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The 2008 NCAHC Annual Conference was attended by over 90 healthcare professionals representing a variety of organizations. NCAHC recognizes that improving the quality of care delivered is a goal shared by all health care providers. So, rather than focusing on just the challenges, this year's conference highlighted unique "best practices" designed to offer insights on collaborative solutions to improving healthcare delivery. The conference explored some fascinating insights on Medication Adherence; John Miall our keynote speaker set the stage for the following speakers. Our attendees then learned more about best practices with two different panels, one focusing on electronic technology and ePrescribing and the other on best practices surrounding Medication Adherence. Over lunch, we announced the 2008 winner of NCAHC's Eagle Award which is presented to an individual or organization who has positively impacted healthcare in our communities, and we received an update from last years winner.
The keynote address was given by John Miall, special consultant to the American Pharmacists Association Foundation (APhA). John Miall is a co-founder of The Asheville Project and shared his expertise in designing programs like "Asheville" that manage the cost and improve health outcomes associated with chronic disease. These goals are achieved through patient education, intensive oversight, and stakeholder alignment. John Miall provided the data on diabetes from "Asheville" that showed a decrease in direct medical costs per patient per year from $7000 to less that $5000 sustained over a 5 year period. In addition, health outcomes improved for other chronic conditions. LDLs for diabetics dropped from 121 to 95 on average over 5 years. Another fascinating finding was that sick-leave usage decreased among the group from 12.6 days at baseline to 5.67days at year 5. John Miall reported that this model is now being applied to other disease states including; asthma, cardiovascular and depression. The model, called HealthMapRx, is being used by employers across the country who are looking to manage costs of their health plans & improve health outcomes.
Our first panel of speakers was Holt Anderson from The North Carolina Healthcare Information and Communications Alliance, Inc (NCHICA). and Grace Terrell M.D. from Cornerstone Healthcare. Holt Anderson opened the presentation surrounding building a foundation for Electronic Prescribing and Medication Adherence. He gave an overview of NCHICA and explained how the organization collaborates with other healthcare entities. He reported that 20% of Medicare beneficiaries have 5 or more chronic conditions, with 40 office visits per year accounting for 75% - 80% of total Medicare expenditures. He noted most doctors are not using electronic medical records and the risk for drug errors is seven times greater in seniors than are people under 65 years of age. He noted the projected spending on healthcare as a percentage of gross domestic product from 2007 - 2082 would increase from 16% to 49%. In summary he reported that electronic medical records can improve and reduce errors but one big hurdle would be guaranteeing privacy. Dr. Grace Terrell continued building the foundation of e-prescribing by conducting a live demonstration of Cornerstones electronic prescribing and medical record system by Allscripts. She demonstrated the following:
The afternoon panel was made up of Best Practices revolving around Medication Adherence. Our first speaker was Andy Scibelli of Florida Power and Light (FPL). Mr. Scibelli reviewed Health and Well being as a valued based approach as noted by his best practice. He noted the FPL health and well being strategy is to continue to improve and maintain the health and well being of employees through competitive health benefit programs which are financially and operationally efficient. He reported in 2007 $2.0 Trillion dollars were spent on Health Care. He continued to note their total population management and the total medical and pharmacy costs paid. He discussed FPL's targeted conditions and the enhanced benefit for expanded prescription drugs.
Gretchen Jenkins, PharmD then gave an overview of KDI Health Solutions and their Clinical Pharmacist Services in North Carolina which improve Medication Adherence. She explained the definition of Clinical Pharmacy services and reported the 18 patient care practices throughout North and South Carolina they service. She noted 9 of their diabetes education sites are ADA recognized. The Kerr Drug Associates program has an internal program for all Kerr Drug associates with diabetes or at high -risk for diabetes. She reported that the ChecKmeds program offers the following:
Ron Smith gave a report on the initial observation of Blue Cross and Blue Shield of North Carolina's Medication Dedication Program. He noted that non-adherence is the # 1 cause for readmission to hospitals. Healthcare costs related to poor medication adherence are estimated to approach $100 billion a year. Despite all of the evidence showing the benefits of taking prescription drugs as prescribed, studies have shown that only 50% of people are adherent to medications as directed by their physicians. He explained an overview of the program:
Intervention One: Value-based benefit Designs
Intervention Two: Automated Refill Reminder Calls
Intervention Three: Enhanced ePRESCRIBE Messaging
Mr. Smith noted the following as Initial Observations with the BCBSNC program:
The last panel speaker was Bryan Bray, PharmD who discussed the models Piedmont Pharmaceutical Care Network, LLC has developed that can be utilized to include solutions for chronic disease. He reviewed the statistics comparing diabetics and non-diabetics. He then detailed a case study of a program implemented in 2003 at a manufacturing plant with approximately 700 employees pointing out a total saving of $908,455 over a 4 year period by enrolling 31 participants in the Diabetes Management program. Clinical results that noted improvement in the participant's quality of life was noted.