Archive for the ‘Medication Management’ Category

Improve Medication Adherence, and Payors Pay Attention

June 20th, 2017 by Patricia Donovan
medication adherence

Training in motivational interviewing helps Novant health set medication adherence goals that are meaningful to patients.

Seeking additional dollars from managed care contracts? Work harder at getting patients to adhere to medication therapies, advises Rebecca Bean, director of population health pharmacy for Novant Health. Here, Ms. Bean describes ways her organization is improving medication adherence, including pharmacist referrals, while enhancing Novant Health’s bottom line.

Medication adherence is a huge focus for our organization. There are some quality measures related to adherence, including CMS Star measures. They are triple-weighted, which indicates they mean a lot to payors. Often, medication adherence is a way to get additional dollars through managed care contracts. Our pharmacists work hard at helping patients adhere to medication therapies.

We have found some benefit to using adherence estimators. Adherence estimators give you a better feel for what is causing the patient to have difficulty with taking their medication. The other finding is that oftentimes providers are unaware; they have no idea patients aren’t taking medications. This becomes a safety issue; providers may keep adding blood pressure medications because they are not getting that blood pressure to goal. If for whatever reason the patient suddenly decides to take a medication they weren’t taking before, there could be a serious issue with taking all of those blood pressure medicines at one time.

The other benefit to estimating adherence and identifying root causes is that it frames the discussion with the patient. I don’t want to spend an hour talking to a patient about why it’s important to take this blood pressure medicine when it’s actually a financial issue. If I know it’s a financial issue, then I can make recommendations on cost-saving alternatives. It helps you to be more efficient in your conversation with the patient.

The other challenge of adherence is that patients are reluctant to be honest about this issue. You have to be creative to get the answers you need or get to the truth about adherence. If you flat out ask a patient if they’re taking their medications, most of the time they will say yes.

One other helpful strategy when working with patients to set adherence goals is to have them set goals that mean something to them. It’s not helpful for me to set a goal for a patient. If I ask them to tell me what they’re going to do, then they’re accountable for that. It is very helpful to get your staff trained in motivational interviewing. This trains them to meet the patients where they are and to understand what is important to that patient, which helps you frame the medication therapy discussion.

Source: Leveraging Pharmacists to Reduce Cost and Improve Medication Adherence in High-Risk Populations

pharmacists and medication adherence

Leveraging Pharmacists to Reduce Cost and Improve Medication Adherence in High-Risk Populations examines Novant Health’s deployment of pharmacists as part of its five-pronged strategy to deliver healthcare value through medication management services.

Infographic: The Battle for Medication Adherence

May 24th, 2017 by Melanie Matthews

Patient adherence to a prescription regimen can reduce costs and improve the quality of life, according to a new infographic by Medical Marketing & Media.

However, healthcare providers and pharmaceutical companies struggle to find the best tools, words and technologies that will improve adherence rates among patients with chronic conditions.

The infographic examines the impact of non-adherence and how text messaging and “polypills” can impact adherence.

Leveraging Pharmacists to Reduce Cost and Improve Medication Adherence in High-Risk PopulationsWhen it comes to medication management for Medicare beneficiaries, there are more than 25 different factors that can complicate proper use of prescribed medicines—from affordability issues, even among the insured, to fear of a drug’s side effects to potential dangers from high-risk medications or health conditions.

Leveraging Pharmacists to Reduce Cost and Improve Medication Adherence in High-Risk Populations examines Novant Health’s deployment of pharmacists as part of its five-pronged strategy to deliver healthcare value through medication management services.

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Reducing SNF Readmissions: Clinical Targets, Quality Scorecards Elevate Performance

May 23rd, 2017 by Patricia Donovan

reducing SNF readmissions

Michigan’s Tri-County Collaborative holds the line on hospital readmissions from 130 participating SNFs.

Three geographically close Michigan health systems shared more than a concern over escalating readmissions from skilled nursing facilities (SNFs).

As Henry Ford Health System (HFHS), the Detroit Medical Center and St. John’s Providence Health System ultimately discovered from Michigan Quality Improvement Organization (MPRO) data in 2013, they also shared about 30 percent of their patient population.

This revelation, combined with the pinch of new hospital readmission penalties from the Centers for Medicare and Medicaid Services (CMS), prompted the three to set aside competition and siloed strategies and forge a coordinated approach to reducing readmissions from SNFs.

Today, the resulting Tri-County SNF Collaborative operates with a set of clinical and quality targets and metrics created in tandem with more than 130 member SNFs. Tri-County’s dozen participation requirements for SNFs range from regular reporting through a dedicated SNF portal to achievement of specified performance metrics.

“We developed collaborative relationships,” explained Susan Craft, director of care coordination for the family caregiver program in HFHS’s Office of Clinical Quality & Safety. “We wanted to have very open, honest conversations to review issues that were identified and find ways to resolve those.”

Ms. Craft shared the roots, framework and results of the SNF collaborative, which launched in the first quarter of 2015, during Reducing SNF Readmissions: Quality Reporting Metrics Drive Improvements, a May 2017 webcast now available for replay.

Once admitted to the collaborative, member SNFs must report on 14 metrics in four key areas: acuity, care transitions, quality and readmissions. In return, SNFs receive a 13-point unblinded quarterly scorecard with metrics on readmissions and patient acceptance response times, among many others.

A multidisciplinary team within Tri-County Collaborative reviews all SNF metrics bi-annually to determine each facility’s continued participation.

As for the collaborative’s impact since its launch, Henry Ford Health System achieved a nearly 20 percent drop in Medicare SNF readmissions as well as a 28 percent reduction in SNF lengths of stay. The initiative also identified opportunities for improvement, resulting in enhanced outpatient scheduling and nurse-to-nurse handoffs and interventions focused on SNF-specific issues like sepsis, Ms. Craft explained.

Despite these advancements, the collaborative still faces the inherent challenges of competition and transparency, as well as SNFs’ hesitancy to adopt value-based practices. “Our SNFs are still entirely dependent on fee for service [payment models],” said Craft. “They haven’t been impacted by penalties and value-based purchasing, although that is coming for them next year.”

Although not yet referring to participating SNFs as “preferred providers,” the collaboratives hopes to one day equip patients with complete data pictures to guide them in SNF selection. Also on Tri-County Collaborative’s radar are home care agencies, concluded Ms. Craft.

“We know there needs to be a lot of coordination across all post-acute care settings.”

Listen to Susan Craft describe how Michigan’s SNF Collaborative set aside competition to improve quality and readmission rates.

Infographic: Improve Patient Engagement To Increase Medication Adherence

March 3rd, 2017 by Melanie Matthews

Chronic illnesses treated with long-term use of medications could be more successful with improved medication adherence rates, according to a new infographic by Fleming. Some 50% of patients do not take their medications as prescribed.

The infographic drills down on the factors related to non-adherence, the cost of non-adherence and the impact of technology on patient engagement.

Improve Patient Engagement To Increase Medication Adherence

Framework for Patient Engagement: 6 Stages to Success in a Value-Based Health SystemIntermountain Healthcare’s strategic six-point patient engagement framework not only has transformed patient care delivered by the Salt Lake City-based organization but also has fostered an attitude of shared accountability throughout the not-for-profit health system.

Framework for Patient Engagement: 6 Stages to Success in a Value-Based Health System details Intermountain’s multilayered approach and how it supports its corporate mission: Helping people live the healthiest lives possible.

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Infographic: A Digital Prescription for Medication Adherence

December 26th, 2016 by Melanie Matthews

A Digital Prescription for Medication AdherenceMedication adherence is a $337 billion problem in the U.S. healthcare industry. Patients failing to take their prescriptions or follow treatment plans result in more than $100 billion every year in hospitalizations alone, and healthcare spending on noncompliant patients is nearly double the cost of abiding patients, according to a new infographic by epam.

The infographic examines how telehealth can be used to improve medication adherence.

2016 Healthcare Benchmarks: Medication ManagementMedication management is the standard of care that ensures each patient’s medications (whether prescription, nonprescription, alternative, etc.) are individually assessed for appropriateness, effectiveness, safety given the individual’s comorbidities, other medications and ability to be taken as intended, according to a 2012 Patient-Centered Primary Care Collaborative definition. And while medications represent only a fraction of overall medical cost, they wield considerable influence over patients’ chronic condition outcomes, utilization, cost and care experiences.

2016 Healthcare Benchmarks: Medication Management compiles actionable data on the infrastructure, challenges and outcomes of medication management initiatives, based on responses from 101 healthcare organizations to the August 2016 Medication Management survey by the Healthcare Intelligence Network. Click here for more information.

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Infographic: Leveraging Data To Improve Medication Compliance

October 26th, 2016 by Melanie Matthews

Some 75 percent of patients admit to not taking prescription medication as directed, according to a new infographic by SCIOInspire, Corp.

The infographic examines the extent of medication non-adherence, the impact on care quality and outcomes and how data can be used to reduce non-adherence.

2016 Healthcare Benchmarks: Medication ManagementMedication management is the standard of care that ensures each patient’s medications (whether prescription, nonprescription, alternative, etc.) are individually assessed for appropriateness, effectiveness, safety given the individual’s comorbidities, other medications and ability to be taken as intended, according to a 2012 Patient-Centered Primary Care Collaborative definition. And while medications represent only a fraction of overall medical cost, they wield considerable influence over patients’ chronic condition outcomes, utilization, cost and care experiences.

2016 Healthcare Benchmarks: Medication Management compiles actionable data on the infrastructure, challenges and outcomes of medication management initiatives, based on responses from 101 healthcare organizations to the August 2016 Medication Management survey by the Healthcare Intelligence Network. Click here for more information.

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Have an infographic you’d like featured on our site? Click here for submission guidelines.

Engage a Pharmacist and 12 More Prescriptions for Medication Management

October 20th, 2016 by Patricia Donovan

Half of medication management programs engage retail or community pharmacists in 2016.

When should a pharmacist be brought in for a medication management consultation?

When the patient requests a consult, experiences general medication adherence issues, or suffers complications from medications, say respondents to the 2016 Medication Management survey by the Healthcare Intelligence Network.

The 101 respondents to the August 2016 survey also indicated that as a general medication management guideline, and with or without a pharmacist’s involvement, polypharmacy patients, individuals taking high-risk medications, those registering frequent ER or inpatient stays and those transitioning between care sites should receive priority.

Drilling down to clinical red flags for medication management, a diagnosis of diabetes is a key indicator, say 84 percent, followed by congestive heart failure or hypertension, say 81 percent of respondents.

Despite the inclusion of pharmacists in 90 percent of medication management programs, 42 percent of respondents say pharmacists are not currently reimbursed for medication management-related tasks.

Other medication management metrics documented by the survey include the following:

  • The three most common components of medication management programs are education and health coaching (71 percent), a medication needs assessment (69 percent) and pharmacist counseling (68 percent).
  • A pharmacist-driven clinical assessment is the most reliable standard for measuring medication management, say 63 percent of respondents.
  • E-prescribing and aids such as medication event monitoring system (MEMS) caps, pillboxes and calendars are the most common medication management tools, according to 49 percent of participants.
  • Patient-reported medication data is the information most commonly assessed for medication management, say 78 percent, closely followed by medication refill patterns (75 percent) and claims data (53 percent).
  • Half of responding medication management programs engage a retail or community pharmacist.
  • Fifty-eight percent of respondents not currently engaged in medication management plan to launch a program in the coming year.
  • Forty-four percent of respondents share electronic health records for medication management purposes.
  • Beyond a pharmacist-driven assessment, the Medication Possession Ratio (MPR) is the key measure of medication management for 31 percent of respondents.

Click here to download an executive summary of survey results: Medication Management in 2016: Polypharmacy, Diabetes Patients Priorities for Pharmacist-Led Interventions.

Infographic: The Impact of Medication Reconciliation on Readmission Rates

July 18th, 2016 by Melanie Matthews

Medication reconciliation programs, in which pharmacists review patients’ medication regimens and provide adherence counseling during the patient’s transition from hospital to home, reduced ths risk of hospital readmission by 50 percent and helped avoid unnecessary healthcare costs, according to a new study from the CVS Health Research Institute.

A new infographic by CVS highlights the survey findings, including details on the impact of medication non-adherence on readmission rates and how a pharmacist intervention reduced readmission risks.

Medication Management: Using Clinical Pharmacists To Complete Comprehensive Drug Therapy Management Post Discharge in High-Risk PatientsA clinical pharmacist-driven medication management effort at Novant Health identifies patients at high-risk for readmissions or ED visits related to adverse drug events. Using a combination of medication reconciliation, pharmacotherapy review, and patient education, Novant Health’s clinical pharmacists are working to reduce preventable readmissions by optimizing medication regimens and removing barriers to adherence among these high-risk patients.

During Medication Management: Using Clinical Pharmacists To Complete Comprehensive Drug Therapy Management Post Discharge in High-Risk Patients a 45-minute webinar on February 3rd, now available for replay, Rebecca Bean, director, population health pharmacy, Novant Health, shares her organization’s medication management approach and why a clinical pharmacist is key to the program’s success.

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Infographic: Connected Technology Improves Medication Adherence

June 10th, 2016 by Melanie Matthews

The use of a connected medication dispensing technology can greatly benefit patients with chronic conditions, helping them better comply with long-term therapy, according to a new study from Philips. Over the span of one year, user data from more than 1,300 patients in the Netherlands was analyzed, showing 96 percent of patients using Philips Medido, a connected medication dispensing solution, were adherent to their medication schedule.

A new infographic by Philips looks at the impact of medication non-adherence, demographic data of the study’s patients and the impact on medication adherence and cost savings from the intervention.

What’s the cost of medication non-adherence? As high as $290 billion annually, according to one frequently cited estimate. An equally bitter pill to swallow is the dismal C+ grade in medication adherence earned in 2013 by Americans with chronic medical conditions, according to the first National Report Card on Adherence from the National Community Pharmacists Association (NCPA).

Fortunately, the healthcare industry is striving to improve performance in this area. 42 Metrics for Improving Medication Adherence: Interventions, Impacts and Technologies provides convincing evidence of the impact of nine key interventions on medication non-adherence—from the presence of pharmacists in patient-centered medical homes to medication reconciliation conducted during home visits.

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Novant Health Pharmacists Dispense Healthcare Value in the Discharge Space

February 25th, 2016 by Patricia Donovan

Novant Health's team of 12 clinical pharmacists supports medication management across the care continuum.

It’s a statistic healthcare organizations know well: 20 percent of Medicare beneficiaries are readmitted to the hospital within 30 days.

Factor adverse drug events (ADEs) into this trend, and the picture becomes more dire.

Enlisting pharmacists to reduce the number of ADEs in the Medicare population is just one goal in a five-point program by Novant Health to deliver healthcare value through medication management services.

“We’ve focused on adverse drug events because we feel they are an opportunity,” explained Rebecca Bean, Novant Health’s director of population health pharmacy. “Many ADEs are potentially preventable, and we know they are a contributor to hospitalizations. We believe pharmacists have a role in reducing risk for ADEs.”

The list of ADE risks is extensive. By the end of Ms. Bean’s February 2016 presentation on Medication Management: Using Clinical Pharmacists To Complete Comprehensive Drug Therapy Management Post Discharge in High-Risk Patients, now available for replay, she had identified more than 25 different factors that can complicate medication management— everything from a patient’s affordability issues, even among the insured, to fear of a drug’s side effects to potential dangers from high-risk medications or health conditions.

In the Novant Health model, an RN care coordinator risk-stratifies the newly discharged, combing real-time hospital discharge notifications for red flags, such as patients taking high-risk medications or having high-risk conditions, signaling the need for a pharmacist referral.

Once referred, pharmacists conduct a comprehensive drug therapy review, keeping an eye out for adverse effects, newly prescribed medications and polypharmacy as well as general medication adherence issues.

“There could be financial barriers to getting their medications. There could be health literacy issues. Those are the sorts of things we want to make sure we’re directing pharmacist resources toward,” noted Ms. Bean.

Aware its providers have limited time to spend with patients, the integrated health system layers its pharmacists as an additional resource to improve quality performance, to incorporate protocols and evidence-based guidelines such as the all-important medication reconciliation. In an era of electronic health record use, the medication list has become dynamic, with many providers editing the list, Ms. Bean notes.

“We’re also utilizing our pharmacy team both on the inpatient and outpatient sides to gather that best possible medication history, and then teach other clinical team members how to best reconcile medications.”

Ms. Bean shared seven ways Novant Health pharmacists impact comprehensive medication management services, including the dozen benefits of incorporating these clinicians into its patient-centered medical homes (PCMH).

Encouraged by early financial gains from pharmacist interventions, particularly in the areas of medication reconciliation, therapeutic monitoring and warfarin review, Novant Health is committed to staff development to further its medication management program, exploring certification programs and even pharmacy resident programs.

“We feel it’s really valuable in the discharge space to be able to get a pharmacist involved with taking care of patients,” Ms. Bean concluded.

Listen to an interview with Rebecca Bean in which she offers ideas to improve the accuracy of medication lists.