Safety, Quality, and the
Pharmacy Practice Model
Initiative: Aligning for Success
Scott Knoer, M.S., Pharm.D.
Chief Pharmacy Officer
Cleveland Clinic
Objectives
•
•
Describe metrics and a process that
can be used to measure the quality of
change that occurred and ensure that a
positive change has taken place
Describe how organizations have
implemented safety and quality
principles in daily practice
A Case Study at the
Cleveland Clinic
•
Impacting metrics that count
- HCAHPS medication scores
- HF readmission reduction
Insured Payor Mix
80
70
60
%
50
Commercial
Exchange
Coml. No Huron
68.2
Governmental
Govt. No Huron
53.2
46.8
53.1
52.8
46.9 52.5
52.5
47.5
71.2
74.2
52.6
47.4
47.5
47.2
40
31.8
30
28.8
25.8
20
10
0
2010
YTD
June
FC11
FC12
FC13
FC14
FC15
FC16
Note: Based on gross charges. Excludes strategic projects in forecasted period.
Detail
Projected Impact of Healthcare
Reform
$
Millions
0
2014
2015
2016
-40
-80
-$96
-120
-$118
-$129
-160
Detail
HCAHPS Scores
•
•
•
Hospital Consumer Assessment of
Healthcare Providers & Systems
Measures patients’ perceptions of their
hospital experience
Tied to hospital reimbursement
Why Do HCAHPS Scores
Count?
•
•
•
Publically reported measures
Beginning this year, government
reimbursement is directly tied into
HCAHPS Scores
Underperformers will get less money
Medication Domain
Questions
•
•
•
Purpose of new medications explained
Side effects described
Medication Communication
- Composite score based on the
percent of patients responding
‘Always’
HF Readmissions
•
•
•
Unplanned readmissions cost Medicare
$17.4 billion a year, and HF is the most
frequent reason for rehospitalizations
(Jencks et al., 2009).
Reducing readmission rates has the
potential to lead to significant cost
savings
You get paid less if you have high
readmissions
http://www.medscape.com/vie
warticle/722234
Ask 3, Teach 3
•
•
Ask 3
Patients will be encouraged to "Ask 3"
so they understand the name, purpose
and possible side effects of their
medications
Ask 3, Teach 3
•
Teach 3: System wide pharmacy
competency
- The name of the medication
- Describe the purpose of the
medication
- Explain possible side effects (Note:
It’s important to use the words
possible side effects in the
conversation)
Pharmacy HF Education
•
•
Every Cleveland Clinic patient
discharges with a primary diagnosis for
HF receives discharge education from a
pharmacist
System competency
Bedside Delivery of
Medications
•
Bedside delivery option for discharge
Rx for all HF patients
- Tech driven literacy survey
- iPad education pilots
Summary of Projects
•
Patient Experience
- Bedside discharge delivery
- HF education
- Ask 3, teach 3 education
Enterprise Medication HCAHPS
Scores
Enterprise 30-Day HF Readmissions
Future
•
•
•
Expand discharge delivery option to all
patients
- Leverage technology
• iPads
• Portable credit card readers
Expand RPh education to selected
groups
Manage the continuum
`
Every Life Deserves World Class Care