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
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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 ManagementSlide15Slide16
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 PreviewSlide35Slide36
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