guidelines and services central locatjon with prescribers therapeutjc outcomes Initjal Assessment Diagnosis Appropriateness Comorbiditjes Medicatjon list Allergies Patjent Educatjon, Counseling, and Resources Reassessment Appropriateness Effectjveness Adverse events Adherence www.therigy.com
30 PATIENT RECORDS www.therigy.com
PM 8: COORDINATION OF CARE Policies and Procedures Care Plan Who Statement Strategies What Goals When Timeframe Resources Patjent desires/motjvatjon www.therigy.com
3 PATIENT RECORDS www.therigy.com
PM 14: DEMONSTRATING PROGRAM VALUE Financial Quality of Benefits Life Patjent Satjsfactjon Clinical Benefits www.therigy.com
PM 15: PROGRAM EVALUATION OUTCOMES REPORTING Clinical Benefits Financial Benefits Patjent Satjsfactjon Quality of Life PAST OUTCOMES PROJECTED OUTCOMES Template letuer Mock reports Technology for reportjng metrics and data www.therigy.com
HOW Organize workflow TECHNOLOGY Automate evidence-based Can Help Meet care plans Accreditatjon Document and report clinical interventjons Requirements www.therigy.com
OUTCOMES REPORTING www.therigy.com
CLEVELAND CLINIC Case Study CHASE DYE, CPHT Specialty and Mail Order Pharmacy Operatjons Manager Cleveland Clinic
2016 2015 Timeline Q4 • URAC Desktop 2014 Review • On-site Visit Q2/Q3 Accreditatjon • URAC In-process Determinatjon 2014 Q1 • Opened 2014 Specialty Pharmacy 2013 • Constructjon • Initjal Caregiver Recruitment • Constructjon Plan • Funds Approved • Director Hired www.therigy.com
• Funds Approved • Director Hired Business Overview Oral and self-injectable products Disease states Driving unique value propositjons Resettjng service expectatjons Service-line integratjons Integrated data warehouse www.therigy.com
The Obstacles of Delivering Specialty Pharmacy Care Faxes and phone calls Specialty Providers Pharmacy • Achieve best possible outcomes • Provide service, cost savings, and value to the payer • Minimize paperwork and delays • Incented on dispensing volume • Overburdened focal point PATIENT Pharma-provided Patjent Services Employer / Payer • Achieve best possible outcomes Program • Minimize out-of-pocket costs • Reduce hassle/delays Needs help! • Get the patjent on drug fast and keep • Provide high quality of service to members them on drug above all costs • Reduce waste • Product of service limitatjons • Optjmize outcomes • Define value
Cleveland Clinic’s Solutjon Electronic links, single point-of-contact, and new opportunitjes for value EHR Link Physician CCF Specialty Pharmacy Follow-up via CarePath Concierge Data Flow Utjlize, but Limit Pharma-provided Patjent Services Employer Program PATIENT
Seeking Accreditatjon External, independent evaluatjon Quality and structure Patjent safety Metrics Limited distributjon drugs and access to payer networks www.therigy.com
Sales discussion and review of standards Gap assessment Quality and clinical oversight commituees Contract negotjatjon Policy and procedure development Accreditatjon Execute agreement Process Staff training and mock survey Desktop submission of materials Requests for informatjon in response to desktop submission On-site review Accreditatjon commituee review and decision Consider URAC a part of your team www.therigy.com
On-site Survey Prepare and Define Mock Offline staff Agenda and audit materials in expectatjons surveys member checklist advance www.therigy.com
INSIDER TIPS Data reportjng Contjnue to work and metrics with URAC Initjal accreditatjon is a great achievement; maintaining ongoing accreditatjon is demanding www.therigy.com
ADDITIONAL TIPS ✓ ✓ Create a project plan ✓ ✓ Identify gaps, set deadlines ✓ ✓ Review, modify, and approve all existing policies and procedures ✓ ✓ Update quality improvement programs and annual reports ✓ ✓ Organize the evidence in one location or file ✓ ✓ Ask URAC questions about interpretations ✓ ✓ Create interview questions ✓ ✓ Organize all onsite materials www.therigy.com
QUESTIONS & ANSWERS www.therigy.com
Contact us today. RUSS ALLINSON russel.allinson@therigy.com PAM DEVAUL pam.devaul@therigy.com Patjent-Centered Therapy Management Sofuware for Specialty Pharmacies @therigy #Therigy4Specialty www.therigy.com
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