CMS Innovation Panel Looks to Medication Adherence as Potential Delivery Innovation

Medication adherence rates for patients enrolled in a collaborative program developed by the University of Pittsburgh School of Pharmacy, Highmark, RiteAid and CE City, a technology company, was significantly improved and continued to improve over time compared to a control group, according to Dr. Janice Pringle, director of the program evaluation research unit at the University of Pittsburgh School of Pharmacy.

Dr. Pringle describes the intervention, which takes a patient-centered approach to pharmacy visits combined with motivational interviewing by the community pharmacists to improve adherence rates. Dr. Pringle also shares how the collaborative has evolved following its first year results, as well as her recent appointment to CMS’ Innovation Advisors Program. As part of her focus on the Innovation Advisors Program, Dr. Pringle will be working with RTI to develop pay for performance models for the community pharmacist program.


Length: 13:07 minutes

Telephonic Case Management: Protocols for Behavioral Healthcare Patients

Though adult mental health patients, substance abusers and children and adolescents may face different behavioral health issues, there’s a common reason behind their frequent hospital and ER visits, explains Jay Hale, LPC, CEAP, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance. Hale’s organization uses a set of telephonic case management protocols to reduce avoidable inpatient and ER use by these populations. He describes some of the barriers telephonic case managers might face during member outreach, red flags that indicate a physician visit is warranted, and the role of primary care providers in the member’s care continuum.

Hale presented during a March 7, 2012 webinar, Telephonic Case Management: Protocols for Behavioral Healthcare Patients, during which he shared the case management protocol developed by his organization, including using scripts and surveys to assess patients’ engagement in the treatment process and identify patients at-risk.


Length: 10:20 minutes