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Conference Summary

2012 NCAHC Annual Conference


It has been suggested that as much as 60% of all Health Care costs are influenced by an individual’s behaviors and decisions.

This years Guest Speakers will explore how patient care can be delivered, its impact on patient adherence, as well as tips, tools, and interventions that can drive measureable improvements.
Please join us as we will have topics on Behavior Change, Pharmacy Quality Measures, and Challenges and Opportunities as the healthcare environment is ever changing...

Our speakers put in perspective how organizations and individuals interpret patient engagement and the importance of engagement in health care. Dr. Leigh Ann Simmons opened the conference with engagement definitions and current research. Dr. Tom Warcup offered a perspective on practical implementation in a health care setting. Quality Measures once an option are now mandated in health care. Dr’s David Nau and Mark Conklin from Pharmacy Quality Alliance (PQA) reviewed the principles of Quality Drivers and examples for these measures in pilot programs. Amanda Rhodes rounded out the morning with practical implications for addressing adherence and provided helpful hints on a better means for engagement. In a panel format over lunch, our attendees had the opportunity to ask our speakers the tough questions and gain additional insights into ways to improve patient engagement with a particular focus on behavior change and adherence. Tom Bauer, last year’s Eagle Award Winner, closed the educational portion of our program. He reminded us to remember that measures are important, but it is all about the patient and better care. Dr. Julie Ann Gouveia-Pisano and Seth Dearmin introduced us to NCAHC’s many activities and our participation in Script Your Future. We invite you to sign up for our newsletter, become a member and we hope to see you next year at the 2013 Conference.
 

9:00 – 9:15 AM
Welcome & Program Overview
Beth Skinner,
PharmD President, NCAHC
9:15 – 9:45 AM
Address:
Patient Engagement – Is It a Reality?
Leigh Ann Simmons, PhD,
Duke University
9:45 – 10:15 AM

New Care Deliveries – Insights from Carolina Advance Health and the Patient Center
Approach: Tom Warcup, MD,
Carolina Advance Health
10:15 – 10:45 AM
Quality Drivers & The Case for Pharmacy Engagement:
David Nau, PhD, RPh, CPHQ, FAPhA,
Pharmacy Quality Alliance, Inc.

10:40 - 11:00 AM
BREAK

11:00 – 11:30 AM
The Role of Performance Information in Guiding Improvements in Pharmacy Care:
Mark Conklin, PharmD,
Pharmacy Quality Alliance, Inc.

11:30 – 12:00 PM

Medication Adherence Programs – Lessons Learned:
Amanda Cook Rhodes,
Director, Client Strategy and Solutions at
McKesson Patient Relationship Solutions

12:00 – 12:45 PM

Lunch and Panel Discussion

12:45 – 1:15 PM
Health Literacy and Engagement –
Measures are important but keep your eye on the patient:
Tom Bauer M.B.A, R.T. (R), HFA,
Remarkable Experience Coach,
Organization Improvement, Novant Health
1:15 – 1:30 PM Communications:
NCAHC & Script Your Future,
What’s New and Review of Community Outreach:
Julie Ann (TJ) Gouveia-Pisano,
BSPharm, PharmD, BCPS, NCAHC,
Seth Dearmin, NCAHC & Script Your Future

 

Elizabeth P. Skinner, Pharm.D., R.Ph.
Sr. Manager
GlaxoSmithKline

Bio | Slides

Summary

Beth Skinner, President, NCAHC kicked off the 2012 NCAHC Annual Conference – Patient Engagement: Are there New Opportunities? with a big thank you to the new members and enhanced member participation in 2012. During her presentation, she highlighted the accomplishments of the year and put forth a challenge for 2013 to continue to capitalize on our Mission and Vision with a broader membership outreach.

  • The MISSION of the North Carolina Alliance for Healthy Communities (NCAHC) is...
    • Promote Educational Awareness and serve as a resource for North Carolina's healthcare communities.
  • The VISION of the NCAHC is...
    • Improve treatment adherence for North Carolinians through a collaboration of diverse healthcare organizations.

In 2012, NCAHC has enhanced our organizational communications to promote adherence to medicines awareness. Communications included an updated and more focused web site www.ncahc.org and the implementation of quarterly newsletters highlighting accomplishments and actions taking place within the organization and within the North Carolina community. We even had the opportunity to gain exposure on the National front with the submission of comments on the implications of medication adherence to the Office of Assistant Secretary for Health.

  • NCAHC continues to provide information and support Medication Adherence Initiatives. These include the following:
    • BRFSS analysis and plan for reporting and manuscript development
    • National Consumer League – Committed Partner- Support Script Your Future
  • Please look for additional communications on upcoming community events supporting Script Your Future in November.

 

Leigh Ann Simmons, PhD,
Duke University

Bio | Slides

Summary

Patient Engagement – Is It a Reality?:

  • Goal is to find common ground between patients and providers
  • It is important and we need to figure out what it means even though there is no one definition of patient engagement

Patient engagement can include Skills, Knowledge, Action, Empowerment, Action, Participation, Planning, Communicating, Decision-making, Confidence, and Organization

The National eHealth Collaborative 2012 Survey showed that patients use educational materials and online resources to learn about better health or their own health condition. We want patients to be in better health.

There are general assumptions made about Patient Engagement

  • Involvement-asking questions, accessing medical records and doing research
  • Skills-Problem-solving, self-management, self-assessment, reducing risks
  • Adherence-Take medications, self monitoring of health, following doctor’s orders
  • Health-Physical, mental, emotional, spiritual well-being

Engaged patients are more “engaged” in healthy behaviors, disease specific self-management, preventative behaviors and health information seeking

 

Tom Warcup, MD,
Carolina Advance Health

Bio | Slides

 

David Nau, PhD, RPh, CPHQ, FAPhA,
Pharmacy Quality Alliance, Inc.

Bio | Slides

Summary

  • Medicare is driving greater attention to medication-related quality via the Medicare Star Ratings
    • Costs vs. quality
    • How does the healthcare system define the quality of medication used
    • PQA takes the lead on development of medication-related quality measures for evaluation of health plans, PBMs and pharmacies
  • Medicare drug plans receive a summary rating on quality
    • Five measures are from PQA:
    • 2 measures of medication safety
      • High risk medications in the elderly
      • Appropriate treatment of blood pressure in persons with diabetes
    • 3 measures of medication adherence
      • Oral diabetes medications
      • Cholesterol medication (statins)
      • Blood pressure (renin-angiotensin-aldosterone inhibitors)
    • Due to the higher weighting of clinically-relevant measures, the PQA measures account for 45% of Part D summary ratings in 2013
    • Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) – Awareness to Pharmacist = Potential for Meaningful Patient Engagement
      • Measures
        1. Appropriate Treatment of Hypertension in Diabetes
        2. Use of renin-angiotensin system (RAS) antagonists
        3. Proportion of Days Covered (Adherence)
        4. Statins
        5. Oral diabetes medications
        6. RAS Antagonists (ACE, ARB, DRI)
        7. Use of High-Risk Medications in the Elderly
        8. Drug-Drug Interactions
    • EQuIPP can provide pharmacies with info on their performance on these Part D Star Ratings

This information can be harnessed by the pharmacy to more effectively engage patients.

 

Mark Conklin, PharmD,
Pharmacy Quality Alliance, Inc.

Bio | Slides

Summary

This presentation was about EQUIPP. This is a system that PQA is utilizing to track performance information. The discussion centered on what it is, how it is used, how organizations cope with it, and how it can lead to better patient engagement.

EQUIPP is derived from quality measures, and is based on guidelines. It is intended to improve standardization, provide comparative evaluations, and provide transparency. It is often displayed by using reports or dashboards.

Organizations manage performance Information in many ways: shock and disbelief, denial, anger, bargaining, guilt, Reflection, and acceptance and hope.

It is used for benchmarking, payment and incentives, decision support, and incentive benefit design.

EQUIPP allows technology to push systems forward. Specifically, it allows organizations to focus on work differently to make sure what is measured gets improved. Measurement is the first step, and these systems enable the information to guide practice management.

 

Amanda Cook Rhodes, Director,

Bio | Slides

Summary

McKesson implemented an initiative to drive adherence through behavioral coaching at the pharmacy. Pharmacists are trained on behavioral coaching, and patient engagement. Interventions are integrated through work flows.

The Evolving Role of the Pharmacist

  • Trusted advisors
  • Accessible
  • Trained on patient interactions

Differing needs of Pharmacists

Independents

  • Typically have 1-2 stores
  • They do everything – wear lots of hats
  • Develop deep relationships

Chains

  • Pharmacists tend to be younger
  • Focus is on dispensing and clinical care

Pharmacists tend to fall into two categories: Adapters – recent grads, moving to a contemporary business model. Traditionalists – have face to face relationships with patients, are suspicious of technology, resistant to change.

Training was focused on delivering messages positively to change patient behavior. Pharmacists learned to engage patients, uncover barriers and find ways to work around them. The result was that patients who received coaching averaged 4 incremental refills over a 12 month period.

Lessons Learned:

  • Select an engaged patient. Patient must be present – don’t talk to someone that is picking the med up for them or try to converse through the drive-through.
  • Allow patients to drive the conversation. Ask questions correctly, (ex. Do you have questions about your medications?”, rather than, “What questions do you have about your medications?”.
  • Not every drug category is a candidate for face to face coaching, ex. Urinary incontinence.
  • Training is not a one-time event, but a continual process.
  • Consider the uniqueness of everyone involved.
  • Show empathy.

 

Lunch and Panel Discussion

Summary

  • Instead of making a lunch presentation for the Eagle Award winner, NCAHC developed a speaker panel to highlight some of the key challenges for medication adherence and patient engagement moving forward. Panelists included were:

    Dr. Thomas Warcup, D.O.

    Mark Conklin, Pharm D. MS,

    Amanda Cook Rhodes

    Tom Bauer, MBA, R.T. HFA

    Robert Nauman

    Carolina Advanced Health

    Pharmacy Quality Alliance

    McKesson Patient Solutions

    Novant Health

    BioPharma Advisors Moderator



  • Each speaker was asked to reintroduce themselves and respond to this question. What does the future hold for adherence initiatives moving forward and what do each of you see as a benchmark moving forward to know we are progressing?

    Dr. Warcup suggested that the patient is the one at the center of care and as they become more empowered and knowledgeable, they become more confident. This is what he thought should be watched.

    Mark Conklin again emphasized that quality of program interventions is something that should be worked on and that pharmacists involvement levels help demonstrate that evolution.

    Amanda Rhodes suggested that big pharma brands are beginning to recognize the power of patients to create change and they are seeing more patient centered communications being developed by their clients.

    Tom Bauer said he would in his talk that followed highlight how patients can gain confidence even by using something simple like the ask me 3 questions to create better adherence.

  • The next question revolved around how health plans view payments for this type of medical management.

    Dr. Warcup mentioned Carolina Advanced Health’s approach and collaboration with Blue Cross Blue Shield of North Carolina and how the patients really are different and seem to be improving health outcomes in just a short period. In fact, other insurers are looking at this model as a way in which universal payments may decrease because of this approach.

    Mark Conklin described how health plans focus on quality metrics and which practitioner is in the best position to make an impact on care. He went on to discuss the value pharmacists play in that team care approach. Dr. Warcup also spoke up in favor of their pharmacist on their medical team.

    Amanda Rhodes did not comment.

    Tom Bauer added that Novant Health is making a big commitment to making HCP payments or helping HCP’s with staff supplements to accomplish improvement in care.

  • The third and final question related to the one key takeaway the panelists wanted the audience to remember about their presentation.

    Dr. Warcup emphasized the value of a team based approach to care and that medication adherence is a key element in helping improve medical care.

    Mark Conklin wanted people to remember that 2 safety and 2 adherence measures would be part of the Medicare star rating points for CMS and as a result there will be an increased focus by Quality professionals on medication adherence.

    Amanda Rhodes highlighted the need to include behavior based segmentation in some of the programs pharma clients build into their patient adherence efforts.

    Tom Bauer said stay tuned because he was speaking next and he would give you a real world example of patient who made real progress with the type of interventions he built at Novant Health.

    Rob Nauman added a comment made by Leigh Ann Simmons about the value of the engaged patient and the importance of 4 things from the patient. 1) Involvement, 2) Developing skills to manage their disease, 3) Adhering to the medication prescribed and 4) commitment to their health.

 

Tom Bauer M.B.A, R.T. (R),
HFA, Remarkable Experience Coach,

Bio | Slides

Summary:

Sam’s Story: Sam goes to his doctor complaining of a headache. He has high blood pressure and must take his diuretic medication every day. However, on Sundays Sam would skip his diuretic dose so he wouldn’t have to get up in the middle of church. Sam did not know that missing that one pill every week could cause poor blood pressure control and the ensuing headache.

Nine out of ten Americans do not receive health information in a way they can understand. The relationship between patients and providers can often complicated by certain communication barriers including:

  • Patient anxiety about disease states/medications, Lack of time for either the patient or the provider, Medical jargon, A failure to ask question (either patients or providers), Low health literacy, Not listening (either patients or providers)

Denny’s story: Denny served 2 tours in Iraq on the second tour he got hurt. He went to Walter Reid Hospital where they rebuilt his hand. When he got back to base he reinjured his knee (originally from paratrooping). He was put on oxycodone for the pain but it was not working. He had been given 2 prescriptions but did not want to take too many medications and be “strung out” on drugs so he decided to only take one. It was never explained to him that the other prescription was for ibuprofen which would decrease the swelling in his knee thereby reducing the pain without additional narcotics.

Tom explained that at Novant Health they were closing the gap between patient and provider understanding by implementing the Ask Me 3™ and teach-back techniques into every day practice. At Novant they have taught providers to use Ask Me 3™ questions while educating patients and also encouraged patients to use this technique to help them remember to ask questions during their appointment. The teach-back method is also used at Novant to validate the transfer of knowledge from provider to patient. These techniques have a significant impact including:

  • An 18% increase in overall patient understanding, A 44% increase in CHF patients’, understanding of their care plan, A 50% reduction in preventable readmission for CHF patients in a Charlotte Hospital and increased length between admissions, Significant enhancement in patient satisfaction in communication with providers and understanding of what they needed to do for their health

Julius’s Story: Two and a half years ago Julius was diagnosed with basal cell carcinoma on his ear which he had taken care of. Unfortunately, he was then diagnosed with colon cancer. Julius did whatever his doctor told him he needed to do to fight this cancer including having his colon resected. After this Julius had a meltdown. He began throwing chairs and not acting like himself. It turns out Julius’s doctors had taken him off his antidepressant without the necessary taper. Julius then learned to importance of not being a passenger in your healthcare, but a navigator. So when Julius was diagnosed with prostate cancer he was able to have a frank conversation with his provider about what treatments he was willing and not willing to undergo.

In summary we have learned:

  • Health literacy can be a foundation to build upon
  • Adherence requires the attention of everyone on the healthcare team
  • Promising strategies are being developed
  • No magic Bullets exist

“Do the right thing, for the right reason, in the right way.” Adherence is the right thing: outcomes will improve, expenses will decrease, and quality of life will increase.

 

Julie Ann (TJ)
Gouveia-Pisano, BSPharm, PharmD, BCPS, NCAHC,
Seth Dearmin, NCAHC & Script Your Future

Bio | Slides

 

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