Mike Gifford
President & CEO, ARCW
Katy Caldwell
Executive Director, Legacy Community Health Services
Mary Elizabeth Marr
CEO, Thrive Alabama
Rick Fons
Vice President of Pharmacy Services, ARCW
Mike Gifford, MBA
President and Chief Executive Officer
AIDS Resource Center Wisconsin
 Pharmacy is among the most important HIV
services for our patients and clients.
• Medications are life-prolonging, life-saving
• Challenges to access medications remain
significant
• Access and adherence is critical to viral
suppression
 Truly integrated care is the emerging bestpractice model of care for HIV patients and
clients.
• Quality over quantity; improved quality outcomes
• Pharmacy is still often times left out of health care
service delivery models
• Payment reform
 Unpredictable revenue sources risk the
sustainability of HIV services
• Government funding has been level or decreasing
• Private funding has been stagnant
• Many AIDS service providers are facing difficult
choices because of financial constraints
• Pharmacy services can be a new, earned, large
revenue source
 The presentation includes important examples of
different models of pharmacy services for HIV
patients
•
•
•
•
Contracted pharmacy
In-house pharmacy
On-site pharmacy
Off-site pharmacy
 It is important for HIV/AIDS service providers to
evaluate and decide the best model of pharmacy
services for their organization, patients and clients
Katy Caldwell
Executive Director
Legacy Community Health Services
 Ryan White Grantee since the Beginning
• Parts A, B, C & D
 Family Planning Grantee
• Title V & X
 FQHC Status since 2004
• First look-alike and then fully deemed
 Full 340b Access for all Patients
• Contract with Walgreens & Wellpoint (mail-order)
2004
CHOICES
Contract or Start Our Own
Pros & Cons of Each
Cost
Control
Knowledge
Control
Retain
Profit
Drug Pricing
Ins. Contracts
Liability
DEA Raids
Class A License
Retain Profit
Lack of Control
No Cost
Dispensing Fees
Control
Core
Comp
Reputation
Inventory
RetainTracking
Profit
Accountability
Shared Liability
Ins. Contracts
Buying Power
Corp. Decisions
Locations
 5 years
• One location on site
 Separate lease
• Market rate rent
 We own inventory
 We pay dispensing fee
 We contract with distributor
• At their approval
 They bill insurance companies
• Detailed reconciliation
 They prepare/file all docs to OPA
 May request staff changes
• For any reason
 Pharmacist must be trained
• In HIV, Behavioral Health & Hep C
 Standard insurance
• On both sides
 Must meet our LEED standards
 Must honor all methods of pay
• Sliding scale, ADAP & grant funded meds
Mary Elizabeth Marr
CEO
Thrive Alabama
(formerly AIDS Action Coalition of Alabama)
 Ryan White Grantee since 2000
• Parts B, C & D
 Davis and Hames Clinics
• 600+ Clients
• Additional site opening 2015
 Full 340b Access for all Patients
• Contract with Walgreens & Curant Health (mailorder)
Specialty Pharmacy
 Largest independent specialty
340B pharmacy in the nation
 Home Delivery – FedEx
 In-care Coordinators
• Client Adherence
• Collaborate with Clinical staff
on adherence issues
• Clients have $0 co-pay when
dispensed
Store Front
 Throughout 12 county region
 Some clients prefer a
storefront & direct contact
with a pharmacist
 Same day pickup
 INFRASTRUCTURE
• Administrative Costs
•
•
•
•
Finance Staff (3)
HR (1)
ED (1)
Data (1)
• Vehicles for Transportation
• Cut our Overall Transportation Costs
• Building Fund
 SMMAP (Sandra Moon Medical Assistance Program)
•
•
•
•
Medical Co-Pays
Physician Appointments
Medication Co-pays
Laboratory Co-pays
 INSURANCE
• Monthly Premiums
• Insurance Deductibles
Aug 2011
Apr 2015
$250,000
350
325
300
$237K
$200,000
250
$150,000
200
195
150
$100,000
100
$50,000
50
0
29
Clients
40
Prescriptions
$3K
$Revenue
Viral Load Suppression
100%
90%
80%
70%
60%
50%
2009
2010
2011
2012
2013
2014
VL<=1000
71.2%
74.9%
76.1%
79.2%
85.9%
87.2%
VL<=200
62.7%
68.4%
71.2%
72.6%
80.9%
84.5%
VL<=48
54.7%
56.8%
60.6%
64.1%
72.3%
79.7%
 Potential Challenges ability to fund PrEP:
• Costs
•
•
•
•
Physician Costs
Laboratory Costs
Insurance Assistance
Patient Assistance Programs
Richard Fons, RPh, AAHIVP
Vice President of Pharmacy Services
AIDS Resource Center of Wisconsin






Nation’s first CMS Approved HIV Medical Home
191 staff
13 clinics and offices
Operates an in-house pharmacy model
Six pharmacist and ten technician staff
Two pharmacy locations: Milwaukee and
Madison
ARCW
2009
ARCW
2014
Number served
2,523
est. 2,950
% with an Undetectable Viral Load
69%
85%
Patients
Financial
ARCW budget
Net Income
Net Assets
Cash on hand
$12.5 million
$45.9 million
$303,000
$1.8 million
$4.2 million
$8.9 million
$653,000
$3.4 million
Staff
Employees
132
191
1. Expanded our Medical Home model of care
2. Improved clinical outcomes
• HIV
• Primary care
3. Improved organizational talent
4. Improved overall margin over outside
contract pharmacy model of care
 Pharmacist-Driven Institutional Protocols
• Improved patient outcomes
• Anticoagulation, Hypertension, tobacco cessations
• HIV therapy selection/ Adherence
 Medical-Home Pharmacist
• Comprehensive medication reviews
• Medication procurement
• Education/research/clinical decision support
 Revenue Generation
•
•
•
•
Medical-home patient management fee
Clinical outcome incentive bundle payments (Medicare/3rd Party)
Prescription capture
“Incident to” CPT billing
ARCW
2009
ARCW
2014
Patients With an Undetectable
Viral Load
69%
85%
Prescribed HAART
74%
95%
With diabetes that is well
managed
NA
83%
Prescribed preventative PCP
treatment
91%
95%
With controlled hypertension
NA
59%






Full time, in-clinic pharmacist
Dental clinic in Green Bay office
Expanding behavioral health to 5 more offices
Medication Copayment Assistance Program
Increased number of food pantries
Additional staff: medical provider, case
managers and psychiatrist
Year
Pharmacy revenue
Pharmacy revenue
reinvested in patient
services
2011
$7,019,604
$915,322
2014
$33,044,565
$5,683,483
 Webinars are available on our website for on-demand viewing.
 You will find slides from today’s presentation posted to the
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 Join us for our other webinars this month!
Engagement in Care: From Cascade to Continuum to Control
Wednesday, May 20, 2015 @ 2:00 PM ET
(Registration will soon be open at our website: www.nationalhivcenter.org )