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Conference Summary

2011 NCAHC Annual Conference

The NCAHC Annual Meeting- 2011 focused on the Addressing Medication Adherence and Beyond. A group of about 100 attendees from various aspects of North Carolina's health care communities convened at the Embassy Suites in Cary, NC. At this meeting, we addressed medication adherence which warrants multifaceted approaches. Our speakers reviewed local and national campaigns, new adherence data for North Carolinians and successful implementations integrating multiple approaches to address medication taking behaviors.  This program included timely topics as well as a moderated panel discussion.

8:30 – 9:00 AM
Registration and Light Continental Breakfast Exhibits Open

9:00 – 9:15 AM
Welcome & Program Overview Beth Skinner, PharmD President, NCAHC
9:15 – 9:45 AM
Patient Centered Medical Home and Medication
Adherence – Are There Opportunities?
Terry McInnis, MD, MPH President, Blue Thorn Inc.
9:45 – 10:05 AM

Organizational Best Practices –
Specialty Pharmacy – A Rising Area of

Jason Cooper, MS
Vice President, Cigna Clinical Analytics
Co-Chair, Research/Outcomes/Quality,
Care Continuum Alliance
10:05 – 10:30 AM
Addressing Health Literacy and Improving
Adherence in a Provider Setting – A
Discussion of Results

Tom Bauer M.B.A, R.T. (R), HFA
Remarkable Experience Coach,
Organization Improvement, Novant Health

10:30 - 10:45 AM

10:45 – 11:05
Script Your Future – A National Adherence
Initiative – Raleigh/Durham Focused Survey
Results and Review of Initiatives

Rebecca Burkholder
Vice President of Health Policy
National Consumers League

11:05 – 11:25 AM

BRFSS* Results – NCAHC Analysis of
Medication Adherence: Are There Trends for
North Carolinians?
Betsy LaForge, MPH
Director, Healthcare Program Development
and Management
Blue Cross and Blue Shield of NC
11:25 AM – 12:25 PM

Lunch and Presentation of the
NCAHC's Eagle Award

12:30 – 1:30 PM
Panel Discussion and Q & A
Terry McInnis
Jason Cooper
Tom Bauer
Rebecca Burkholder
Betsy LaForge

Panel Moderator: Derek Prentice, MD
Consulting Medical Director,
North Carolina State Health Plan
1:30 PM Adjournment
* Behavioral Risk Factor Surveillance System

Download the Conference Agenda Download the Conference Agenda


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

Bio | Slides

  • Welcome and Program overview: At this conference, we’ll look at new trends in medication adherence as part of a holistic approach to patient care
  • Beth introduced our new NCAHC logo; 501c3 non-profit made up of diverse organizations throughout NC.  Beth recited the NCAHC Mission and Vision
  • NCAHC has ~6 general membership meetings per year plus committee meetings based on inititiatives needs; one Annual Confernce (Fall)
  • Objectives:  revise Mission and Vision; change our website to provide more focus; support Medicatin Adherence Initiatives (BRFSS analysis and plan for reporting, request for grant); NCL committed partner; conduct an Annual Conference.
  • Coming soon…a new look and feel for the website with two resources Prescription Drug Coverage & Med Management and Medication Adherence and Safety
  • 2012 objectives:  1) increase Initiatives:  communicate NC BRFSS results, identify. opportunities for Script Your Future campaign; pilots; Enhance Communications (web, twitter, etc.); Increase membership
  • Acknowledged memberships
  • Shared Todays’ agenda:  Trends: PCMH and Medicatin Adherence (Terry McInnis), Organizational Best Practices and Specialty Pharmacy (Jason Cooper); Addressing Helath Literarcy (Tom Bauer);  Script Your Future-A National Campaign to Improved Adherence (Rebeca Burkholder/ NCL); BRFSS Results-NCAHC Analysis of Results (Betsy LaForge); Panel Discussion


Betsy LaForge, Director, Healthcare Development and Program Development, BCSBNC

Bio | Slides

Summary: Betsy La Forge is the Director of Healthcare Program Development and Management for Blue Cross and Blue Shield of North Carolina. In her role at Blue Cross, she is responsible for designing innovative care management and wellness programs. Blue Cross has received national recognition for several of these award winning initiatives in preventive care and obesity management.

Betsy has over 20 years of health care experience implementing health improvement programs in hospitals, clinics, worksites and health plans in both California and North Carolina. She has been a member of the NC Alliance for Healthy Communities since 2003, served as the Alliance President in 2006 and currently co-chairs the Alliance's Initiatives Committee, which is responsible for collecting, analyzing and reporting data related to medication adherence in North Carolina. Betsy holds a masters degree in public health from UCLA.

Betsy introduced the group to the results from the 2010 BRFSS Medication Adherence data. This is a major initiative for the NCAHC over the next three years, and track and trend whether we're seeing changes over time.

BRFSS survey (sample size ~11,000+)—contains questions for all-states and NC-specific questions that were added by various organizations for a fee; NCAHC added medication adherence questions for 2010. Her presentation covered:

  • NC—overall prevalence for adherence
  • Females tend to be more non-adherent, particularly, Hispanic females
  • Differences are most striking (high non-adherence) among students and those who are unable to work
  • Non-adherence did not differ b/n insured/ and non-insured
  • Difference by income level and the more conditions an individual has, the more non-adherence (2 conditions or more appears to be the cut off)
  • Adherence varies by condition (looked at Diabetes, Heart Diesease, Asthma): Diabetes were most adherent, heart Disease—least adherent
  • More non-adherence was seen:
    • If health status is perceived as fair or poor—more non-adhernce
    • Unhealthy mental or physical days
    • Limited activity
    • Dissatisfaction with life
    • Limited sleep
    • Limited social support

Reasons for non-adherence:

1 in 4: didn’t think med would help
1 in 3: concern about side effects
1 in 2: expense
1 in 4: med didn’t seem to help

Striking differences between Raleigh/Wake and state wide

  • 90.6% of respondents reported that their HCP spoke with them about the importance of taking all medications.
  • Concerns about taking medications for pain
  • Too busy, lazy, don’t like taking meds

Next steps…..

  • NCAHC will release a full report of the results in early 2012
  • NCAHC will continue to sponsor BRFSS medication adherence data moving forward to establish trends
  • Remember to visit the NCAHC website:  Medication adherence and safety and ___ resources   centers


Jason Cooper Vice President of Clinical Analytics for Cigna

Bio | Slides

Organization best Practices—Considerations; Specailty Pharmacy—A Rising Area of Inerest

Co-ChairCare Continuum Alliances, plus leads a workgroup on Med Adherence; and also VP of Cigna Clinical Analytics

Care Continuum Alliance (CCA) has been working on organizational best practices around medication adherence.  CCA has an outcomes guideline available on their website—these include guidelines for measuring Medication Adherence via med possession ratio (MPR) and also includes a measure on persistence (do you refill as appropriate); and includes information on what to measure and how to measure for common chronic conditions. Goal for this year was to improve upon a basic framework by including PCMH.  There’s an organization best-practice assessment: link to the pilot is at  CCA is going to offer a webcast on Monday, November 14 from 1-2 pm EST.

Building a Best-Practice Approach to Improved Med Adherence in Organizations: Move from personal 1:1 assessment to more robust intervention suites in a highly systemic approach with quality measures in place. Aligned incentives is important to move towards a best in class capability (i.e., P4P, PCMH an ACOs give us the opportunity to explore these)

Specialty Pharmacy—Jason Cooper

Jason highlighted important facts on specialty pharmaceuticals and trends. Specialty pharmaceuticals tend to be made through bioengineering processes and tend to be more expensive. These can be infused or self-injectable. 70% of time, these meds will be adjudicated on the medical side, so you need to evaluate med claims to assess. So why care? Of the top 16 drugs, 5 were specialty in 2009, 11 will be in 2012, and by 2014--most will be specialty meds.

Cost and clinical management strategies need to be equally effective under pharmacy and medical benefit; medical pharmacy mangers emerge (Specialty Pharmacies)


Rebecca Burkholder—VP Health Policy National Consumers League "Script Your Future" A National Public Education Campaign to Improve Adherence

Bio | Slides

Rebecca updated the group on the progress of the NCL- Script Your Future campaign.

Opened with Video of National Medication Adherence campaign with comments by the US Surgeon General to highlight the campaign and launch activities and provide an overall view of the campaign.

Review of National and RDU Focused Survey Results and upcoming opportunities:

  • Why? 1/3 patients never fill their Rx,
  • History:  NCPIE 2007 report on adhernce-- one step to launch a national campaign around medication adherence
  • NCL has signed over 100+ committed partners
  • Raise the importance of taking meds as direction as a means to improve outcomes
  • Respiratory, Cardiovascular
  • Audience: Patients/Consumers and HCPs
  • A national 3-yr. campaign focused on  6 target markets
  • Campaign Focus
    • Key Learnings based on focus groups: patients don’t understand the consequences of not taking meds
    • Impact on family if pt. doesn’t take meds
    • Empowerment: pts. want to be in control of their health
  • 3 key messages based on learning from focus groups
    • If you don’t take your med as directed you’re putting your health at risk
    • If you have to your HCP
    • Script your
  • Campaign resources to use and share
    • consumer website is the hub; “I Will” theme; pledge to take meds is empowering; text reminders; other tools and resources, including “ask me three” and pledge cards
    • HCP website includes tools and campaign resources
    • Social media channels
    • Print ads and Posters
    • Ads—PSAs from Surgeon General

Student Pharmacy Adherence Challenge—Competition during October Pharmacists Month

  • 100 pharmacy colleges across US have signed up. Contest for students to use materials to discuss the importance of medication adherence


  • National and in target markets
  • Quantitative and qualitative communication metrics (web, media, committed partner engagaement)
  • Research and Data partnerships to assess fills/refills

She summarized key findings from their baseline surveys (National and Raleigh area)

  • Pts. do not “always” take meds as they should
  • Raleigh patients express a high willingness to ask questions, but that communication is not actually happening, especially among pharmacists
  • High incidence of chronic disease among adults in Raleigh (high cholesterol)
  • In Raleigh, over 1/3 say they don not always adhere; less likely to be convinced of importance and don’t always understand consequences
  • Raleigh patients view questions lists, auto refills, reduced copays and 7-day pill boxes as most useful tools for improving adherences.  Age divide:  electronic reminders—under age 50 were 2x as likely to find useful
  • How can we help?  Share information. Connect with other committed partners. Finacnacial contributions. Participate
  • Raleigh market launched in June

Please consider becoming a committed partner for this three-year campaign.

BRFSS Results: NCAHC Analysis of Medication Adherence: are their trends for NorthCarolinians?


Terry McInnis, MD, MPH, FACOEM
President- Blue Thorn, Inc.

Bio | Slides

Patient Centered Medical Home and Medication Adherence—Are There Opportunities

Terry recognized the audience made up of various organizations throughout the state collaborating. She highlighted work that has been conducted through the Patient Primary Care Collaborative (PCPCC), and currently co-leads Medication Task Force.

Her topic covered how medication management fits in with coordinated care: evidence indicating PCMH Med management? "It is critical for success in ACO/PCMH". It is important to recognize 10 steps in comprehensive medication management and to recognize that a standardized EBM practice approach is essential for clinical pharmacist delivered services to succeed in optimizing patient outcomes.

Terry reviewed PCPCC and 6 Centers that are part of PCPCC; she also reviewed PCPCC resources and publications; Medication Management is the most requested guide.

Medical Home Care: Our patients are those who are registered in the medical home and care is determined by a proactive plan to meet the patients needs with or without visits; care is standardized based on EB guidelines; quality care and improvement are measured; a prepared team of professionals coordinates all patients' care (may include care coordinators working with phys. offices); tests and consultations are tracked; a multidisciplinary team works at the top of their licenses to serve patients; providers and pharamicsts engage patients in understanding and coordinating med mgmt 75% of all healthcare costs are related to chronic disease; after lifestyle interventions, medications are the primary weapons used in modern med to prevent and control disease (80% of what we use); so we have to get this right to reduce costs and improve outcomes; 33% of all us peole tke 5 or more Rxs; average for ambulatory patients is 4; one of two ambulatory patients has a drug therapy problem that needs to be resolved or results in clinical or economic consequences--~ only about 15-20% are "adherence related"

Pharmaceutical Care Process

  • Assesement: Is the Patient on the appropriate drug therapy to begin with (indicated safe convenient)? ID drug problems
  • Care Plan: Assess and Achieve goals of therapy; resolve drug therapy issues (is the med effective in getting the patient to goal, is it safe,is the patient taking the med, etc) , prevent drug therapy issues
  • Evaluation:  record actual patient outcomes; evaluate status in meeting goals of therapy and reassess

Terry highlighted several projects including

  1. MTM services—the Minnesota experience (BCBC commercial/employee lives). J Am Pharma Assoc. 2008
    • MTM delivered and documented by pharmacists
    • Avg. 6.4 conditions, ~ 8 meds
    • Patients were targeted by chronic disease (not by spend)
    • #1 problem is always “Needs additional Drug Therapy”; dosage too low is #2 in this study; non –compliance was 9.6% of the problem, but we need to focus after we insure that pt. is on right med and right dose
    • Clinical outcomes improved from 76% to 90% and 2.2. drug problems were found per patient
    • MTM services provided a 12:1 ROI
  2. Medicaid High Risk telephonic program
    • Avg of 9 med conditions, avg. # drugs 13; avg patient seen 3x per year by pharmacists; avg. of 7 drug therapy problems per patient
    • Problems found: #1 patient needs additional drug therapy, dosage too low was #2
    • Results: goals met went from 54% to 80% with a net saving per pt. ~ $1600

In summary, a focus on the diseases first, then make sure that we’re using the right meds at the right dose, then evaluate the impact on health outcomes


Tom Bauer — Organization Improvement, Novant Health

Bio | Slides

Tom highlighted the importance of medication adherence from the patient perspective and the need for health literacy.

Sam's story—Sam didn't take his meds b/c he couldn't afford them; if the HCP had known he/she could have helped, but Sam said didn't know why he needed the medicine.

Health Literacy definition—the ability to read, understand, and act upon health information. 9/10 patients do not receive health information in a way that they can use or understand. HCPs believed that 89% of their pts. understood side effects, but only 57% understood. Affects on health literacy:

Communication barriers: anxiety, lack of time, failure to ask questions, low health literacy, medical jargon/acronyms, not listening. #1 impact on a person's health and well being is health literacy.

How do we bridge the gap? Ask Me 3 created by Partnership for Clear Health Communication

Novant changed their language of communication to include the three questions: What is my main problem, what do I need to do, why is it important for me to do this?

Novant implemented "teach back process" to evaluate the transfer of knowledge (using ask me 3 as part of the language of communication). HCP asks the patient to repeat what he heard, and that gives the HCP to re-teach if necessary.

Forsyth Med Ctr.—test of over 250 Patients using ask me 3. The outcome showed significant movement towards full recollection, and the patients adherence went up. Published in J. Stroke in March 2011.

Presbyterian Hospital—gave patients with CHF a 100 pt. test, avg score was 38.5; afer ask me three and teach back the scores moved to ~85, and hospital reduced preventable admissions by half.

Another hospital implemented "ask me three" and "teach back", and found that Patient Satisfaction jumped. Novant implemented at urgent care and hospitals and found significant movement.

Now 90% of Novant staff can recall the three questions and now they're measuring implementation.

Conclusion: The patient cannot be a partner in their well being and care if they don't understand what's required for them. Ask Me 3 and Teach Back combined with simplified language can be powerful tools in improving health literacy (HCP should sit down across from patient); clinical Outcomes are impacted positively b improved understanding. Member satisfaction is enhanced by improved understanding; productivity in phys. Offices is improved, and it's believed that cost of care will be reduced as well.


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