CareTriage: Recognizing Pharmacists as Valuable Members of the Healthcare Team

Troy Trygstad PharmD MBA PhD – CCNC VP Pharmacy Programs

Joe Moose PharmD – CCNC CPESN Coordinator

Improving care through shared knowledge

•Learning Objectives (for CE)1. Be able to identify various "actor-setting"

combinations that contribute to patient-centered medication optimization within the Medical Neighborhood.

2. Understand the role of community pharmacy as an advantageous point of capture in a population management strategy.

3. Identify strategies to match interventionists to patients based on patient specific medication management needs.

The Challenge

The Opportunity

“Create a Pharmacy Home, virtual or otherwise, where drug use

information from multiple sources* is gathered to better inform

prescribing and intervention strategies”

Medication Optimization is a Team Sport

What does the Medical Neighborhood look like?

Patient Panel

Hospital

PharmacySpecialty Providers

Community Resources

Prospective and Retrospective Quality Data

HH/Rehab/SNF

PCP & Clinic TeamCare

Management Team

Quality Improvement

Teams

“It Takes a Village”

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Diversity of Participants in Medication Management

• PHARMACeHOME Participationpatient count (in past 30 days):

RN 7,469 PharmD 5,296 CPhT 2,627 Non-Licensed Program Support 675 RPA/RPT 621 RPh 592 Non-Licensed CM 179 Non-Licensed Program Personnel 177 LPN 170 CCM 157

BS 118 Non-Licensed CM Support 113 MSW 79 BSW 60 LCSW 46 TBD 33 NP 11 LCAS 5 LPC 4 MPH 4

What’s the role of community pharmacy?

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CCNC Enrollees

CCNC Enrollees with total

medical cost > $10,000

Enrollees on CCNC

Priority list

Enrollees on TC Priority

list

Enrollees on Medication

Management Priority list

Total number of members 1,348,229 112,529 17,753 153,241 6,377 Total medical cost 4,078$ 27,527$ 23,813$ 18,215$ 25,345$ # of Inpatient visits 0.11 0.52 1.41 0.45 1.04 Inpatient costs 369$ 3,464$ 5,337$ 2,924$ 6,456$ # of mental health inpatient visits 0.01 0.04 0.04 0.04 0.04 ED visits 0.67 1.65 2.94 1.74 3.05 ED cost 178$ 745$ 1,262$ 816$ 1,657$ Outpatient visits 4.30 9.43 12.04 8.70 12.28 Mental health outpatient visits 0.62 1.88 1.04 1.53 1.14 PCP visits 2.09 2.91 2.53 2.65 3.52 Pharmacy visits 4.97 19.63 16.95 23.05 35.03 Pharmacy costs (Pre Rebate) 721$ 5,177$ 3,342$ 4,298$ 6,183$

CCNC Focus Population(s)

Value Added Services

Required Services

Standard Services Included within TECCA Participation Agreement Exhibit C• Proactive waste management program

• Patient counseling and adherence coaching

• Assist with medication reconciliation

**Although not required, all current pharmacies have also indicated availability of comprehensive medication review services

Incremental Benefit of a Multi-Credential, Multi-Setting Pharmacy Care Team to Transitional Care Process

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Pharmacy Home Activities (n=1,087) Usual Care (n=1,087)

Pharmacy Home Activities plus Home Visit (n=1,004) Usual Care (n=1,004)

Pharmacy Home Activities plus Hospital Visit (n=2,590) Usual Care (n=2,590)

Time to First Re-admission from Discharge (in days)

Pro

po

rtio

n o

f N

ot

Ho

spit

aliz

ed

0 90 180 270 0 90 180 270 0 90 180 270 360 360

How can all of this activity be done efficiency and with a high level of coordination?

(who, what, when, where, and how)

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Product Overview

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Population Population To Touch How To Touch Them

Need Generalized Med Management

Some Have More Specific Needs

Adherence/Coaching

Therapeutic Discrepancies

Therapeutic Considerations

Patient Needs

Intervention Selection

Actors-SettingsInterventions

Prioritize Patients with most need

Identify best intervention based

on data

Deliver intervention guidance

Logistics Engine

CareTriage and Prescriptive Analytics

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RIG

HT

PATI

ENT

RIG

HT

INTE

RVEN

TIO

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RIG

HT

CARE

TE

AM M

EMBE

R

RIG

HT

SETT

ING

RIG

HT

TIM

ING

/PRI

ORI

TY

Motivational Interviewing to Improve Adherence

General Medication Education

Comprehensive

Medication Therapy

Management

Medication Reconciliation Post Hospital

Discharge

Nurse Care Manager

Social Worker

Pharmacy Technician

Pharmacist

Pharmacy

Home

HH/Rehab/SNF

Hospital

Telephone

CareTriage identifies patients at risk for negative outcomes, and provides intervention guidance for the right providers in the appropriate setting and time.

CareTriage can be used to guide a wide array of interventions including transitional care services, critical follow-up appointment prioritization, and medication reconciliation services.

Engine Guidance

ClaimsClinical

Program ListsModel Outputs

User ImputationWorkforce Status

Intervention Status

Data

Any Problems?How Important?

What Should be Done?Who Should do It?

Where Should it be Done?When Should it be Done?

Should there be Follow-Up?

Answer:Credential: Pharmacist

Setting: Community DwellingTask: Help Afford Meds

Rec: Pt. Assistance Program

Conventional Approach

Next Generation Approach

Engine AlertDataClaimsClinical

Any Problems? Yes/No

High Positive Predictive Value

Population View

What are patients, employers, taxpayers paying for?

Some expenditures are investments, others are the result of lack of investment

The Value Proposition at the End of the Day

For more information contact Troy Trygstad at ttrygstad@n3cn.org or 919.260.5241

Visit us on the web at communitycarenc.org