Paving the Way for the
‘One Team’ Approach:
Pioneer ACO MTM Program Update
Pharmacy Support Meeting
Open Discussion
November 14, 2013
Partners and Funding
• Partners:
• Trinity Pioneer ACO
• The University of Iowa
• OutcomesMTM
• Iowa Pharmacy Association
• Community Pharmacies in ACO Service Area
• Funding Acknowledgements
• National Association of Chain Drug Stores (NACDS)
Foundation
• Community Pharmacy Foundation
• McKesson
Objectives
• Assess the effects of an integrated MTM program for ACO
patients on all-cause hospitalization rates
• Assess the 30-day hospital readmission rates for the ACO
patients
• Evaluate the impact of an integrated MTM program on the
incidence of adverse drug events that result in an emergency
department visit for ACO patients
• Assess the effect of an integrated MTM program on per capita
Part A and Part B Medicare costs for ACO patients
• Characterize the types and frequencies of drug-related
problems identified and resolved by the pharmacist-delivered
MTM services for ACO patients
Research Methods: Overview
• 2-year study overall
• Will operate integrated MTM program for at least 12 months
• Will compare integrated MTM program in Pioneer ACO (Fort
Dodge area) to usual care under Medicare Shared Savings
Program (Waterloo area)
• Encompasses all ACO patients, though focus on high-risk
patients
• Will track effects of the MTM program via Medicare claims and
MTM claims data
• Quality indicators
• Utilization and costs
MTM Referral Process – Trinity ACO
High Risk Transition
of Care Patients
MyNurse
Nurses complete a 24 hr postdischarge telephone evaluation on all
hospitalized patients. Refer patients with
med issues to the MTM Pharmacists(unable
to teach back; complicated regimens; high
risk medications).
Trinity Pharmacists Identify patients
on high-risk medications or fit criteria for
needing post-discharge follow-up.
High Risk Chronic Care
Patients
Population Management
Pharmacist
High risk patients identified by review of
claims data (high risk medications; multiple
prescribers; high medication costs).
Primary Activities
Iowa Health ACO
Pharmacists
(Triage High-risk Patients)
Referral
Communication
OutcomesMTM
MTM-Trained Community
Pharmacist Providers
•
•
•
•
Create linkages with case management & analytics
Identify and triage high risk MTM patients
Solve medication issues telephonically, if able
Send referrals to MTM-Trained Community
Pharmacists via OutcomesMTM platform
Primary Activities
• Complete MTM activities for all referred patients
• Assist with transition of care patients (medication
reconciliation).
• Communicate with PCP/home care as needed
• Assist with monitoring and follow-up for pts started on
high risk med (ex: insulin, steroids, antiplatelets,
warfarin).
• Assist with adherence monitoring and adherence tools
• Document activities in OutcomesMTM platform
Integrated MTM Program:
Screening and Assigning
• Screening
• High Risk Transition of Care Patients
• Internal risk assessment prior to discharge- Trinity Pharmacists
• MyNurse follow-up
• High Risk Chronic Care Patients
• Analysis of utilization & clinical data within ACO
• Analysis of drug claims data by OutcomesMTM
• Assigning
• OutcomesMTM will assign at-risk, targeted patients to receive services from
either ACO pharmacy personnel or community pharmacists
• ACO pharmacists can provide immediate services prior to discharge
• Community pharmacists provide MTM services when patient transitions to
home
Integrated MTM Program: MTM Care
• Will follow OutcomesMTM standard set of covered services
• Comprehensive Medication Review (CMR)
• Prescriber Consultation
• Patient Adherence Consultation
• Patient Education & Monitoring
• For discharged patients, CMRs can include a medication
reconciliation to compare post-discharge medications with
those prior to hospitalization
• BEST PRACTICE: Share current medication list with prescriber
• After service delivery, the pharmacist will file MTM claim using
OutcomesMTM web platform for reimbursement
Current MTM Program Timeline
• Summer 2013
• Communication to patients, prescribers, and pharmacies
• October 17th – Pilot Begins with 2 Clinics
• UnityPoint Clinic in Fort Dodge: Dr. Birkett
• Humboldt Family Practice: Dr. Dvorak
• November 8th – Full Implementation
• Fax/E-mail blast announces official rollout
• Nov 2013 – Oct 2014
• Community pharmacy MTM services delivered to ACO patients
• Nov/Dec 2014
• Claims run-out and data collection
• 2015
• Data analyses and report writing
• Throughout
• Regular meetings with UnityPoint and project planners
MTM Care Referral Form
Feedback & Discussion
• Communication Amongst Prescribers & Pharmacists
• Fax process
• SOAP format
• Communication between all parties
• Barriers
• Communication with Patients
• Privacy issues
• Cognitive impairment situations
• Overall Program
• Clinical Interventions
• Workload concerns
Additional Resources:
• ACO Phone Numbers
• MTM Help Line for Patients: 515.574.6385
• UnityPoint Hospitalist Line: 515.574.6332
• Patient Brochure includes:
• What is the Trinity Pioneer ACO? MTM?
• Benefits of a Medication Review
• Frequently Asked Questions
• Provider Communication Forms
• Medication Therapy Management Concern Form
• Information Request Form
• DRAW Tool
• TIMER Tool
Pharmacy Education and Support Update
• Pharmacy Support Meetings
• Thursday, February 27th at 6:00pm in Fort Dodge
• MTM and ACO Quality Measures
• Accredited for Pharmacists & Pharmacy Technicians
• On-Demand Health Coaching Series (2 x 1 hr of CPE)
• Engaging Patient Through Health Coaching
• Health Coaching Tools for Pharmacists
• Register on www. GoToCEI.org with the code “ACO13”
• Complimentary IPA Membership for Technicians ($65 value)
• Register at www.iarx.org, Click Membership, then Join/Renew
• Use code “IPAACO”
Questions
• Bill Doucette, U of I
• William-Doucette@uiowa.edu
• Jennifer Kownacki, UnityPoint
• Jennifer.Kownacki@unitypoint.org
• Jessica Frank, OutcomesMTM
• jfrank@outcomesmtm.com
• Scott Leigh, Trinity Hospital
• Scott.Leigh@unitypoint.org
• Justin Riesberg, OutcomesMTM • Craig Logemann, UnityPoint
• jriesberg@outcomesmtm.com
• Craig.Logemann@unitypoint.org
• Chris Donner-Tiernan, Hy-Vee
• csdonner@yahoo.com
• Anthony Pudlo, IPA
• apudlo@iarx.org
THANK YOU!