Health Share Pharmacy Workgroup Experience Jim Slater Facilitator Workgroup Pharmacist Participants Adventist Health CareOregon Central City Concern Clackamas County (Mental Health Services) Kaiser Foundation Health Plan of the Northwest Legacy Health System Multnomah County Oregon Health & Science University Providence Health & Services Hospital Health Plan Medical Group Specialty Pharmacy Tuality Healthcare Washington County (Mental Health Services) • Janice Hogue… • Jim Slater, Dean Haxby… • Sandy Anderson • TBD • Steve Logan, Nancy Louie Lee… • Kathy Stoner, Cory Huot… • Carol Richmond, Michele Koder… • Yen Pham, Amy Szczukowski… • • • • Priyesh Patel… Steve Stoner… Helen Noonan-Harnsberger/Greg Dietzman… Terri Bianco… • Brian Dotter… • TBD Shared Expectations & Questions • What are you hoping to accomplish with collaboration? • What questions do you have about the HSO? • What questions do you have about working together as a workgroup? • What do you think would make a great collaborative relationship? Scope • Collaborative workgroup of pharmacy staff from each HSO partner • Goal is to demonstrate the power of collaboration using collective resources of the collaborative participants • Indentify 3-5 cost-saving drug-therapy initiatives with savings measurable in 6-12 months Possible Traits of a Successful Initiative • Clear evidence or experience suggesting good chance of cost-savings (direct/indirect [high correlation]) • “Shovel Ready” – Can be implemented in 3 months • Collaborative partners can provide sufficient staff resource allocation to be successful • Members and/or Providers likely are positively impacted (Triple Aim) – Tangible experience for the better • Project can work in more than one setting/facility • More than one HSO partner participates together – Even better to work across the system (Plan + Hospital + Clinic/Medical Group) Some Cost-Saving Drug Utilization Levers That Can Be Pulled – Others? • Improving PCP and office staff productivity – Formulary & prior-authorization standardization & unification – EMR best practice – formulary communication & individualized drug therapy plan documentation and updating (EPIC and other platforms) • Ensuring success of drug treatment care plans for high-acuity individuals – Concurrent review/collaboration – hospitalization – Medication reconciliation/transition-of-care post-discharge drug treatment plan F/U (Handovers) Clinic ↔ Hospital ↔ Clinic – Monthly coordinated fills (Adherence packing, dispensing appointments, clinical pharmacist monitoring/updates of drug therapy care plan) • Pro-active steps to protect at-risk members – Hepatitis C (readiness –to – treat, progress/refill monitoring) – Safe Opiate Use (standardizaton: dose ceilings & quantity limits, tapering protocols, instruments: D.I.R.E Score, applying prioritized list coverage/PA criteria) – Guideline Note 1 & 12 – best practice oncology & palliative care – Mental heath access issues ( PCP education on appropriate antipsychotic drug therapy & pearls, limiting off label/poor evidence use) Project Idea Brainstorming • Open Discussion – What projects would lend themselves towards a 6-12 month cost-saving (Triple Aim) objective? Internal & External Communication • Goal: Inspire/achieve orderly & effective team collaboration within the CCO and within the tri-county – How should we proceed with inside and outside interest to join the work? – What are key opportunities to consider in how we communicate our work? – What other groups of pharmacist should we consider to keep in the loop and what is the right juncture? Project Implementation Ideas • One page sponsor report created for each project to report up to HSO • At least co-leads for each project (creates continuity and back-up to keep it moving) • Roll-up dashboard to track progress for each project – regular reporting (monthly) • LEAN/A3 API methodology encouraged to refine work on each project towards success Timeline/Strategy (2012 – 2013) • 3Q2012 – Form pharmacy workgroup and identify projects, • 4Q2012 – Form sub-workgroups, interpret scope into actionable steps • 1Q2013 – Monitor projects, CQI/Lean along the way, monthly progress reports • 2Q2013 – Presentations to collaborative of success/learning’s – Start working on next year objectives TCMC Pharmacy Work Group Draft Sponsor Report Project Title: Date Updated: Oversight Owner(s): Milestones: Implementation Owner(s): Key Stakeholders (KS),: Next Steps/Timeline: Scope: Goals: Key Learning's: Success Defined: Barriers/Concerns: *Report Change **Process Change VSMs and A3s for Project Management Current State VSM Future State VSM PDSA New Current State VSM Future State Plan Project Implementation Brainstorming • Open Discussion – What project resources can we collectively contribute? – What training would help project teams be successful? – What infrastructure do we need to secure pathway towards project success? Pharmacy Workgroup Steps Establish Pharmacy Director Workgroup with representation form each CCO Board Partner 1 Orient workgroup to known CCO facts and workgroup goal 2 Gather key questions and expectations from workgroup participants 3 Conduct Ease & Impact exercise to help identify project ideas 4 Agree on initial projects for first year. Define initial scope 5 Create sub workgroups with CCO partner staff for each project 6 Report to HSO CMO workgroup progress Report out progress or clarification needs to pharmacy director workgroup8 Subgroups meet monthly and interpret scope to create actionable 9 steps 7 Medication Reconciliation Process Mapping Workshop 12-17-2012 Thank You!