Health Partners Provider Webinar August 18, 2017
Who’s who • Matt Gallagher Associate, Network Performance • Jackie Shine Resident, Clinical Services • Lauren Adair Senior Associate, Network Performance
Agenda The Objective About OutcomesMTM About the Health Partners Program Who Participates (Pharmacy network) Interaction with Providers & Patients Types of Recommendations Benefits to All Q&A
The Objective Understand the Health Partners Medication Therapy Management Program Utilize understanding for collaboration and patient care
Experience: • One of the first MTM companies • Has worked with Medicare, Medicaid, Commercial, employer groups and other payers Approach: Leverage personal relationships in communities combined with innovative, user-friendly technology to impact patient outcomes and improve healthcare
Patient Relationships - Impacting Adherence Connectedness with a pharmacy and its staff is the single strongest individual predictor of prescription medication adherence -NCPA (2013) Medication Adherence In America
MTM and Quality Measures
Medicare Star Ratings • Annual ratings of Medicare plans made available on Medicare Plan Finder and CMS Website (beginning in 2008) • 2 year data lag – e.g. 2017 Ratings represent 2015 performance • Ratings are displayed as 1 to 5 stars • Stars calculated for each measure, then rolled up into domain, summary and overall
Part D Star Measures • Patient-Safety Measures Measure Weighting Medication Adherence for Diabetes Medications (non-insulin) 3 Medication Adherence for Hypertension (RAS Antagonists) 3 Medication Adherence for Cholesterol (Statin) 3 MTM Program Completion Rate for CMRs 1 • Display Measures • Statin Use in Patients with Diabetes (SUPD) • High Risk Medications (HRM) • Drug-Drug Interactions • Adherence to Antiretroviral Therapy • Excessive doses of oral diabetes medications
HEDIS Measures • Measures all plans • 81 individual measures across 5 domains • Routine health screenings and immunizations • Customer satisfaction surveys • Call answer timeliness • Drug therapy: CAD, Hypertension, Diabetes, COPD
HEDIS Measures • OutcomesMTM Impact • Assessments and Comprehensive Care • Assessment of High Risk Medications • Comprehensive Diabetes Care • Management of Common Disease States • Adherence • Filling gaps in care
Interactions with Provider and Patient Types of Interventions
Pharmacy to Prescriber Communication • Fax or phone • OutcomesMTM provides fax forms
Prescriber and Patient Acceptance - Medicare 90% 84% 79% 80% 70% 60% 50% 40% 28% 30% 16% 20% 11% 15% 10% 0% 2015 2016 2017 Prescriber Patient
Prescriber and Patient Acceptance - Medicaid 90% 84% 80% 79% 70% 60% 50% 40% 30% 24% 20% 15% 15% 10% 10% 0% 2015 2016 2017 Prescriber Patient
Top Interventions - Medicare** 4,742 Adherence check-ins (+ 90 day) 4,909 2,600 Adherence Monitoring 1,175 3,344 CMR 2,246 1,522 Needs patient education 1,574 478 Needs Drug Therapy 326 2016 2017
Top Interventions – Medicaid** 25,852 Adherence check-ins 18,117 4,777 Needs Patient Education 4,295 6,514 CMRs 2,936 1,294 Needs Drug Therapy 992 512 Suboptimal Drug 461 2016 2017
Closing the loop
Pharmacist Prevented Additional Healthcare Costs Personal Pharmacist™ Jodi Miguel, 5 Star Pharmacy & Medical Supply, Southampton, PA Jodi initiated a claim following a CMR after identifying a patient was taking both the long-acting and short-acting formulations of their medication for diabetes. Jodi recognized that both therapies were not necessary to treat the patient’s diabetes. Jodi contacted the patient’s prescriber and confirmed the patient should be taking the immediate release formulation. In follow-up, Jodi deactivated the prescription for the long-acting formulation and counseled the patient on the appropriate medication to continue. Thanks to Jodi’s intervention, prevented additional healthcare costs. Great work, Jodi!
Q&A
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