The Pharmacy Care Network
How Expanding The Care Continuum Improves
Patient Care and Delivers Financial Benefits
Mike Sanborn, President and CEO
Baylor Health Carrolton
Introduction
• The Role of Pharmacy in a Continuous Care
Model
– Ambulatory & Retail
– Inpatient Care
– Home Health & Skilled Nursing
– Clinic
• Food for Thought
• Next Steps
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The Role of Pharmacy in a
Continuous Care Model
Pharmacy
Hospital
Home Health &
Skilled Nursing
Clinic
Medication
Therapy
Management
Comprehensive
Medication
Reconciliation
Transitions with
Medication
Therapy
Management
Coordinated
Prescribing &
Specialty
Ambulatory & Retail Pharmacy
Revenue Opportunity
• Patient Fill & Adherence
• Employee scripts
– Savings incentives
– Self Insured
• Medication Therapy
Management
• Health Maintenance
– Immunizations,
Screenings, etc.
Your Pharmacy Network
$
$
$
$
Pharmacy data helps
improve adherence and
patient outcomes
3
Ambulatory & Retail Pharmacy
Impact on Readmissions
• Patient Monitoring
– Disease state management
– Medication management
– Reduce adverse reactions and
side effects
– Increase adherence
4M
avoidable
readmissions
annually
69%
stem from failed drug
therapy
!
Local retail pharmacists can offer significant expertise in retail management
4
*According to a study by the federal Agency for Healthcare Research and Quality.
Inpatient Pharmacy
The Current Value-Based Purchasing Landscape
Hospital Performance
Clinical Process of Care (45% of total performance)
AMI-7a Fibrinolytic Therapy
Received within 30 Minutes of
Hospital Arrival
AMI-8a Primary PCI Received
within 90 Minutes of Hospital
Arrival
HF-1 Discharge Instructions
SCIP-Inf-2 Prophylactic Antibiotic
Selection for Surgical Patients
SCIP-Inf-3 Prophylactic Antibiotic
Discontinued within 24 Hours After
Surgery End Time
SCIP-Inf-4 Cardiac Surgery Patients with
Controlled 6 a.m. Postoperative Serum
Glucose
Readmissions
Outcomes (25% of total
performance)
Patient Experience of
Care (30% of total
performance)
Unfilled prescriptions
MORT-30-AMI Acute
Myocardial Infarction (AMI) 30day mortality rate
Communication with
Nurses
Patient comprehension
MORT-30-HF Heart Failure (HF)
30-day mortality rate
Communication with
Doctors
Medical information or
test results not provided
MORT-30-PN Pneumonia (PN)
30-day mortality rate
Responsiveness of
Hospital Staff
Family lack of
knowledge to provide
adequate care
Patient follow up with
doctor
PN-3b Blood Cultures
Performed in the Emergency
Department Prior to Initial
Antibiotic Received in Hospital
SCIP-Inf-9 Urinary Catheter Removed on
Postoperative Day 1 or Postoperative
Day 2 (**new for 2014**)
Pain Management
PN-6 Initial Antibiotic Selection
for CAP in Immunocompetent
Patient
SCIP-Card-2 Surgery Patients on BetaBlocker Therapy Prior to Arrival Who
Received a Beta-Blocker During the
Perioperative Period
Communication about
Medicines
SCIP-Inf-1 Prophylactic
Antibiotic Received within One
Hour Prior to Surgical Incision
SCIP-VTE-1 Surgery Patients with
Recommended Venous
Thromboembolism Prophylaxis Ordered
Cleanliness and Quietness
of Hospital Environment
SCIP-VTE-2 Surgery Patients Who
Received Appropriate Venous
Thromboembolism Prophylaxes within 24
Hours Prior to Surgery to 24 Hours After
Surgery
Discharge Information
Overall Rating of Hospital
Adverse events
Medication
reconciliation
Clear discharge
instruction
Inpatient Pharmacy
The Current Value-Based Purchasing Landscape
Hospital Performance
Clinical Process of Care (45% of total performance)
AMI-7a Fibrinolytic Therapy
Received within 30 Minutes of
Hospital Arrival
AMI-8a Primary PCI Received
within 90 Minutes of Hospital
Arrival
HF-1 Discharge Instructions
PN-3b Blood Cultures
Performed in the Emergency
Department Prior to Initial
Antibiotic Received in Hospital
PN-6 Initial Antibiotic
Selection for CAP in
Immunocompetent Patient
SCIP-Inf-1 Prophylactic
Antibiotic Received within
One Hour Prior to Surgical
Incision
SCIP-Inf-2 Prophylactic Antibiotic
Selection for Surgical Patients
SCIP-Inf-3 Prophylactic Antibiotic
Discontinued within 24 Hours After
Surgery End Time
SCIP-Inf-4 Cardiac Surgery Patients with
Controlled 6 a.m. Postoperative Serum
Glucose
SCIP-Inf-9 Urinary Catheter Removed on
Postoperative Day 1 or Postoperative
Day 2 (**new for 2014**)
SCIP-Card-2 Surgery Patients on BetaBlocker Therapy Prior to Arrival Who
Received a Beta-Blocker During the
Perioperative Period
SCIP-VTE-1 Surgery Patients with
Recommended Venous
Thromboembolism Prophylaxis
Ordered
SCIP-VTE-2 Surgery Patients Who
Received Appropriate Venous
Thromboembolism Prophylaxes within
24 Hours Prior to Surgery to 24 Hours
After Surgery
Readmissions
Outcomes (25% of total
performance)
Patient Experience of
Care (30% of total
performance)
Unfilled prescriptions
MORT-30-AMI Acute
Myocardial Infarction (AMI) 30day mortality rate
Communication with
Nurses
Patient comprehension
MORT-30-HF Heart Failure (HF)
30-day mortality rate
Communication with
Doctors
Medical information or
test results not provided
MORT-30-PN Pneumonia (PN)
30-day mortality rate
Responsiveness of
Hospital Staff
Family lack of
knowledge to provide
adequate care
Pain Management
Patient follow up with
doctor
Communication about
Medicines
Cleanliness and Quietness
of Hospital Environment
Discharge Information
Overall Rating of Hospital
Adverse events
Medication
reconciliation
Clear discharge
instruction
Driving Results
• Interviews with top/bottom 5%
hospitals for AMI mortality
• Among other factors, top
performers heavily engage
pharmacists, those at the bottom
don’t.
• In high performing hospitals:
– “pharmacists were closely
integrated into care processes,
and they actively informed and
influenced clinical decisions.”
Curry LA, et al. Ann Intern Med. 2011;154:384-390.
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Inpatient Pharmacy
Impact on Readmissions
• Intake Medication
Reconciliation
– Pharmacist or technician realtime engagement through
EHR
• Discharge Medication
Reconciliation
• Discharge With Medication In
Hand
– Counseling with patient and
family
– Tech with iPad uses Facetime
with pharmacist
Comprehensive
pharmacy
management - from
intake to discharge
and beyond
Inpatient Pharmacy
Clinical Initiatives
• Formulary management
• Indigent support programs
– Pharmacy assistance programs recover medication and devices
– 340B offers significant outpatient cost reduction
• Informatics
– Streamline automated utilization and order-set process in EHR
– Beware of automated over-prescribing
• Value analysis team
– Comprehensive study should include pharmacy costs to
determine lower cost options
– Focus on total care cost
• Shortage management
– Shared communications of availability within the health system
9
Pharmacist Value
Economic effects of pharmacists on health outcomes
• Meta-analysis of 126
publications
– Subdivided into several different
kinds of analyses
• Future studies should build on the
literature and focus on using
pharmacists’ expertise in
medication therapy to increase
access to health care, maximize the
quality time providers spend with
patients, and improve the quality of
care delivered in an efficient and
cost-effective manner.
10
Chisolm-Burns MA, et al. Am J Health-Syst Pharm. 2010;67:1624-1634
Pharmacist Impact on Heart Failure VBP
and Core Measures
• Pharmacist-managed heart
failure medication education
and discharge instruction
“Significant reduction in 30-day
all cause readmissions, increase
in rate of ACEI/ARB prescribing
at discharge for LVSD, and
positive impact on patient
satisfaction”
11
Warden BA, et al. Am J Health-Syst Pharm. 2014;71:134-9
Home Health and SNF
Transitions with Medication Therapy Management
• Outreach on medication
coordination and reconciliation
• Good marketing and relations
with health system
• Care coordination with primary
care physician
– Understand expectations for
post-hospital care
Positive relations with
local SNF’s demonstrates
health system ease of
doing business
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Clinic Pharmacy Services
The Growing Specialty Market
• Convergence of health systems with
clinics
• Significant growth projected
• Opportunity to source purchasing
through hospital
• Become a provider or partner to
control costs and quality
– Better quality than white bag/brown
bag
– Significant 340B opportunity
Improve
quality and
coordination of
care
13
Clinic Pharmacy Services
Helping to Manage Disease
• Complex disease state management
– Diabetes, anti-coagulation, heart
failure, etc.
• High touch increases patient
satisfaction
• Drug selection
• Prescription capture to improve
medication adherence
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Additional Food for Thought
• Re-evaluate compounding expenses
• Harmonize your formulary with your provider
network
• Specialty pharmacy is a growing business
• Medication Therapy Management services
– New revenue
– Volume needed
– Outcomes will demonstrate more opportunity
• PBM evaluation
– Evaluation of alternatives
15
…And the Pharmacist’s Role in ACOs
Benefits of Future State
• Pharmacy services leveraged as clinical, strategic
and financial asset
• Incorporation into care teams
• Drives patient adherence and satisfaction
• Reduces readmissions
• Pharmacy leaders now lead an effective,
coordinated pharmacy enterprise across system
• Better relationships and coordination of care
across the continuum
17
Next Steps
• How you can engage your pharmacy team
– Meet with your pharmacy leaders
– What are the first feasible steps pharmacy can take
to support the changing dynamics of your health
system?
– What resources are needed to support long-term
goals?
– Are vendors and GPOs partnering to deliver value
and support your goals?
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Thank you
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