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Administrator
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Registered: ‎02-22-2010
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Pharmacy and ACOs Webinar

[ Edited ]

Thanks for joining our webinar with L. David Harlow on "Accountable Care for Pharmacy Executives and Decision Makers."

View the on-demand webinar or download the slides.

 

Have a question for David? Post it here and he will do his best to answer your questions for a limited period of time.

Administrator
Posts: 578
Registered: ‎02-22-2010
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Re: Pharmacy and ACOs Webinar

Here are some questions from our live presentation:

 

Q: Many of the ACO and PCMH models seem to describe the value of pharmacists around activities such as increasing generic utilization rates.  How do we communicate the larger value offering of pharmacists in this new model?

 

Q: There are been much talk recently about accountability.  Pharmacists seem to resistant to taking accountability within the team setting. What are you are your thoughts on accountability.


Q: It seems certain that organizations will find metrics/dashboards that show real time performance to ensure CQI and ACO success.  Are there specific metrics for pharmacy functions, "pharmacy-sensitive" metrics?


Q: Can you discuss the episode of care payments? What is an example?  Say an admit for a planned surgery.


Q: Can you comment on the various risk models options that an ACO can enter into (low risk/low benefit, etc)?


Q: Where do you see the LTC place in the ACO model?

Expert
Posts: 6
Registered: ‎08-24-2011

Re: Pharmacy and ACOs Webinar

Q: Many of the ACO and PCMH models seem to describe the value of pharmacists around activities such as increasing generic utilization rates.  How do we communicate the larger value offering of pharmacists in this new model?

 

This is of course one of the challenges we have, generic utilization rates are essentially reminders that this is best practice, very little brain power associated with that initiative which is what you allude to. My take on this is keep people focused on the value of "crossing the wall" IE transitions. If you can show what your pharmacist are bringing to the table INSIDE the hospital and use similar examples that could hold up in PCMH that makes a compelling case. However, if collaborative practice is a foreign term start educating the physicians that it can be done, find a physician champion to help make your case. Pick ONE chronic disease that the PCMH may be struggling with and offer a pilot. Remember PCMH has quality markers it has to meet and pharmacist are ideally suited to help on the med management side. TALK in READMISSION terms and administration will take note...not just in pharmacy speak.

 

Hope that helps

Expert
Posts: 6
Registered: ‎08-24-2011

Re: Pharmacy and ACOs Webinar

Q: There are been much talk recently about accountability.  Pharmacists seem to resistant to taking accountability within the team setting. What are you are your thoughts on accountability

 

Sad isn't it. To use Spider Man as my example, "With Great Power Comes Great Responsibility!" or in our case accountability. If we as professionals want to be at the descision making table, we must be accountable for what we ORDER.  If all we are going to do is talk in terms of recommendation....teams can use Epocrates for free to do that!! Im sorry, saying you don't want to be accountable in my mind is the same as saying you don't want to be paid. Harsh as that may sound, the healthcare system requires us to do more or get out of the way and that kind of dead weight is exactly why we struggle so hard to be recognized as providers. If you are a leader in your organization, you cannot tollerate that mindset because it is infectious.

Expert
Posts: 6
Registered: ‎08-24-2011

Re: Pharmacy and ACOs Webinar

[ Edited ]

Q: It seems certain that organizations will find metrics/dashboards that show real time performance to ensure CQI and ACO success.  Are there specific metrics for pharmacy functions, "pharmacy-sensitive" metrics?

 

Now this is getting to the fundamentals of the kind of change we are talking about!  I wish I could see this a bit more clearly myself, the difficulty is that since we are still working on (even here) what some best practice model for pharmacy looks like those could be variable from my site to yours.

 

That said, consider what we are working on and how I am approaching this. Creating CQI of course means you need to be familiar with your baseline quality and how you define that. One measure of pharmacy process quality might be how often patients get discharged only to find out that the mediation is not covered by their insurance at retail or they simply can't afford them.  What process (prescreening) do we do PRIOR to discharge to ensure this does not happen that impacts that because we know that one of the drivers of readmission are inappropriate med use or noncompliance due to may reasons one of which is certainly funds.

 

One of the fundamental threads in pharmacy needs to be Medication Reconciliation. Pharmacy needs to be the stewards of this process. So if I use that as one of my baselines, we are working on a discharge med screening process that starts at admission and is part of our Med Rec process that allows the pharmacist to review the proposed DC meds prior to DC and make actionable recommendations to the MD. So CQI here maybe 1) how many did we find and 2) how many did we get changed...and of course what would have been the negative consequence.

 

This is just an example of what my thought process is but, again, as we get further in to this pharmacy model redesign we will see the processes more clearly and only then will we really be able to vette out CQI...if you have more questions about the above (which we will publish) please feel free to email me at ldharlow@carilionclinic.org I would love to explore this or any ideas you may have, because this is work we all benefit from.

 

I hope that was helpful

Expert
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Re: Pharmacy and ACOs Webinar

Q: Can you discuss the episode of care payments? What is an example?  Say an admit for a planned surgery.

 

As far as I can tell this is another proposal by Medicare and others similar to "shared savings" in that it is thus far conceptual because I know of no one accepting such payments...but keep in mind the take home message...it decreases reimburesment ACROSS an organization.

 

So it would look like this: Patient is admitted to XYZ organization and has a knee replacement. The payor can identify this as an Episode of Care to some endpoint say full mobility. So the MD, hospital, PT, hospital meds, therapy, (maybe infections as a result of poor processes? yikes) are payed similar to a DRG except it extends potentially outside the hospital. So you might think of it that way...

 

The problem is how do you define these? I have seen this payment scheme suggested for chronic diseases, becaues patients with these see multiple MD's lots of labs poor coordination etc etc. NOW, remember that 20/'80 conversation....this is where that money is spent poorly, so again look at what a pharmacist following an evidence based protocol/collaborative practice could save in just coordination since the organizations MD's will have signed off on the best practice....

 

Everyone can see the waste but simply changing the payment mechanism will not fix that without some process change on the part of the organizations

Expert
Posts: 6
Registered: ‎08-24-2011

Re: Pharmacy and ACOs Webinar

Q: Can you discuss the episode of care payments? What is an example?  Say an admit for a planned surgery.

 

This topic is much more complicated than this comment section will allow clarity on. Ron Klar wrote a great blog on this subject in HealthCare Affairs http://healthaffairs.org/blog/2011/01/25/the-importance-of-the-shared-savings-aco-model/ that describes the challenges and what the different risks are and to whom.

 

Im not putting you off, it's just that he did a much better job than I will be able to do free hand for you here and it is a very significant issue.

 

That being said, again for Pharmacy Exec's the take home message is that one way or the other, the funds we will have for staffing and processes will continue to shrink at least as a %. If organizations are talking of reimbursement and the "risk" associate with what they choose, recognize that it is a gamble or a calculate risk...but risk nonetheless. Thus your CFO's risk is your risk and you should be familiar with how your organization plans to be reimbursed over the long haul.

 

Excellent question Thanks

 

 

 

 

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Expert
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Re: Pharmacy and ACOs Webinar

Q: Where do you see the LTC place in the ACO model?

 

LTC patients are part of the continuum for certain and they are HEAVY HITTERS in terms of usage. So opportunities are HUGE for collaboration between LTC and ACO or LTC as part of ACO. The ACO has a vested interest in the success of decreasing readmissions from LTC so

 

For instance, LTC patients have extensive medication lists, also have financial constraints also have MULTIPLE CHRONIC conditions. Humm beginning to sound familar?? Your organization needs your pharmacists and the LTC pharmacy and consultant to collaborate create a CARE PLAN that addresses potential pitfalls and reasons a resident has been admitted in the past and come up with ways to mitigate those in the future. That is good care for the individual and decreases the overall expense to the healthcare system.  The beauty of LTC is that they ideally compliance doesn't have to be as big a variable as the general public .. so there is one are that you are a leg up on to making impact.

 

Also if you follow this process then to the above CQI question...look at this process full of potential for CQI measure on both sides of the wall!!!