Welcome to the November 2015 JCPP Meeting

1. Welcome to the November 2015JCPP Meeting Wifi Code: lorienmeetings@yahoo.com Luggage may be stored at front desk

2. CEO Discussion

3. CEO Discussion Agenda College / School of Pharmacy applicants Topics for 2016 meetings Other issues

5. Welcome to the November 2015JCPP Meeting Wifi Code: lorienmeetings@yahoo.com Luggage may be stored at front desk

6. JCPP Purpose • JCPP focuses on collaboration, coordination and communication at the national level, and action oriented activities where identified and agreed upon by JCPP member organizations. • Its primary action activities will occur at the organizational level, and reported to JCPP in quarterly updates by each organization Adopted by JCPP CEOs May 2015

7. Agenda 9:00 AM   Call to Order 9:10 AM JCPP Website Update 9:40 AM Perspectives from Payers/Decision-makers 10:45 AM – Break 11:00 AM 11:00 AM – Noon Perspectives from Researchers/Consultants Noon - Luncheon 12:50 PM 1:00PM Group Discussion 2:00pm CCP Update 2:15PM Hot Topic Discussion • Future Topics • Update on JCPP Action Plan Implementation 3:00PM Additional Issues and Wrap Up 3:15 PM  Adjournment of Meeting

8. 2016 Meeting Dates (Embassy Suites in OId Town Alexandria – awaiting signed contracts): Meeting  Date of Meeting Winter                              Wed, January 13, 2016  Spring                              Thur, June 2, 2016          Summer                           Tues, August 2, 2016   Fall                                   Tues, November 29, 2016

9. Future Meeting Agenda Topics Winter               Wed, January 13, 2016  Spring                Thur, June 2, 2016  

10. Agenda 9:00 AM   Call to Order 9:10 AM JCPP Website Update 9:40 AM Perspectives from Payers/Decision-makers 10:45 AM – Break 11:00 AM 11:00 AM – Noon Perspectives from Researchers/Consultants Noon - Luncheon 12:50 PM 1:00PM Group Discussion 2:00pm CCP Update 2:15PM Hot Topic Discussion • Future Topics • Update on JCPP Action Plan Implementation 3:00PM Additional Issues and Wrap Up 3:15 PM  Adjournment of Meeting

11. JCPP Website Update

12. jcpp.net

13. Agenda 9:00 AM   Call to Order 9:10 AM JCPP Website Update 9:40 AM Perspectives from Payers/Decision-makers 10:45 AM – Break 11:00 AM 11:00 AM – Noon Perspectives from Researchers/Consultants Noon - Luncheon 12:50 PM 1:00PM Group Discussion 2:00pm CCP Update 2:15PM Hot Topic Discussion • Future Topics • Update on JCPP Action Plan Implementation 3:00PM Additional Issues and Wrap Up 3:15 PM  Adjournment of Meeting

14. Health Plan Perspective On Medication Management Dan Rehrauer Sr. Manager, Medication Therapy Management Program HealthPartners

15. HealthPartnersat a glance Largest consumer governed nonprofit health care organization in the nation Serves more than 1.5 million medical and dental health plan members nationwide Founded in 1957 as a cooperative Offer an MTM benefit across our population delivered by a network of community based pharmacists Integrated health care organization providing health care services and health plan financing and administration

16. HealthPartners Vision Health as it could be, affordability as it must be, through relationships built on trust.

17. HealthPartners MTM Program Pillars Optimal medication use occurs on a continuum and requires ongoing assessment and support MTM services must leverage pharmacists unique skill set to optimize the medication use experience for patients Drug therapy problems are identified and resolved in the context of the whole patient MTM services are most effective when delivered through existing patient relationships and when they are integrated with primary care

18. Total Cost • 11:1 ROI in a high risk targeted MTM population • $4000/engaged member savings Savings net of fully loaded expenses No difference in pharmacy cost Cost savings driven by reduction in ED/Hospital utilization Experience • Consistently high patient experience Health • Consistent improvement in clinical markers of disease control

19. So What’s the Problem?

20. The Catch 22 • We need more CMM • Until a patient experiences CMM, they think they already get this from their doctor and/or pharmacist • Almost no plans pay pharmacists for this service and those that do underpay • Not enough pharmacists provide the service to meet the needs of health plan membership • Not enough pharmacists provide the service to enough patients to get good at doing it

21. Responsibility and Opportunity • The health care world is changing • We are the best equipped profession to improve medication use • Improving medication use leads to better health and lower total costs • We need to take responsibility for medication related outcomes

22. Where pharmacists need to be • “Pay me to improve the health of your members”, not “pay me to provide a CMR for your patients” • Think population • Need to take care of the people not showing up as well as those that do • Think “how much of my population has controlled blood pressure” not “How much of my population is adherent to their RAS agent” • Think “how many of my diabetics are reaching their HbA1C goal” not “how many diabetes medication changes recommendations did I have accepted”

23. Partnerships with local physicians/physician groups Information systems that support population health work integrated with the care provider teams you support Medical records access

24. HealthPartners Current Approach to CMM Reimbursement • No required or provided documentation platform • Required documentation elements that indicate CMM provided • Continuity of Care Document • Allows for collection of CMS required data reporting elements and minimal clinical outcome data • CMS Standard format/CCD creator for those without capability to generate • Fee for service payment

25. HealthPartners Current Approach to Alternate Reimbursement of Pharmacies • Partners in Excellence • Adherence • Persistence • Patient Satisfaction • Pilot programs • BP control • Asthma adherence and total cost of care

26. HealthPartners Future Approach to CMM Reimbursement • Continued use and expansion of CCD • Partners in Excellence in 2016 • Value based reimbursement in 2017 • Withhold portion of FFS payment that has opportunity to be earned at the end of the year when quality measures met

27. HealthPartners Future Approach to Pharmacy Reimbursement • Expansion of successful pilots • Continue exploration of partnerships with pharmacies willing to take responsibility for outcomes • Pressure to become integrated with local providers • CPAs • Medical record access

28. Quality Measures: Opportunities for Expanding Pharmacists’ Patient Care Services Alexandra Lin, PharmD Blue Cross Blue Shield of Michigan November 17, 2015

29. Agenda • Quality Rating System (QRS) Overview • Opportunities for Pharmacists to Improve Quality Measures

30. What is the Quality Rating System (QRS)? A system that rates Qualified Health Plans (QHPs) based on relative quality and price Think the Commercial version of Medicare Part D Stars Centers for Medicare & Medicaid Services. Health Insurance Marketplace Quality Initiatives. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Health-Insurance-Marketplace-Quality-Initiatives.html. Accessed November 5, 2015.

31. Purpose of QRS • Inform consumers regarding the quality of healthcare services and enrollee experience with useful and comparable information • Facilitate regulatory oversight of QHPs offered • Allow issuers to improve performance through self evaluation Overview of 2015 QRS Requirements for QHP Issuers. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/Issue-Brief-4-QRS-Requirements-for-Issuers.pdf. Accessed November 5, 2015.

32. QRS Scores on HealthCare.gov • 2015 is the beta test year for QRS • Ratings information will be publically displayed beginning fall 2016 • Health Insurance Marketplace. Available at: https://www.healthcare.gov/. Accessed November 5, 2015. • Quality Rating System Measure Technical Specifications. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiatives GenInfo/Downloads/2015-QRS-Measure-Technical-Specifications.pdf. Accessed November 5, 2015.

33. QRS Measure Set • Evidence based recommendations supported by NCQA, PQA and AHRQ • Consists of 43 measures, 12 of which are survey measures collected as part of the QHP Enrollee Survey NCQA=National Committee for Quality Assurance; PQA=Pharmacy Quality Alliance; AHRQ=Agency for Healthcare Research and Quality Quality Rating System Measure Technical Specifications. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/2015-QRS-Measure-Technical-Specifications.pdf. Accessed November 5, 2015.

34. Quality Rating System Measure Technical Specifications. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Quality InitiativesGenInfo/Downloads/2015-QRS-Measure-Technical-Specifications.pdf. Accessed November 5, 2015. Asterisk (*) – Collected as part of QHP Enrollee Survey

35. Asterisk (*) – Collected as part of QHP Enrollee Survey Quality Rating System Measure Technical Specifications. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Quality InitiativesGenInfo/Downloads/2015-QRS-Measure-Technical-Specifications.pdf. Accessed November 5, 2015. Asterisk (*) – Collected as part of QHP Enrollee Survey

36. Health Plan’s Dilemma

37. Crosswalk of Quality Measures aHEDIS measure required for NCQA Accreditation of Commercial Health Plans bStars evaluates for HbA1c poor control (>9.0%) cMedicare population • Quality Rating System Measure Technical Specifications. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/2015-QRS-Measure-Technical-Specifications.pdf. Accessed September 10, 2015. • Centers for Medicare & Medicaid Services. Medicare 2016 Part C & D Star Rating Technical Notes.

38. Poll the Audience In your opinion, which quality measures can pharmacists have a significant role? Select all that apply. • Medication adherence • Antibiotic overuse • Diabetes disease management • Controlling high blood pressure • Asthma medication management

39. Poll the Audience In your opinion, what practice settings are pharmacists most effective in providing direct patient care? Select all that apply. • Community/Retail • Integrated within a primary care practice site (e.g., PCMH or physician organization) • Pharmacist-run clinics • Phone-a-pharmacist programs • Hospital: Pharmacist participation in medical rounds

40. Multi-Pronged Strategy to Address Quality Measures • Adherence Patient Outreach Call Program • Health Fairs • Pharmacy Benefit Quick Guide • Pharmacy Website & Mobile Apps Network Pharmacies Patients Prescribers • Pharmacy Reports & Dashboards (patient level adherence rates) • Pay for Performance • Prescriber Reports & Dashboards (patient level detail) • Incentive Programs Data Data

41. Michigan Pharmacists Transforming Care and Quality (MPTCQ) • Blue Cross Blue Shield of Michigan Collaborative Process Improvement Initiative (CPI) • Connects clinical pharmacists with Patient-Centered Medical Home (PCMH) practices • Goal: Improve patient care and outcomes through integration of clinical pharmacists in direct patient care Quality Collaborations. Value Partnerships. Available at: http://www.valuepartnerships.com/vp-collab/pharmacy/. Accessed November 5, 2015.

42. MPTCQ Milestones/Payment: Year 1 • Participation funding from BCBSM to support program development and implementation • Fully integrate pharmacist practice model at 2-3 practice sites • Provide direct patient care to at least 8 patients/day x 4 days/week = 32 patients/week by end of year 1 • Continuous program development/management: 1 day/week

43. Pharmacist Transformation Champion

44. MPTCQ Milestones/Payment: Year 2 • Collaborate with physician organization (PO) leadership to devise a creative care model (e.g., central/regional model) to meet their unique needs • PO will fund additional clinical pharmacists to expand program across their practice sites • Participation funding from BCBSM to support program enhancement and ongoing management • Potential performance-based payment from BCBSM

45. How MPTCQ Received Approval HEDIS=Healthcare Effectiveness Data and Information Set IHS Inc., The Complexities of Physician Supply and Demand: Projections from 2013 to 2025. Prepared for the Association of American Medical Colleges. Washington, DC: Association of American Medical Colleges; 2015. Available at: https://www.aamc.org/download/426242/data/ihsreportdownload.pdf?cm_mmc=AAMC-_-ScientificAffairs-_-PDF-_-ihsreport.

46. BCBSM Leadership Approval

47. Conclusions • Pharmacists can have a major role in improving quality measures for QRS, Stars and HEDIS • Understanding the different rating systems for the Marketplace, Medicare Part D and Commercial populations is crucial for pharmacists in expanding their patient care services

48. Questions? 48

49. Perspectives from 17 years of comprehensive medication management

50. Who is Fairview Health Services?