William Seavey PharmD Clinical Pharmacist Specialist EMMC ...
William Seavey PharmD Clinical Pharmacist Specialist EMMC ...
William Seavey PharmD Clinical Pharmacist Specialist EMMC ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>William</strong> <strong>Seavey</strong> <strong>PharmD</strong><br />
<strong>Clinical</strong> <strong>Pharmacist</strong> <strong>Specialist</strong><br />
<strong>EMMC</strong>, Beacon Health, Care Transitions
Objectives<br />
Identify the goals of Accountable Care<br />
Organization (ACO)<br />
Describe the roles of hospital<br />
pharmacists in ACOs<br />
Describe the roles of ambulatory care<br />
pharmacists in ACOs<br />
Identify key healthcare team members<br />
Examine ACO Quality Measures
Accountable Care Organization<br />
A network of physicians and other<br />
providers that work together to improve<br />
the health, healthcare outcomes, and<br />
reduce the costs of a population<br />
Pioneer ACO – CMS specific program<br />
for a population of Medicare patients
Pioneer ACOs in Maine<br />
MaineHealth Accountable Care<br />
Organization (Maine Medical Center, Lincoln County<br />
Health Care, Pen Bay, plus many more)<br />
Beacon Health LLC (Eastern Maine Healthcare, Inland<br />
Hospital, Penobscot Community Health, plus many more)<br />
Central Maine ACO (Lewiston)<br />
Maine Community Accountable Care<br />
Organization LLC (Federally Qualified Health Center)
3 Goals of an ACO<br />
Improve care for individuals<br />
Improve health for the population<br />
Reduce growth in expenditures/decrease<br />
costs
Pioneer ACO Quality Measures 3<br />
Quality care is measured by 33 different<br />
measures<br />
• This is reduced from the proposed 65!<br />
<strong>Pharmacist</strong>s can have an impact of 22+<br />
of these measures<br />
Full list attached
Community Care Model<br />
Inpatient<br />
Ambulatory Care<br />
Community<br />
Community Based Care Delivery Model. EMHS Strategic Planning Committee. September<br />
25, 2012 2
Key Team Members<br />
Transition<br />
coordinators<br />
Inpatient,<br />
outpatient care<br />
managers<br />
Home health<br />
agencies
Role of the <strong>Pharmacist</strong><br />
The goals of ACO’s exactly line up with<br />
the way that pharmacists practice<br />
• Most effective medication for given disease<br />
• Cost awareness<br />
<strong>Pharmacist</strong>s must continue to advocate<br />
for expanded roles in the new model<br />
Reimbursement will be based on quality,<br />
not fee for service
Inpatient Pharmacy<br />
In an ACO a patient is not discharged, the<br />
care is moved to another location<br />
Limited resources for a large group of<br />
patients<br />
Need to risk stratify which patients could<br />
best use a pharmacists intervention<br />
• ASHP Foundation accepting grant applications<br />
for a study as we speak
Inpatient Pharmacy<br />
Quality measures to start with<br />
All Condition Readmission<br />
• Examine any re-admission within 30 days of<br />
discharge<br />
• Look for medication errors, non-adherence,<br />
incomplete treatment, incomplete<br />
medication reconciliation etc.
Inpatient Pharmacy<br />
Quality Measure: Ambulatory Sensitive<br />
Condition Admissions<br />
• COPD, Asthma, Heart Failure<br />
<strong>Pharmacist</strong> intervention and education<br />
as part of the care team can improve<br />
care
Inpatient Pharmacy<br />
Improve care transitions<br />
• Medication reconciliation<br />
• Discharge counseling?<br />
Finding patient barriers to success<br />
• Adherence?<br />
• Transportation?<br />
• Financial?<br />
Communication outside the hospital!!
Ambulatory Care Pharmacy<br />
Many large ACO like corporations have<br />
extensive networks of Ambulatory Care<br />
pharmacists (Geisinger Health, Kaiser<br />
Permanente)<br />
In Maine, the Veterans Administration is<br />
a well established practice
Ambulatory Care Pharmacy<br />
The traditional roles of an ambulatory<br />
care pharmacist are exactly in line with<br />
an ACO<br />
• Medication Reconciliation<br />
• Disease state clinics<br />
• Adherence Monitoring
Ambulatory Care Pharmacy<br />
Chronic diseases make up many of the<br />
quality measures<br />
• Diabetes Mellitus (6 measures)<br />
○ Patients with A1c less than 8<br />
○ Patients with A1c greater than 9<br />
○ Tobacco non-use<br />
○ Aspirin Use<br />
○ LDL less than 100<br />
○ Blood pressure less than 140/90
Ambulatory Care Pharmacy<br />
Other diseases in Quality Measures<br />
• Ischemic Vascular Disease (2 measures)<br />
• Heart Failure (1 measure)<br />
• Coronary Artery Disease (2 measures)<br />
• Hospital admissions for COPD/Asthma, HF,
Conclusion<br />
ACOs are a great opportunity for<br />
pharmacists to expand their practice<br />
Creative thinking in the inpatient setting<br />
can make an impact<br />
Must expand current ambulatory care<br />
practice!
References<br />
1. Pioneer Accountable Care Organization Model:<br />
General Fact Sheet. Center for Medicare &<br />
Medicaid Innovation. May 22, 2012.<br />
2. Community Based Care Delivery Model. EMHS<br />
Strategic Planning Committee. September 25, 2012<br />
3. Quality Measurement & Health Assessment Group.<br />
Accountable care organization 2012 program<br />
analysis quality performance standards narrative<br />
measure specifications. Final Report. December 12,<br />
2011. RTI Project number 0213195.000.004.<br />
Available at:<br />
http://www.cms.gov/medicare/medicare-fee-forservicepayment/sharedsavingsprogram/downloads/aco_qu<br />
alitymeasures.pdf
Change language