THE VISION OF PHARM-2-PHARM

Reece K. Uyeno, Pharm.D.Hospital Consulting Pharmacist Manager, Pharm2PharmMartha Harkey, PhDCommunity Consulting Pharmacist, North Shore Pharmacy

THE VISION OF PHARM-2-PHARMLeverage underutilized pharmacist expertise across thecontinuum of care to achieve the three-part aim of the CMSInnovation Center: Better care Better health Lower total costs“Pharm2Pharm” “Hospital Pharmacist to Community Pharmacist” care transitionand coordination model focused on medications

BEFORE THERE WAS PHARM-2-PHARM,THERE WAS THE MINNESOTA EXPERIENCE *“Beginning in 1999, Fairview Health Services of Minneapolis/St. Paulimplemented the ‘Collaborative Practice of Pharmaceutical Care’ at 6 of 15primary care clinics, where pharmacists now play an integral role in the delivery ofcare” *RESULTS: Improvements in clinical outcomes Reductions in cost*Isetts et al., Clinical and economic outcomes of medication therapymanagement services: The Minnesota experience.J Am Pharm Assoc. leid 1043431#Methods

IMPROVED PATIENT OUTCOMES80%70%60%Patients receiving face-to-facemedication managementservices provided bypharmacistsComparison group NOT receivingthese pharmacist services50%40%30%20%10%0%Met HEDIS criteria forhypertension managementMet HEDIS criteria forcholesterol management*Isetts et al., Clinical and economic outcomes of medication therapymanagement services: The Minnesota experience.J Am Pharm Assoc. leid 1043431#Methods

REDUCED TOTAL COST OF CARE (EVEN WITH INCREASE IN DRUG COSTS)*Isetts et al., Clinical andeconomic outcomes ofmedication therapymanagement services: TheMinnesota experience.J Am PharmAssoc. leid 1043431#Methods

THE VISIONLeveraging the underutilized community pharmacist to achievethe three-part aim of the CMS Innovation Center:- Better care- Better health- Reduced costs

Pharm2Pharm Patient Timeline

PHARM-2-PHARM MEDICATION PROCESSES**Adapted from: Pharmaceutical Care Practice – The Patient Centered Approach,Cipolle, Morley, and Strand, 3rd Edition, McGraw Hill, 2012

MODEL IMPLEMENTATION TO DATELaunched in 4 counties: Maui, Kauai, Hawaii, HonoluluOver 1,500 patients enrolled and handed off to Community Consulting PharmacistsThrough intensive CQI efforts, implemented and revised Standard Operating Procedures “Toolkit” Training

HEALTH INFORMATION TECHNOLOGYPROGRESSSecure messaging: All care transition documentsLab access: Majority of physicians haveauthorized the ConsultingPharmacists to have access to theirenrolled patients’ labs via HHIEare now being sent by the Hospital ConsultingPharmacist to the Community ConsultingPharmacist via HHIE’s secure messagingsystemHCS Med 360: Consulting Pharmacistsare now using this to conductpreliminary medication reconciliationand maintain accurate medicationlist.Virtual translation service: Now availableto Community ConsultingPharmacists, allowing non-Englishspeaking patients to be enrolled% of care transition documents sent fromHospital to Community Pharmacist via HHIE

HCS MED 36014 Robust data sources including but not limited to:PBM’s MedCo, Caremark, Catamaran, ExpressScripts, ArgusPharmacies CVS, Walgreens, SafewayInsurance HMSA, Wellpoint, Aetna, Humana, HumanaSurescripts

HCS MED 360 VIA HHIELongitudinal fill history screen shot: shows gaps in med use

HCS MED 360 VIA HHIEPill Identifier

HCS MED 360 VIA HHIECompleted Med Rec Screen Shot: shows “inactivated med’s” (previous doses and regimens),clinician-added OTC’s and herbals

HCS MED 360 VIA HHIEInteraction checker

HCS MED 360 VIA HHIELongitudinal charting of clinical info screen shot: to correlate with med use

HCS MED 360 VIA HHIEPrintable Completed Med List: shows confirmed meds, who confirmed, etc.

HCS MED 360 VIA HHIEPrintable Patient Education Materials

HHIE PATIENT REGISTRY Simplified workflow walkspharmacists through thepatient managementprocess Attempts to reducepharmacist workflowredundancy to improveefficiency.

HHIE PATIENT REGISTRY Maintains patientdemographics, programstatus, providerassociations and more Records patient programactivity for reporting andpotential analytics

HHIE PATIENT REGISTRY Pharmacists are provided apersonalized list view ofpatients of interest Pharmacists can filter, sortand search for patientsbased on multiple criteria

HHIE COMMUNITY HEALTH RECORDAccess to Clinical ReportsReal-time Laboratory Results

HHIE DIRECT SECURE MESSAGING

SUMMARY: HIT USE VIA HHIE FORPHARM2PHARM PATIENTSHITCURRENTPOTENTIALSecure messagingPharmacist to pharmacistPharmacist to physicianHCS med rec, medlistPharmacist:access/update atenrollment, readmission,each visitNurse/physician:access/update at ER,admission, office visitPatient registryPharmacist: enrollmentlist, active patient listPhysician: high riskpatient listLAN translationPharmacist: across thecontinuumPhysician: office/followup visitsCommunity healthrecordPLANNED: Pharmacistaccess to supportmedication monitoringNurse/physician: accessinfo updated bypharmacist

Total patients enrolled and handed off through March 20141,157Average per patient acute care utilization 365 days prior to theirPharm2Pharm enrollment/hand-offTotal cost of acute care for these patients 365 days prior to theirPharm2Pharm enrollment/hand-offAverage per patient acute care cost 365 days prior to theirPharm2Pharm enrollment/hand-off% of patients by race/ethnicity3.1% of patients by age5% 18-4411% 45-5420% 55-6432% 65-7423% 75-8410% 85 30.6M 26,44138% White/Caucasian26% Hawaiian14% Filipino13% Japanese3% Other Pacific Islander2% Hispanic/Latino0.7% Black0.7% Chinese0.4% American Indian2% Other/unknown

THREE-YEAR FOCUSLAUNCHYear 1- Staff- Contracts- SOPs & tools- Training- Evaluation Plan- EnrollmentIMPROVEYear 2- CQI- HIT- Provider collaborationsSUSTAINYear 3- Payment models- Partnerships

ACKNOWLEDGEMENT OF FEDERAL FUNDINGThe project described is supported by Funding Opportunity Number CMS-1C1-120001 from Centers for Medicare and Medicaid Services, Center for Medicare andMedicaid Innovation.Its contents are solely the responsibility of the authors and do not necessarilyrepresent the official views of HHS or any of its agencies.

BEFORE THERE WAS PHARM -2-PHARM, THERE WAS THE MINNESOTA EXPERIENCE *“Beginning in 1999, Fairview Health Services of Minneapolis/St. Paul implemented the ‘Collaborative Practice of Pharmaceutical Care’ at 6 of 15 primary care clinics, where pharmacists now p