VA Pharmacy Conference
2008
Consolidated Mail
Outpatient Pharmacy Operations
Kenneth Siehr
Deputy Chief ConsultantPharmacy Benefits Management Service
Consolidated Mail Outpatient Pharmacy Operations
Department of Veterans Affairs
Overview
•
•
•
•
•
A little about me
Life of a VA mail out prescription
Outpatient prescription fulfillment system
CMOP today
CMOP history
– How we got to where we are
• CMOP of Tomorrow
• How does this affect you?
Who Is This Guy?
• 30+ years in Federal Pharmacy
– Pharmacy Intern VA Madison 1977
•
•
•
•
•
•
Army Pharmacist 1978-81
VA Staff Pharmacist 81-82
VA Pharmacy Supervisor since 1982
Chief of Pharmacy 1988
Managed Multiple Services at Medical Center
VISN Formulary Leader (VISN 12) when
positions were established
• PBM Manager 2004
• Present Position 10/07
The Life of a VA Mail Out
Prescription
Life of a VA Mail Out Prescription
Provider Orders
Medication
1 Hour to ??
Awaiting
Verification
Patient
Receives
10 Hr
12 – 48 Hrs
48 Hrs to ??
CMOP
Filling
Awaiting Transmission
to CMOP
Delivery to Patient
Goal: Delivery to Patient with 10 days of Patient/Provider request
VHA Outpatient Medication Fulfillment System
Contracting and Procurement
Medical Centers
CMOP
Delivery to Patient
Goal: Delivery to Patient with 10 days of Patient/Provider request
Medical Center
• Interface between
– Patient and fulfillment system
– Provider and fulfillment system
• Ensures right
– Medication for patient clinically
– Dose, frequency
– Cost efficiency
• Dispenses Prescriptions (20%)
– Window
– Mail
• Responsible for Performance
– Chief of Pharmacy, Facility TMT, VFL
CMOP
• Dispenses Prescriptions (80%)
– Mail
• Primary Interface
– Patient delivery services
• USPS, FedEx
• Mail consolidators
• Direct to patient vendors
– NAC for outpatient medication contracts
– Contractors for direct to patient delivery
• Responsible for Performance
– CMOP Director, National CMOP and PBM
Contracting and Procurement
• National Pharmacy Benefits Management
Services
–
–
–
–
Formulary Management
Identifies contacting opportunities
Monitors utilization
Contract compliance
• National Acquisition Center (NAC)
– National contracts, BPAs, FSS
• Procurement and Contracting staff at each site
and CMOP
• Responsible for Performance
– Chief of Pharmacy, CMOP Director
– National PBM, NAC
Delivery to Patient
• Window at Medical Centers
• To Patient’s Home
– Contracted or third party vendors
• US Postal Service
• Federal Express or similar vendor
– Mail consolidators
• Facilitate and speed process
– Direct to patient contractors
• Responsible for Performance
– Contracting Officer for contracted services
– USPS
VHA Outpatient Medication Fulfillment System
Contracting and Procurement
Medical Centers
CMOP
Delivery to Patient
Goal: Delivery to Patient with 10 days of Patient/Provider request
VA CMOP National System
Leavenworth
Hines
Chelmsford
Charleston
Tucson
Tucson
Murfreesboro
Dallas
CMOP Today
• 7 separate locations
• Each highly automated and highly efficient and
successful but with different equipment and
software
• Different practices, processes and products
– Murfreesboro – Media Mail
– Hines – mail manifesting
– Various prescription and mailing labels
• Limited national CMOP information system
• Beginnings of organizational support structure
• Collection of 7 individuals, not an integrated
system
CMOP: Grass Roots Effort
• Grass roots effort
– Concept proven at West LA and Leavenworth
• RFP Process
– Equipment centrally funded
– Medical Centers selected were to provide support
• Facilities Management, Contracting, Human Resources etc.
– Medical Centers serviced provided inventory funding
• CMOP Director reported to local Board
• CMOP needed and fostered entrepreneurial
culture
– Highly successful results
Each CMOP a Contract
• Each CMOP the result of a turn key
contract with a vendor
– Vendor provided all equipment and software
• Different vendors = different equipment
and software not designed to integrate
with other CMOPs
Early CMOP Organization
• Each CMOP essentially owned by the
Medical Centers it serviced
• Reporting to a Board made up of
customers
• Unique equipment and software
• Organizational support provided by host
site
CMOP Tomorrow
• 7 integrated locations
• Each highly automated and highly efficient with different
equipment but the same software
• Standardized practices, processes and products
– Same product list
– Centralized customer interface, QA etc.
– Patient medications from any CMOP
• Robust national CMOP information system accessible by
users
– Standardized reports
– ProClarity cubes
• Mature and effective organizational support structure
How Does This Affect You?
• Ability to seamlessly shift workload
between CMOPs
– Equipment breakdown, disaster recovery
– Specialty CMOPs
– Patient centric, ship from closest CMOP
• More tools
– Track Rx and package
– Report and trend problems
– Track and validate costs
Murfreesboro Zip Code Distribution
How Does This Affect You?
• Standardized product lists
– Medical/Surgical supplies
– Medications and pack sizes
• Medication event prevention
– Screen and identify inappropriate Rx
directions
– Rx quantity checks
Get Involved and Work With Your
VISN Formulary Leader as We
Transition
