Expanding Medication Therapy Management Services beyond the Part D population

1. Expanding Medication Therapy Management Services beyond the Part D population Winston Wong, Pharm.D.Associate Vice President – Pharmacy Management

2. Program Part D Results • Since 2006 • 7,492 patients were touched • 768 in 2006 • 4,027 in 2010 • Estimated cost avoidance $5,342,616 • Average cost avoidance per patient: $ 713.11 per patient overall $1,010.18 per patient in 2010 • Participating Pharmacist: 369 • 2010 Pull:Push ratio – 43%:57% • TIP response rate: 9%

3. Program Recognition National Recognition • American Pharmacist Association • 2009 APhA-APPM Pharmacy Practice Merit Award • CMS • QIO • Delmarva Foundation for Medical Care Local Recognition • Maryland Pharmacist Association • 2009 MPhA Honorary President’s Award

4. The CareFirst Approach to Medical Management • Medical Management Infrastructure • Primary Care Physician/Providers • No one better positioned to be the quarterback and central point of coordination for the care of most people. • Engaged, longstanding relationship between member and PCP goes hand in hand with a patient centric approach that is essential to achieving the best possible outcomes. • Medical Management Coordination • Care coordinators will interface between CareFirst and the physician provide the tools and needed information to that will allow the physician to care for their patient • Pharmacy Management will interface into this process with the Medication Management Services program Advanced Illness 3% Population; 29% of Cost Multiple Chronic Conditions 7% Population; 23 of Cost At-Risk Population 10% Population; 19% of Cost Stable Population 30% Population; 22% of Cost Healthy Population 50% Population; 7% of Cost

5. Your Rx Advisor Program– Process Flow MMS Personal Care Pharmacists Delivery Source: Searchlight Pharmacist Practices Search Light Data Mining/Screening CareFirst Pharmacy Management/MMS Clinical Pharmacist CareFirst Regional Care Coordinator Hospital Transition Coordinator Local Care Coordinator Hospitalized Member Primary Care Medical Home Practice (PCMH) CareFirst Rx Book of Business 5