Implementing the MTM Business Model: Setting a Solid Foundation for Services

1. Implementing the MTM Business Model: Setting a Solid Foundation for Services Rebecca W. Chater, RPh, MPH, FAPhA Director of Clinical Services Kerr Drug, Inc.

2. Financial Disclosure Rebecca W. Chater, RPh, MPH, FAPhA, Kerr Drug, Inc. declares no conflicts of interest or financial interests in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, or honoraria.

3. Learning Objectives After attending this session, participants will be able to: Identify the components of an internal marketing strategy for establishing an MTM service Describe compensation and reimbursement issues that affect the financial viability of an MTM service Discuss potential strategies for marketing MTM services to third-party payers and cash-paying patients Identify steps that will facilitate implementation of MTM services in a community pharmacy

4. Self-Assessment Questions The best road map to successful delivery of clinical pharmacy services is an effective: Marketing plan Pro forma Business plan Service mix

5. Self-Assessment Questions 2. MTM return on investment (ROI) for a self-insured employer is a measurement of the total cost savings to the employer divided by the total cost of the: a. Total cost of MTM/pharmacist services b. Co-pay waivers c. Pharmacist time d. MTM administrative fees

6. Self-Assessment Questions 3. Based on the Asheville Project model, which of the following outcomes can be projected? a. Decreased cost of medications b. Decreased physician visits c. Decreased hospitalizations d. Decreased laboratory costs

7. What Are You Selling?

8. What Is Your Marketing Strategy?

9. Purpose of a Business Plan Articulate mission, vision Community needs assessment Define service mix Identify stakeholders Summarize marketing plan Project financials Revenue Expenses

11. Business Plans: Macro, Micro Clinical Services Division Executive Summary Organization Mission / Vision Business Model Service Mix Stakeholders Overall Marketing Plan Pro Forma Expenses Revenue Individual Clinical Sites Practice Mission / Vision Community Needs Assessment Review of Current Business Business Expansion Ideas Four-Walls Marketing Plan Revenue Projections

12. Business Plan Considerations All sources of revenue and all associated costs Location of MTM service delivery Pharmacy Worksite Other Infrastructure for MTM service delivery Workflow By appointment

13. Business Plan Considerations Precision allocation of pharmacist time Adequate tools Training Equipment Documentation Billing/Payment/ Reconciliation Adequate support staff Technical aspects of clinical services Correspondence Patient appointments/ reminders MD faxing Precision Allocation of Pharmacist Time�maximizing billable time; avoidance of all ineffective and inefficient use of time; careful monitoring of all non-revenue generating activities.Precision Allocation of Pharmacist Time�maximizing billable time; avoidance of all ineffective and inefficient use of time; careful monitoring of all non-revenue generating activities.

14. Business Plan Considerations Strategic partners to help you drive your business APhA / APhA Foundation NACDS / NACDS Foundation Community Pharmacy Foundation Academia Internal departments Other national / state associations Medical practices Other community partners

15. Business Plan Considerations Sound decisions in price-making and price-taking Pricing services Time-based Fee-for-service Capitated Responding to RFPs Evaluating PDP contracts Positive return on investment

17. Business Plan Considerationsfor Single Clinical Service

18. Corporate Wellness Service Large on-site analytic risk assessment services requires mobile team to do FLPs, BG, height, weight, abdominal girth measurements Many cost considerations Fixed Indirect (salaries) Direct (training, lodging, food, mileage or gas, facilities) Variable Cassettes Disposables KYN software fee Opportunity costs

19. Corporate Wellness Services Risk Assessment Health Fairs Educational Programs Immunizations Screenings Diabetes Education MTM Cardiovascular/ Dyslipidemia & HTN Osteoporosis Diabetes Asthma Peripheral Artery Disease Thyroid (TSH) Prostate (PSA) Our team provides screening and monitoring services both within our Kerr Healthcare Centers and the greater community. Our offerings include those you see listed, among others� Peripheral Artery Disease�Ankle Brachial Index Osteoporosis�Bone Mineral Density Dyslipidemia�Full Lipid Panel Hypertension�Blood Pressure Diabetes�Blood Glucose, Hemoglobin A1C Asthma�SpirometryOur team provides screening and monitoring services both within our Kerr Healthcare Centers and the greater community. Our offerings include those you see listed, among others� Peripheral Artery Disease�Ankle Brachial Index Osteoporosis�Bone Mineral Density Dyslipidemia�Full Lipid Panel Hypertension�Blood Pressure Diabetes�Blood Glucose, Hemoglobin A1C Asthma�Spirometry

20. Sample Business Plan for Practice Site

21. Mission Statement Mission To be a leading provider of community-based clinical pharmacy services Vision Provide high-quality and innovative services that yield positive health outcomes Maintain long-lasting relationships with customers / patients through quality care delivery Utilize effective marketing techniques to attract local business contracts for MTM services; grow MD referrals Further strengthen QA measures in my practice

22. Description of Current Business MTM Delivery Employers Medicare Part D payers Medicaid Patients / caregivers Immunizations Administer 4,500 influenza vaccines 12 in-store events 12 off-site events Diabetes Education 36 Medicare claims/month Jan-Jun 40 claims/month Jul-Sept 24 claims/month Oct-Dec Consulting / Chart Reviews @ ALFs Quarterly reviews for 1 large facility, 2 small facilities Screening Services (POC testing) Lipids, BP, PAD, PSA, TSH, BG, BMD, LFT Student Preceptorship 4 from Campbell Univ. SOP 5 from UNC SOP 6 from Wingate SOP Practice-based Research Staffing ~20 hours/month

23. Marketing Current strategies In-store signage, bag stuffers, word of mouth Out of store: circular, yard signs, newspaper MD detailing Direct-to-payer Goals Update comprehensive package and tailor to specific audience Review and amend in-store materials Add 1 MD visit per month Enhance pharmacy employees� knowledge regarding complete offerings

24. Business Expansion Ideas Explore grant funding for outcomes collection of existing program APhA Foundation Community Pharmacy Foundation NACDS Foundation PhRMA Grant Departments Establish Clinical Pharmacist Practitioner (CPP) relationship with area physician Anticoagulation services, diabetes management Market Wellness Program in tandem with Immunization Program to local employers Via expanded efforts of marketing dept. Sign two contracts for MTM in Raleigh market

25. Revenue Projections

26. Return on Investment (ROI) Cost savings/ increase in net profit _______________ Total cost of MTM/ pharmacist services

27. Cost Components Before Pharmacist Intervention COG / drug MD visits Hospitalizations ED visits Labs Admin After Pharmacist Intervention COG / drug ? MD visits ? Hospitalizations ? ED visits ? Labs ? Admin ? Pharmacist services

28. Cost Savings of Pharmacist-Delivered Services

29. Considerations in Marketing MTM Persuasiveness = Tailoring message to listener Listener = CFO Key messages Provider track record Impact on payer population Costs to payer Logistics Integration with existing payer programs ROI

30. Sample Presentation toSelf-Insured Employer

45. Questions