ASHP InterSections ASHP InterSections

July 17, 2013

Novel Missouri MTM Program Benefits Patients, Pharmacists

DC Pro is a feature of the MO HealthNet Medicaid program.

DC Pro is a feature of the MO HealthNet Medicaid program.

A NEW FEATURE OF MISSOURI’S MEDICAID PROGRAM is drawing admiration from health care experts around the country for its ability to bring pharmacists and patients together.

The program in question—Direct Care Pro (DCPro)—provides pharmacists with a database of patients in their area who are eligible for medication therapy management (MTM) and other cognitive therapies.

Gloria Sachdev, Pharm.D., a clinical assistant professor, primary care, at Purdue University, West Lafayette, Ind., and director-at-large of ASHP’s Executive Committee for the Section of Ambulatory Care Practitioners, is one of the program’s admirers.

​“I would love Indiana to one day have the IT infrastructure in place to provide MTM like Missouri does,” she said, calling DCPro “an amazing example of how to operationalize MTM services in a streamlined manner.”

Gloria Sachdev, Pharm.D.

Gloria Sachdev, Pharm.D.

Pharmacists under the Missouri program receive direct reimbursement as health care providers, and a variety of conditions are covered, including asthma, chronic obstructive pulmonary disease, diabetes, gastroesophageal reflux disease, heart failure, hypertension, and hyperlipidemia.

“The number of covered conditions is constantly expanding,” according to Sandra Bollinger, Pharm.D., provider outreach coordinator with Xerox, which manages MO HealthNet. She added that only a handful of states allow pharmacists to bill directly to their Medicaid programs as health care providers.

Helping Patients During Care Transitions

The program is an excellent example of how pharmacists can help patients during transitions of care, according to Justine Coffey, JD, LLM, director of ASHP’s Section of Ambulatory Care Practitioners.

“It’s a great model because it ensures that patients receive the care they need once they leave the hospital and are back in the community setting,” Coffey said, noting that patients receive better care when pharmacists are involved in medication management decisions.

“This program provides both an opportunity for better patient care and new opportunities to advance ambulatory pharmacy practice.”

Opportunities for Intervention

Pharmacists who are registered with MO HealthNet can log into the DCPro system and view a list of all patients who are eligible for cognitive services. The information is based on gaps in Medicaid claims that would have been filed had the patient been keeping up with their care for a particular disease state.

Next, pharmacists select which patients they want to assist and then “reserve” an intervention (many patients are eligible for multiple interventions). They then contact patients and arrange face-to-face consultations. Interventions can take place in outpatient clinics, patients’ homes, or in areas of community pharmacies that are designated for patient care. Once reserved, an intervention must be completed within 30 days or the patient is released back into the database.

For example, consider an MO HealthNet patient who has diabetes, but has not had an A1C blood test for more than 90 days. The MO HealthNet system will detect that a claim for the test has not been filed.

Based on that care gap, the system automatically adds that patient’s name and flags the intervention for which the patient is overdue. A pharmacist seeing the information can provide the test as well as additional counseling.

During an intervention, DCPro guides the pharmacist through questions that must be answered before it allows users to move to the next topic. It also fills in progress notes and submits the billing automatically once an intervention is complete.

Reimbursement (which is based on the amount of time spent with the patient rather than the nature of the intervention) is calculated in 15-minute increments. Payment ranges from $10-$20 per 15-minute period with a one-hour maximum per intervention. There is no limit on the number of intervention hours a pharmacist can bill annually.

“Pharmacists who use the system don’t have to keep their own records regarding which patients are eligible. They can just log in to see a complete list of all eligible patients in their area,” said Dr. Bollinger. The system also handles all recordkeeping and billing.

Justin May, Pharm.D.

Justin May, Pharm.D.

Utilizing Program Results to Increase Pharmacist Reimbursement

Pharmacists at Red Cross Pharmacy’s 15 locations regularly check DCPro for any pending MTM and cognitive therapy claims, said Justin May, Pharm.D., director of pharmacy with the chain, based in Marshall, MO.

“Ideally, we use the system as part of our adherence program,” he explained. “A pharmacist takes a look at a patient’s medications five to seven days before the prescriptions are filled and identifies patients who require cognitive services. Then, they set up intervention times. When patients come in to pick up their prescriptions, we sit down with them to conduct the interventions for whatever health issues are indicated.”

Chuck Termini, B.S. Pharm., RPh, a hospital staff pharmacist and independent clinical pharmacist in Kansas City, MO, connects with many of his MO HealthNet patients through referrals from nursing homes and community pharmacies, who contract with him to provide cognitive services. But he also mines the database for additional interventions.

“I almost always find patients who need help,” Termini said, estimating that he interacts with about 60 MO HealthNet patients each month.

Although pharmacist enrollment in the system has been slow to catch on, Dr. Bollinger is optimistic that the numbers will grow as pharmacists learn of these new opportunities for patient intervention and care.

“My goal is to get every pharmacist in the state enrolled,” she said, adding that growing enrollment will help her make a case to state legislators to increase reimbursement rates. “It may take a little time, but I’m confident they will increase eventually.”

Dr. Bollinger also said that MO HealthNet has been able to demonstrate cost savings resulting from decreased emergency room visits and hospitalizations among patients who participated in the program.

“This is a huge opportunity for health-system pharmacists who can get past the idea that the business comes to them, because it doesn’t,” said Termini. “You have to be proactive in assisting patients.”

–By Steve Frandzel

           

July 15, 2013

West Penn Clinic Successfully Treating Underserved Patients

Pharmacists at West Penn are a key part of the transition-of-care team as indigent patients move from inpatient care to care at the Health and Wellness Clinic.

PITTSBURGH KNOWS A THING OR TWO about comebacks. The Rust Belt capital suffered big losses when the steel industry collapsed in the 1980s, but returned to prosperity with a diversified economy. The West Penn Hospital also faced its own budgetary crisis a few years ago, after peaking in patient volume in 2008.

In 2010, we were forced to significantly downsize and reduce patient care services due to the financial difficulties of our parent organization. After an acquisition and two years of rebuilding and revitalization, we have turned things around with the reopening of a transformed emergency department, an increase in patient beds, technology upgrades, and the biggest transformation yet: the opening of a “new concept” health and wellness clinic in downtown Pittsburgh.

The West Penn Hospital Health and Wellness Clinic, which opened in February 2013, helped us to re-establish our reputation as a cornerstone of medical care in Pittsburgh and the surrounding Bloomfield-Garfield community. Funded 100 percent by proceeds from the hospital’s 340B drug discount program, the clinic provides critical medical services to underinsured and otherwise underserved patients.

Jennifer Davis, Pharm.D.

Jennifer Davis, Pharm.D.

Since its inception, the pharmacy services department has been a driving force behind West Penn’s 340B program.  As the system director for outpatient pharmacy services, I’ve taken the lead in the overall operations of the new clinic. We run the clinic as efficiently as possible, saving time and resources by using existing space and personnel, including on-staff physicians. The funds generated by our 340B program pay for medications that patients might not otherwise be able to afford and for the cost of staffing the clinic.

As a 340B-covered entity, West Penn Hospital contracts with local pharmacies to fill prescriptions using inventory purchased by the hospital at the 340B price. Through this contract pharmacy network, we provide discounted medications to uninsured patients and generate much-needed supplemental revenue from prescriptions covered by insurance.  The revenue, in turn, is used to cover the cost of the downtown Health and Wellness Clinic as well as costs associated with other uncompensated care.

Clinic Grows, Hospital Readmission Shrinks

Physicians at the clinic see uninsured and underserved patients weekly, and we expect to see more patients as word spreads. With funding generated by the 340B program, we help patients offset the costs of their medications. They literally benefit twice from the same 340B savings—patients now have increased access to care and their prescription costs are lower.

As with most hospitals today, readmission is a hot topic at West Penn. Pharmacists at the clinic help keep patients from using the hospital’s emergency department by providing disease management, medicine adjustments, and lab monitoring services. In addition, we receive prescription compliance data from our 340B program administrator to help clinicians monitor the patients who use the program. In February alone, the clinic saw 52 patients. We were also able to hire a full-time receptionist. By year’s end, the clinic hopes to see 800 patients.

Transitioning to Better Care

At the clinic, we are strong advocates for the “transition of care” program, which helps patients use the wellness clinic and Allegheny General Hospital (AGH) Apothecary (one of the hospital’s 340B contract pharmacies) and other local contract pharmacies. This program helps to ensure the coordination and continuity of care as patients transfer between different locations or different levels of care within the same location.

Another service we offer at the clinic is bedside medication counseling at discharge and seeing these patients at the clinic for medication management. AGH Apothecary fills prescriptions as needed. Pharmacists also provide post- hospitalization follow-up for patients who are unable to see their regular doctor.

Key Partners in Setting up the Clinic

With the health and wellness clinic, we have made the best possible use of the hospital’s 340B savings. Starting the clinic, however, took planning, resourcefulness, hard work, and a partnership with a contact pharmacy administrator, Wellpartner, to manage the program.

Wellpartner has expertise in creating custom 340B retail pharmacy networks that include both chains and independents.  Our network is well balanced with the right geographical coverage, which helps increase 340B program utilization.

The hospital first implemented its 340B contract pharmacy program in 2011, after a local pharmacist noted that uninsured and underinsured patients from the hospital’s Joslin Diabetes Center could no longer pay for their medications. Currently, West Penn’s 340B program uses 29 contract pharmacies, filling more than 8,800 prescriptions in 2012.

I also credit the hospital’s C-suite for helping to get the clinic started. They were huge champions for us, and I believe that with strong C-suite support any hospital can implement such a program.

The economy has caused plenty of setbacks for us and for people in need throughout our service area.  But the West Penn Hospital Health and Wellness Clinic proves that with hard work and ingenuity, positive results are possible, even in the worst of times.

–By Jennifer Davis, Pharm.D., Director of Outpatient Pharmacy Services, West Penn Health System, Pittsburgh

 

 

 

December 18, 2009

Bridging the Continuity-of-Care Gap

Elaine Ladd cuts the ribbon at the grand opening of the Ladd Family Pharmacy, the only independent ambulatory care pharmacy in Boise, Idaho.

ELAINE LADD, Pharm.D., BCPS, is a busy woman.

As a clinical pharmacy specialist at Saint Alphonsus Regional Medical Center in Boise, Idaho, Ladd rounds with fellow healthcare professionals as part of a medical team.

As a clinical assistant professor of pharmacy practice at Idaho State University (ISU) College of Pharmacy, she educates students on therapeutic options.

And, as owner of Ladd Family Pharmacy, the only independent ambulatory care pharmacy in Boise, she provides medication therapy management (MTM) services to her patients.

Ladd has discovered professional success along the continuum of care.

Educating, Empowering Patients

By counseling patients in both the hospital and in her pharmacy, the new practitioner said she is more effective in ensuring that patients receive the proper medication therapies and that they are educated about the medicines they take.

“My staff and I are cheerleaders, educating patients and empowering them to take control of their disease states,” Ladd said. “It’s a family here, and we want patients to know that we care.”

Ladd Family Pharmacy offers an on-site MTM clinic, compounding services, home delivery of prescriptions by bicycle couriers, and free exercise classes.

Ladd’s mentor of several years, ASHP President Kevin J. Colgan, M.A., FASHP, strongly supports her uncommon endeavor, which he believes provides distinct services to optimize patients’ therapeutic outcomes.

“I think the clincher for me is that Elaine is using this pharmacy to develop sustainable patient programs,” he said. “I think we all can learn a great deal from Elaine’s approach to patient care.”

MTM Clinic a Success

Ladd’s MTM clinic has been a particular success. Customers are asked to schedule a free consultation at the clinic if they take more than two medications for a condition, were prescribed eight medications in a three-month period, or spend more than $4,000 a year on medications.

Staff pharmacists review the patients’ medication histories, screen for needed vaccinations, inquire about drug interactions, monitor medication use, and administer medicines.

The pharmacy also offers rotations for ISU pharmacy students, who learn about compounding, disease management, and other topics. In July, the pharmacy plans to host its first pharmacy resident. Ladd plans to introduce additional MTM clinics for diabetes, hypertension, and lipidemia.

Improving Health with Exercise, Education

Upstairs, customers stretch during free yoga and Pilates classes or attend educational seminars on managing diabetes and weight loss. Nurse practitioners and ISU students conduct health fairs on smoking cessation, heartburn awareness, diabetes, and skincare
screenings. Down the hall, Ladd’s husband, Kip, works in the office as the pharmacy’s business manager.

Patients from Saint Alphonsus Regional Medical Center, where Elaine Ladd works as a clinical specialist, often come to her MTM clinic for follow-up medication counseling.

Staff at the college are impressed with Ladd’s operation.

“There is an urgent need for pharmacist-provided MTM in Boise,” said Barb Mason, Pharm.D., FASHP, professor and chair of the

ISU College of Pharmacy Department of Pharmacy Practice. “Elaine’s sincere passion for patient-centered care and desire to work collaboratively with physicians is sure to bring her success in any endeavor she pursues.”

So far, Ladd’s unique approach is working. The pharmacy has only been open six months, but pharmacists already fill an average of 80 prescriptions on weekdays. And those numbers are trending upward.

Ladd believes that the unique pharmacy services offered by her four pharmacists and six pharmacy technicians are a real benefit to patients. And she is interested in seeing more integration in patient-care services among hospitals and ambulatory care settings as technology improves.

“Every step along the continuity of care matters, and pharmacists are uniquely suited to provide the kind of MTM services that patients need,” she said. “I’m excited to be able to bridge both worlds.”

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