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Building a Community Pharmacy Enhanced Services Network in Utah Building a Community Pharmacy Enhanced Services Network in Utah

Building a Community Pharmacy Enhanced Services Network in Utah - PowerPoint Presentation

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Building a Community Pharmacy Enhanced Services Network in Utah - PPT Presentation

CPESN Work Group Meeting September 13 2016 What is a CPESN A Community Pharmacy Enhanced Services Network or CPESN is a quality improvement initiative focused on integrating community pharmacy enhanced services to optimize coordination of health care services to patients and populations in ID: 736205

services cpesn pharmacy network cpesn services network pharmacy care pharmacies enhanced medication quality participation amp provide community agreement management

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Slide1

Building a Community Pharmacy Enhanced Services Network in Utah

CPESN Work Group Meeting

September 13, 2016Slide2

What is a CPESN?A Community Pharmacy Enhanced Services Network or CPESN is a quality improvement initiative focused on integrating community pharmacy enhanced services to optimize coordination of health care services to patients and populations in our state and communities.

 

Core dispensing services are essential and not diminished in this model but rather are enhanced with workflows and professional services that support medication optimization and preventive services to improve population health outcomes.

Examples:

Immunizations, Medication Synchronization with Review, Medication reconciliation after transitions of careSlide3

Goals of the CPESNEstablish a value-based, quality driven pharmacy representation embedded in the community that provides value to patients, populations, payers, other health care professionals.

Increase

both professional satisfaction and business

opportunities

for pharmacists as healthcare providers in an

evolving

healthcare

delivery

system.

3. The network will be prepared to maintain marketing and negotiating ability to secure funding, contracts and participation from payers, accountable care organizations, provider referral networks and others for clinical services and innovative reimbursement opportunities. Slide4

Who Joins?The CPESN will seek:High integrity pharmacies and pharmacists

Demonstrated interest in the delivery of high quality, patient-centered care

Offers valuable patient care services that exceed traditional core dispensing services.

Willing to have enhanced services measured and analyzed across the network for quality improvement efforts Slide5

Participating Pharmacies

Hospitals

Specialty Providers

Community Resources

HH/Rehab/SNF

PCP &

Clinic

Team

Care Management Team

THE MEDICAL NEIGHBORHOOD

CPESN

Workgroups

CPESN

Workgroups

CPESN

Workgroups

Luminaries

Local CPESN

CPESN Collaborators & Partners

CPESN Network Structure

CPESN Workgroups

include:

Network Operations & Communications

Quality Assurance & Performance Measurement

Service Sets

Luminaries

provide local network leadership to the work groups and other network activities.

The

Local CPESN

provides the support structure for key network functions, including training, credentialing, HIT services and connectivity, population health management tools, etc.

CPESN Collaborators & Partners

may include state pharmacy associations, schools of pharmacy, local medical societies, care management organizations, and others. Slide6

What Does CPESN NC look Like? Slide7

NC CPESN Distribution

Geographic Representation of CPESN Pharmacies as of December 1, 2015 Slide8

NC CPESN Participation CriteriaCurrent registration with the BOP in good standingCurrent NC Medicaid pharmacy providerA signed agreement with CCNC that defines scope of work and CPESN participation

Use of CCNC’s PHARMACeHOME application

Agreement to provide a minimum set of enhanced services:

Proactive waste management program

Patient counseling and adherence coaching

Assistance with medication reconciliationSlide9

Types of Enhanced Services

24 Hour Emergency

Services

Adherence Packaging

Collection of Vital Signs

Compounding

Comprehensive

Medication Review

Home Delivery

Home Visits

Long-Acting InjectionsMed Synchronization ProgramMulti-Lingual CapabilityNaloxone DispensingNutritional counselingPoint of Care TestingSmoking CessationStandardized Assessments (PHQ-9)Disease State Management ProgramsSlide10

The Collaboration Card

The Pharmacy Locator ApplicationSlide11

What Does CPESN Iowa Look Like? Slide12

CPESN Highlights: IowaSlide13

Progress in Iowa

Core vs. Optional Service Sets

Roles & Responsibilities

Participation AgreementSlide14

Iowa CPESN Participation CriteriaA signed agreement that defines roles & responsibilities with CPESN participationCurrent registration with the BOP in good standing

Respect patient’s right to choose their own practitioners and pharmacies

Use secure data platforms and applications, when applicable

Agreement to provide a minimum set of enhanced services

Medication Reconciliation

Clinical Medication Synchronization

Adherence Packaging

Immunizations

Complete Medication Reviews with Chronic Care ManagementSlide15
Slide16

Report on the Multi-State Pharmacy Collaborative (MSPC)

Supporting the Development of Community Pharmacy Enhanced Services Networks (CPESN) Beyond North CarolinaSlide17

Multi-State Pharmacy Collaborative (MSPC)Facilitate expansion of high-performing networks*Provide a venue to connect pharmacists and other pharmacy stakeholders who have interest in delivery of financially sustainable, patient-centered care beyond traditional dispensing services

* High Performing Pharmacy Network to coalesce pharmacies based on the principle of providing value beyond selling drug product to effectuate health trajectorySlide18

The Big PictureForm a nationwide “Network of Networks”Increase,

Develop

and

Sustain

High Performing Networks of Pharmacies

that provide enhanced services offerings

Create Marketplace Presence

of CPESN Networks

Create Marketplace Dependency

on CPESN

℠ NetworksFacilitate local value propositions to other care team members to establish margin positive referral patternsCreate care team dependency on clinical activities performed by community pharmacies to mitigate against risk narrow networking or reimbursement reductions on product distributionEstablish Relationships and Reimbursement models with Medical Benefit side of payer infrastructureSlide19

Stages of CPESN Launch

October 2015

December 2015

June 2016

Contact established

CPESN

℠ Launched

Phase 2

Phase 3

August

2016

Phase 1Slide20

CPESN Highlights: Baptist Memorial Health CareLarge health center covering 3 states (MS, AR, TN) Expressed interest in collaborative effort between BMHC

a

nd CPESN

in coverage area

Slide21

CPESN Highlights: MississippiSlide22

CPESN Highlights: KentuckyWellcare Pilot Program (6 months)KY CPESN℠ to provide NPI’s of participating pharmacies

Wellcare to provide patient attribution list with highest cost. Slide23

Making it Happen in UtahSlide24

Work Group

Service Sets

Network

Operations and Communication

Quality Assurance and Performance Measurement

Charge

Provide input on standard and optional services and how those are defined

Provide input on the education and communication about services to providers/stakeholders (i.e. collaboration card, pharmacy locator app)

Plan for establishing, monitoring and growing the CPESN

Input regarding interactive processes and communications needed for collaboration with the CPESN community pharmacies around the care of specific patients

Identify funding and sustainability opportunitiesGuidance about appropriate measures and measure definitions needed to monitor overall performance and quality of CPESN network

Develop and maintain processes for quality assuranceDevelop and maintain processes for outcome collection and measurementOutputBrainstorm list of standard and optional services to present to the larger groupIdentify ideas for communicating stakeholders services to relevant stakeholdersGet input from value purchasers, pharmacists, and other stakeholders (i.e. family physicians) on services to be provided and how they should be definedIdentify the next steps needed to make the network a success – name, branding, outreach, participation agreementThink through process for sharing best practices and ideas among network participants

Identify infrastructure needs for network implementation including funding and other sustainability needs Brainstorm potential external partners Proposed organizational structure of PESN and how decisions will be madeDevelop strategy for engaging additional pharmacistsBrainstorm outcome measurements that could be used to share network value to payers and providersIdentify ways to hold network participants accountable for qualityDevelop plan for collecting measuresSlide25

Service SetsNeeded Services from the Perspective of CCNC Networks:

Adherence packaging and related programs

Medication reconciliation and other transitional care support

Follow up on denied

claims

Med synchronization

Medication reviews for complex patients

Interventions on care alerts

Pain management (including CSRS monitoring)

Medication deliverySlide26

Network Operations & CommunicationsConsiderations:What will you call your network?Process for participant agreement

Infrastructure needs

Who are potential external partners?Slide27

Network Quality AssuranceConsiderations:Site visitsAccreditationLearning needs of participating pharmacies

Peer to peer coaching

Handling of complaints from peers or providersSlide28

Quality Improvement & AssuranceReadiness & baseline characteristics surveyAudit ProcessWorkflow supportDevelop process for informal continuous QI/QA process

Peer to PeerSlide29

Launching a CPESNSlide30

Step 1: Determining Interest Identification of potential participating pharmacies Webinar, Live Meeting, One-on-one discussion with targeted community pharmacistsP

otential luminaries

Organize Voluntary Work Groups

Collectively determine the posture of your CPESN

Schedule live meeting for network decision makingSlide31

Step 2: Develop Network Framework Determine entity that will organize the CPESNNon-profit, For-profit entity, CCNC assistance

Determine name of your CPESN

Determine value proposition of your network

Determine intent of pharmacy participation by Letter of Commitment

or Participation AgreementSlide32

Step 3: Preparing to LaunchIdentify Network Administrator

Survey participants to determine enhanced services offering(s)

Finalize minimum participation criteria

Outline required and optional service sets

Inclusion criteria

Engage Potential Partnerships (SOP(s), Vendors, etc.)

Branding/Logo Development

Establish deadline for Letter of Commitment/Participation AgreementSlide33

Which Level of Support Will Your CPESN Need?

Light

Medium

HeavySlide34

CPESN Website PreviewSlide35
Slide36

Contact InformationAshley Branham, PharmD, BCACPDirector of Network Development, CCNC Director of Clinical Services, Moose Pharmacy

ashley@moosepharmacy.com

Joe Moose,

PharmD

Director of Luminary Development, CCNC

VP, Moose Pharmacy

joe@moosepharmacy.com