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Pharmacy Models for ASOs & CBOs : Increasing Revenue and Improving Treatment for Clients

Learn about different pharmacy models for ASOs & CBOs to increase revenue and improve treatment outcomes for clients.

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Pharmacy Models for ASOs & CBOs : Increasing Revenue and Improving Treatment for Clients

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  1. Pharmacy Models for ASOs & CBOs: Increasing Revenue and Improving Treatment for Clients Mike Gifford President & CEO, ARCW Katy Caldwell Executive Director, Legacy Community Health Services Mary Elizabeth Marr CEO, Thrive Alabama Rick Fons Vice President of Pharmacy Services, ARCW

  2. Introduction to Pharmacy Services Mike Gifford, MBA President and Chief Executive Officer AIDS Resource Center Wisconsin

  3. Importance of Pharmacy Services • Pharmacy is among the most important HIV services for our patients and clients. • Medications are life-prolonging, life-saving • Challenges to access medications remain significant • Access and adherence is critical to viral suppression

  4. Importance of Pharmacy Services • Truly integrated care is the emerging best-practice model of care for HIV patients and clients. • Quality over quantity; improved quality outcomes • Pharmacy is still often times left out of health care service delivery models • Payment reform

  5. Importance of Pharmacy Services • Unpredictable revenue sources risk the sustainability of HIV services • Government funding has been level or decreasing • Private funding has been stagnant • Many AIDS service providers are facing difficult choices because of financial constraints • Pharmacy services can be a new, earned, large revenue source

  6. Models of Pharmacy Services • The presentation includes important examples of different models of pharmacy services for HIV patients • Contracted pharmacy • In-house pharmacy • On-site pharmacy • Off-site pharmacy • It is important for HIV/AIDS service providers to evaluate and decide the best model of pharmacy services for their organization, patients and clients

  7. Pharmacy at Legacy Community Health Katy Caldwell Executive Director Legacy Community Health Services

  8. Legacy Community Health • Ryan White Grantee since the Beginning • Parts A, B, C & D • Family Planning Grantee • Title V & X • FQHC Status since 2004 • First look-alike and then fully deemed • Full 340b Access for all Patients • Contract with Walgreens & Wellpoint (mail-order)

  9. Decision Process for Pharmacy Model 2004 CHOICES Contract or Start Our Own Pros & Cons of Each

  10. Start-up Pros & Cons Pros Cons Control Retain Profit Control Retain Profit Cost Knowledge Drug Pricing Ins. Contracts Liability DEA Raids Class A License

  11. Contract Pros & Cons Cons Pros No Cost Core Comp Inventory Tracking Shared Liability Buying Power Locations Control Retain Profit Lack of Control Dispensing Fees Reputation Accountability Ins. Contracts Corp. Decisions

  12. Contract Terms • 5 years • One location on site • Separate lease • Market rate rent • We own inventory • We pay dispensing fee • We contract with distributor • At their approval • They bill insurance companies • Detailed reconciliation

  13. Contract Terms (continued) • They prepare/file all docs to OPA • May request staff changes • For any reason • Pharmacist must be trained • In HIV, Behavioral Health & Hep C • Standard insurance • On both sides • Must meet our LEED standards • Must honor all methods of pay • Sliding scale, ADAP & grant funded meds

  14. Pharmacy at Thrive Alabama Mary Elizabeth Marr CEO Thrive Alabama (formerly AIDS Action Coalition of Alabama)

  15. Thrive Alabama • Ryan White Grantee since 2000 • Parts B, C & D • Davis and Hames Clinics • 600+ Clients • Additional site opening 2015 • Full 340b Access for all Patients • Contract with Walgreens & Curant Health (mail-order)

  16. Pharmacy Model • Largest independent specialty 340B pharmacy in the nation • Home Delivery – FedEx • In-care Coordinators • Client Adherence • Collaborate with Clinical staff on adherence issues • Clients have $0 co-pay when dispensed Specialty Pharmacy Store Front • Throughout 12 county region • Some clients prefer a storefront & direct contact with a pharmacist • Same day pickup

  17. Use of 340B Funding • INFRASTRUCTURE • Administrative Costs • Finance Staff (3) • HR (1) • ED (1) • Data (1) • Vehicles for Transportation • Cut our Overall Transportation Costs • Building Fund

  18. Use of 340B Funding • SMMAP (Sandra Moon Medical Assistance Program) • Medical Co-Pays • Physician Appointments • Medication Co-pays • Laboratory Co-pays • INSURANCE • Monthly Premiums • Insurance Deductibles

  19. 340B Growth 325 195 $3K 40 29

  20. Treatment Outcomes Viral Load Suppression

  21. 340B / PrEP Program • Potential Challenges ability to fund PrEP: • Costs • Physician Costs • Laboratory Costs • Insurance Assistance • Patient Assistance Programs

  22. Pharmacy at ARCW Richard Fons, RPh, AAHIVP Vice President of Pharmacy Services AIDS Resource Center of Wisconsin

  23. AIDS Resource Center of Wisconsin • Nation’s first CMS Approved HIV Medical Home • 191 staff • 13 clinics and offices • Operates an in-house pharmacy model • Six pharmacist and ten technician staff • Two pharmacy locations: Milwaukee and Madison

  24. ARCW 5 Year Look Back

  25. Why did ARCW open its own pharmacy? • Expanded our Medical Home model of care • Improved clinical outcomes • HIV • Primary care • Improved organizational talent • Improved overall margin over outside contract pharmacy model of care

  26. Clinical Pharmacy Services • Pharmacist-Driven Institutional Protocols • Improved patient outcomes • Anticoagulation, Hypertension, tobacco cessations • HIV therapy selection/ Adherence • Medical-Home Pharmacist • Comprehensive medication reviews • Medication procurement • Education/research/clinical decision support • Revenue Generation • Medical-home patient management fee • Clinical outcome incentive bundle payments (Medicare/3rd Party) • Prescription capture • “Incident to” CPT billing

  27. Clinical Outcomes

  28. Programs Supported by Pharmacy Margin • Full time, in-clinic pharmacist • Dental clinic in Green Bay office • Expanding behavioral health to 5 more offices • Medication Copayment Assistance Program • Increased number of food pantries • Additional staff: medical provider, case managers and psychiatrist

  29. Pharmacy at a Glance

  30. Q&A

  31. Webinars are available on our website for on-demand viewing. You will find slides from today’s presentation posted to the front page of our website: www.nationalhivcenter.org. Please complete the evaluation at the end of the webinar. Your feedback will inform our programming. If you are interested in individualized technical assistance, please visit our website and complete a TA Request Form. Join us for our other webinars this month! Engagement in Care: From Cascade to Continuum to Control Wednesday, May 20, 2015 @ 2:00 PM ET (Registration will soon be open at our website: www.nationalhivcenter.org ) Conclusion Slide

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