Paving the Way for the ‘One Team’ Approach: Pioneer ACO MTM Program Update

1. Paving the Way for the ‘One Team’ Approach: Pioneer ACO MTM Program Update Pharmacy Support Meeting Open Discussion November 14, 2013

2. Partners and Funding • Partners: • Trinity Pioneer ACO • The University of Iowa • OutcomesMTM • Iowa Pharmacy Association • Community Pharmacies in ACO Service Area • Funding Acknowledgements • National Association of Chain Drug Stores (NACDS) Foundation • Community Pharmacy Foundation • McKesson

3. Objectives • Assess the effects of an integrated MTM program for ACO patients on all-cause hospitalization rates • Assess the 30-day hospital readmission rates for the ACO patients • Evaluate the impact of an integrated MTM program on the incidence of adverse drug events that result in an emergency department visit for ACO patients • Assess the effect of an integrated MTM program on per capita Part A and Part B Medicare costs for ACO patients • Characterize the types and frequencies of drug-related problems identified and resolved by the pharmacist-delivered MTM services for ACO patients

4. Research Methods: Overview • 2-year study overall • Will operate integrated MTM program for at least 12 months • Will compare integrated MTM program in Pioneer ACO (Fort Dodge area) to usual care under Medicare Shared Savings Program (Waterloo area) • Encompasses all ACO patients, though focus on high-risk patients • Will track effects of the MTM program via Medicare claims and MTM claims data • Quality indicators • Utilization and costs

5. MTM Referral Process – Trinity ACO High Risk Transition of Care Patients High Risk Chronic Care Patients Population Management Pharmacist High risk patients identified by review of claims data (high risk medications; multiple prescribers; high medication costs). MyNurseNurses complete a 24 hr post-discharge telephone evaluation on all hospitalized patients. Refer patients with med issues to the MTM Pharmacists(unable to teach back; complicated regimens; high risk medications). Trinity Pharmacists Identify patients on high-risk medications or fit criteria for needing post-discharge follow-up. Primary Activities • Create linkages with case management & analytics • Identify and triage high risk MTM patients • Solve medication issues telephonically, if able • Send referrals to MTM-Trained Community Pharmacists via OutcomesMTM platform Iowa Health ACO Pharmacists (Triage High-risk Patients) Referral Primary Activities Communication • Complete MTM activities for all referred patients • Assist with transition of care patients (medication reconciliation). • Communicate with PCP/home care as needed • Assist with monitoring and follow-up for ptsstarted on high risk med (ex: insulin, steroids, antiplatelets, warfarin). • Assist with adherence monitoring and adherence tools • Document activities in OutcomesMTM platform OutcomesMTM MTM-Trained Community Pharmacist Providers

6. Integrated MTM Program: Screening and Assigning • Screening • High Risk Transition of Care Patients • Internal risk assessment prior to discharge- Trinity Pharmacists • MyNurse follow-up • High Risk Chronic Care Patients • Analysis of utilization & clinical data within ACO • Analysis of drug claims data by OutcomesMTM • Assigning • OutcomesMTM will assign at-risk, targeted patients to receive services from either ACO pharmacy personnel or community pharmacists • ACO pharmacists can provide immediate services prior to discharge • Community pharmacists provide MTM services when patient transitions to home

7. Integrated MTM Program: MTM Care • Will follow OutcomesMTM standard set of covered services • Comprehensive Medication Review (CMR) • Prescriber Consultation • Patient Adherence Consultation • Patient Education & Monitoring • For discharged patients, CMRs can include a medication reconciliation to compare post-discharge medications with those prior to hospitalization • BEST PRACTICE: Share current medication list with prescriber • After service delivery, the pharmacist will file MTM claim using OutcomesMTM web platform for reimbursement

8. Current MTM Program Timeline • Summer 2013 • Communication to patients, prescribers, and pharmacies • October 17th – Pilot Begins with 2 Clinics • UnityPoint Clinic in Fort Dodge: Dr. Birkett • HumboldtFamily Practice: Dr. Dvorak • November 8th – Full Implementation • Fax/E-mail blast announces official rollout • Nov 2013 – Oct 2014 • Community pharmacy MTM services delivered to ACO patients • Nov/Dec 2014 • Claims run-out and data collection • 2015 • Data analyses and report writing • Throughout • Regular meetings with UnityPoint and project planners

9. MTM Care Referral Form

10. Feedback & Discussion • Communication Amongst Prescribers & Pharmacists • Fax process • SOAP format • Communication between all parties • Barriers • Communication with Patients • Privacy issues • Cognitive impairment situations • Overall Program • Clinical Interventions • Workload concerns

11. Additional Resources: • ACO Phone Numbers • MTM Help Line for Patients: 515.574.6385 • UnityPoint Hospitalist Line: 515.574.6332 • Patient Brochure includes: • What is the Trinity Pioneer ACO? MTM? • Benefits of a Medication Review • Frequently Asked Questions • Provider Communication Forms • Medication Therapy Management Concern Form • Information Request Form • DRAW Tool • TIMER Tool

12. Pharmacy Education and Support Update • Pharmacy Support Meetings • Thursday, February 27th at 6:00pm in Fort Dodge • MTM and ACO Quality Measures • Accredited for Pharmacists & Pharmacy Technicians • On-Demand Health Coaching Series (2 x 1 hr of CPE) • Engaging Patient Through Health Coaching • Health Coaching Tools for Pharmacists • Register on www. GoToCEI.orgwith the code “ACO13” • Complimentary IPA Membership for Technicians ($65 value) • Register at www.iarx.org, Click Membership, then Join/Renew • Use code “IPAACO”

13. Questions • Bill Doucette, U of I • William-Doucette@uiowa.edu • Jessica Frank, OutcomesMTM • jfrank@outcomesmtm.com • Justin Riesberg, OutcomesMTM • jriesberg@outcomesmtm.com • Chris Donner-Tiernan, Hy-Vee • csdonner@yahoo.com • Jennifer Kownacki, UnityPoint • Jennifer.Kownacki@unitypoint.org • Scott Leigh, Trinity Hospital • Scott.Leigh@unitypoint.org • Craig Logemann, UnityPoint • Craig.Logemann@unitypoint.org • Anthony Pudlo, IPA • apudlo@iarx.org

14. THANK YOU!