Expanding the Care Continuum: Improving Patient Care and Financial Benefits

1. The Pharmacy Care NetworkHow Expanding The Care Continuum Improves Patient Care and Delivers Financial Benefits Mike Sanborn, President and CEO Baylor Health Carrolton

2. Introduction • The Role of Pharmacy in a Continuous Care Model • Ambulatory & Retail • Inpatient Care • Home Health & Skilled Nursing • Clinic • Food for Thought • Next Steps

3. The Role of Pharmacy in a Continuous Care Model Home Health & Skilled Nursing Pharmacy Hospital Clinic Transitions with Medication Therapy Management Medication Therapy Management Comprehensive Medication Reconciliation Coordinated Prescribing & Specialty

4. Ambulatory & Retail PharmacyRevenue Opportunity • Patient Fill & Adherence • Employee scripts • Savings incentives • Self Insured • Medication Therapy Management • Health Maintenance • Immunizations, Screenings, etc. Your Pharmacy Network $ $ $ $ Pharmacy data helps improve adherence and patient outcomes

5. Ambulatory & Retail PharmacyImpact on Readmissions • Patient Monitoring • Disease state management • Medication management • Reduce adverse reactions and side effects • Increase adherence 4M avoidable readmissions annually 69% stem from failed drug therapy ! Local retail pharmacists can offer significant expertise in retail management *According to a study by the federal Agency for Healthcare Research and Quality.   

6. Inpatient PharmacyThe Current Value-Based Purchasing Landscape

7. Inpatient PharmacyThe Current Value-Based Purchasing Landscape

8. Driving Results • Interviews with top/bottom 5% hospitals for AMI mortality • Among other factors, top performers heavily engage pharmacists, those at the bottom don’t. • In high performing hospitals: • “pharmacists were closely integrated into care processes, and they actively informed and influenced clinical decisions.” Curry LA, et al. Ann Intern Med. 2011;154:384-390.

9. InpatientPharmacyImpact on Readmissions • Intake Medication Reconciliation • Pharmacist or technician real-time engagement through EHR • Discharge Medication Reconciliation • Discharge With Medication In Hand • Counseling with patient and family • Tech with iPad uses Facetime with pharmacist Comprehensive pharmacy management - from intake to discharge and beyond

10. Inpatient PharmacyClinical Initiatives • Formulary management • Indigent support programs • Pharmacy assistance programs recover medication and devices • 340B offers significant outpatient cost reduction • Informatics • Streamline automated utilization and order-set process in EHR • Beware of automated over-prescribing • Value analysis team • Comprehensive study should include pharmacy costs to determine lower cost options • Focus on total care cost • Shortage management • Shared communications of availability within the health system

11. Pharmacist ValueEconomic effects of pharmacists on health outcomes • Meta-analysis of 126 publications • Subdivided into several different kinds of analyses • Future studies should build on the literature and focus on using pharmacists’ expertise in medication therapy to increase access to health care, maximize the quality time providers spend with patients, and improve the quality of care delivered in an efficient and cost-effective manner. Chisolm-Burns MA, et al. Am J Health-Syst Pharm. 2010;67:1624-1634

12. Pharmacist Impact on Heart Failure VBP and Core Measures • Pharmacist-managed heart failure medication education and discharge instruction • “Significant reduction in 30-day all cause readmissions, increase in rate of ACEI/ARB prescribing at discharge for LVSD, and positive impact on patient satisfaction” Warden BA, et al. Am J Health-Syst Pharm. 2014;71:134-9

13. Home Health and SNFTransitions with Medication Therapy Management • Outreach on medication coordination and reconciliation • Good marketing and relations with health system • Care coordination with primary care physician • Understand expectations for post-hospital care Positive relations with local SNF’s demonstrates health system ease of doing business

14. Clinic Pharmacy ServicesThe Growing Specialty Market • Convergence of health systems with clinics • Significant growth projected • Opportunity to source purchasing through hospital • Become a provider or partner to control costs and quality • Better quality than white bag/brown bag • Significant 340B opportunity Improve quality and coordination of care

15. Clinic Pharmacy ServicesHelping to Manage Disease • Complex disease state management • Diabetes, anti-coagulation, heart failure, etc. • High touch increases patient satisfaction • Drug selection • Prescription capture to improve medication adherence

16. Additional Food for Thought • Re-evaluate compounding expenses • Harmonize your formulary with your provider network • Specialty pharmacy is a growing business • Medication Therapy Management services • New revenue • Volume needed • Outcomes will demonstrate more opportunity • PBM evaluation • Evaluation of alternatives

17. …And the Pharmacist’s Role in ACOs

18. Benefits of Future State • Pharmacy services leveraged as clinical, strategic and financial asset • Incorporation into care teams • Drives patient adherence and satisfaction • Reduces readmissions • Pharmacy leaders now lead an effective, coordinated pharmacy enterprise across system • Better relationships and coordination of care across the continuum

19. Next Steps • How you can engage your pharmacy team • Meet with your pharmacy leaders • What are the first feasible steps pharmacy can take to support the changing dynamics of your health system? • What resources are needed to support long-term goals? • Are vendors and GPOs partnering to deliver value and support your goals?

20. Thank you