Communicating the Value and Outcomes of the Pharmacy ...€¦ · Cleveland Clinic Abu Dhabi...

7/15/2019

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#FSHP2019

Communicating the Value and Outcomes of the Pharmacy

Enterprise to the C-Suite

Scott Knoer, PharmD, MS, FASHPChief Pharmacy Officer

Cleveland Clinic

#FSHP2019Disclosures

• The Presenter has no conflicts to disclose

#FSHP2019Pharmacist Objectives

• Describe how to tie senior administration’s priorities and expectations to your departmental goals and business plans

• Identify the most appropriate strategies and metrics to demonstrate outcomes to administration

• Summarize how to most effectively communicate the impact of clinical and cost savings initiatives to senior administration

#FSHP2019Technician Objectives

• Define pharmacy metrics• Outline how your position impacts the financial and

quality metrics upon which your department is judged• Use an effective communication strategy to describe your

role to the pharmacy management team and your peers

#FSHP2019Established Feb 28, 1921• Four Physicians• MD Group Practice

Physician-Led Non-Profit Organization• Group Practice Hospital / Clinics

Bring together diverse specialists to think and “act as a unit”

Mission: “…care of the sick, investigation into their problems, and further education of those who serve.”

#FSHP2019

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#FSHP2019U.S. News & World Report’s“2017-2018 Best Hospitals”

No. 2 on National Honor Roll

Rank Hospital Points Specialty

1 Mayo Clinic, Rochester, Minnesota 414 15

2 Cleveland Clinic 385 143 Johns Hopkins Hospital, Baltimore 355 15

4 Massachusetts General Hospital,Boston 354 16

5 University of Michigan Hospitals –Michigan Medicine, Ann Arbor 324 14

#FSHP2019U.S. News & World Report’s2017 Specialties

Rank Specialty Rank Specialty

1 Cardiology &Heart Surgery 4 Diabetes & Endocrinology

1 Urology 4 Neurology & Neurosurgery

2 Nephrology 5 Gynecology

2 Gastroenterology & GI Surgery 5 Geriatrics

2 Rheumatology 5 Cancer

3 Orthopedics 9 Ophthalmology

3 Pulmonology 11 Ear, Nose & Throat

#FSHP2019

1. Mayo Clinic2. Cleveland Clinic3. Singapore General

Hospital4. Johns Hopkins5. Charite – Berlin

6. Massachusetts General Hospital

7. Toronto General Hospital8. University of Tokyo Hospital9. Lausanne University Hospital

– Switzerland10. Sheba Medical Center at

Tel HaShomer

#FSHP2019

ClevelandClinic

Integrated Health Systemserving 6 million patients

Fairview Hospital

Lutheran Hospital

Ashtabula County Medical Center

Euclid Hospital

Hillcrest Hospital

South PointeHospital

Marymount Hospital

Akron General Medical Center

HAvon Hospital

Medina Hospital

H

H

H

H

H

H

H

H

H

FHCFHCElyria Family

Health Center

Westlake FamilyHealth Center

Strongsville Family Health and Surgery Center

Brunswick FamilyHealth Center

Wooster FamilyHealth Center

Solon FamilyHealth Center

Chagrin Falls FamilyHealth Center

Beachwood FamilyHealth and Surgery Center

Willoughby HillsFamily Health Center

Stephanie Tubbs JonesFamily Health Center

Twinsburg Family Health Center

FHC

FHCFHC

FHCFHCFHCFHC

FHCFHC

FHCFHC

Independence FamilyHealth Center

FHCFHC

FHCFHCFHCFHC

Lorain Family HealthAnd Surgery Center

FHC

LakewoodFamily Health

Center

FHCFHC

FHC

FHC

HUnion Hospital

#FSHP2019 #FSHP2019

Cleveland Clinic - Weston

Martin South HospitalMartin North Hospital

Tradition Hospital

Indian River Hospital

Outpatient CenterRegional Hospital

Build a high-quality, value-based, integrated

healthcare system of scale to serve needs of

Florida communities

OUR VISIONOUR VISION

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#FSHP2019

Cleveland Clinic NevadaLou Ruvo Center for Brain Health (Las Vegas)

#FSHP2019Cleveland Clinic Abu Dhabi

Cleveland Clinic CanadaToronto Health & Wellness Center

Cleveland Clinic London

International Locations

#FSHP2019Cleveland Clinic London

#FSHP20192018 CC Pharmacy Enterprise Budget

Inpatient318

31%

HOP/Clinic386

37%

Specialty156

15%

Ambulatory107

10%

Other75

7%

$1.04 Billion

Source: Pharmacy Purchasing Datawarehouse YTD through Dec 2018

Milli

ons

#FSHP2019

Cleveland Clinic Pharmacy Enterprise: 1,410 FTEs

• 19 Retail Pharmacies• Mail Order Pharmacy• Specialty Pharmacy• Home Infusion

Pharmacy

#FSHP2019

What is Important to Your C-Suite• What is the C-Suite?• What is the CEO’s Strategic Plan?• What is important to your Boss should be important to

you…• Cascade strategy throughout enterprise

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#FSHP2019

CEO 2019 Objectives and Key Results (OKRs)

#FSHP2019Care for PatientsObjectives Key Results 2018 Metric 2019 Goal

Zero harm for the safety of our patients Safety Serious Events (#) 87 54

Deliver highest quality careMortality Observed to Expected (Ratio) 0.76 0.74

Deliver optimal patient experience

HCAHPS Would Recommend (% yes definitely) 79% 80.5%

Care for patients across their lifetimes Lives in Primary Care Panels (#) 709,452 TBD

* Milestone-based goals will receive a green / yellow / red based on whether they are on track / delayed / off track

#FSHP2019Research and EducationObjectives Key Results 2018 Metric 2019 Goal

Research tomorrow's treatments Research Funding ($M) $201M $207M

Educate tomorrow's caregivers

Board Pass Rate (%) 94% 100%

Health Education Campus construction* HEC 1st Student 7/1/19

Innovate tomorrow's care Invention Disclosures 67 70


#FSHP2019Care for CaregiversObjectives Key Results 2018 Metric 2019 Goal

Be the safest place in healthcare

Workplace Violence Events(Rate per 100 FTEs) 0.25 0.21

Be the most diverse & Inclusive place to work

Leadership Diversity* Achievement of Annual Goal

Caregiver Diversity* Achievement of Annual Goal

Be the most engaged place to work

Regrettable Turnover 9.3% 8.30%

Would Recommend As Place to Work (%tile) 69th %tile 90th %tile

Be the best place to learn and grow

Caregivers with Development Plans (OKR Goals) 83% 90%


#FSHP2019Care for the OrganizationObjectives Key Results 2018 Metric 2019 Goal

Serve twice as many patients over the next 5 years

Unique Patients (#) 2.01 M 2.57 M

Be responsible stewards of our resources

Operating Revenue ($B) $8.9B $10.4B

EBIDA Margin (%) 10.1% 10.1%

Grow physically

Ohio Growth*90K additional lives from 21 counties12K additional lives from new Ohio

Markets

Florida Integration* Integration Plan by 6/30/19Abu Dhabi Unique Patients Growth(#) 90,985 97,354

London (% project plan milestones) n/a 95%

Grow digitally Virtual Visits (%) 0.88% 1.70%* Milestone-based goals will receive a green / yellow / red based on whether they are on track / delayed / off track

#FSHP2019Care for the CommunityObjectives Key Results 2018 Metric 2019 Goal

Develop our local communities

Economic Impact ($B) $17.8 B n/a

Community Benefit ($M) $906.5 M $950M

Advance important public health initiatives

Opioids Prescriptions (MMEs) 317M 253M


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#FSHP2019Annual Strategic Planning Session

• Every Fall• All Direct Reports and

some guests• Outside speaker to set

the tone

#FSHP2019

Establish one new consult agreement in all

retail locations by 12/31/19.

Increase patients seen under consult

agreements by 10% by 12/31/19

Expand continuation of therapy in retail

locations to include all FHCs by 12/31/19

Increase referrals in smoking cessation by

30% by 12/31/19

Pharmacy OKRsExpansion of pharmacy services

with utilization of consult agreements

Key Result Key Result Key Result

Care Priority: Care for Patients Executive Owner: Sokn, Soder, C

Key Result

#FSHP2019

Implement USP 797, 800 compliance for inpatient and

FHC’s by 12/2019

Completion of caregiver compounding training and

competency by 09/2019

•Documented training for caregivers

Electronic repository for review and audit of all clean room

certification reports with concurrent review with escalation

and resolution if required

OKR- Lead medication safety, quality, and pharmacy regulatory compliance

effortsKey Result Key Result Key Result

Care Priority: Patient Executive Owner: Milner & Egger

#FSHP2019

Reduce pharmacist job description to 1 by

6/2019

Reduce clinical specialist job description

to 1 by 10/2019Number of pharmacists

enrolled in the PARP

OKR- Standardize core pharmacy caregivers key performance

indicators, job description, and development of our pharmacists


Care Priority: Caregiver Executive Owner: Leonard & Glowcz

#FSHP2019

Achieve $11 million in cumulative costs savings

by end of 2nd quarter

Achieve $12 million in cumulative cost savings

by end of 3rd quarter

Achieve actual target of $13 million in cost

savings by end of year 12/2019

• Executive dashboard

• Audit Review

OKR- Ensure cost-effective medication use, formulary

management, and capitalize on new opportunities for cost savings


Care Priority: Organization Executive Owner: Leonard

#FSHP2019

Achieve $11 million in cumulative costs savings

by end of 2nd quarter

Achieve $12 million in cumulative cost savings

by end of 3rd quarter

Achieve actual target of $13 million in cost savings by end of year 12/2019

• Executive dashboard

• Audit Review

OKR- Ensure cost-effective medication use, formulary

management, and capitalize on new opportunities for cost savings


Care Priority: Organization Executive Owner: Leonard

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#FSHP2019

Sales and Marketing

• If nobody knows about it, it didn’t happen…• Must actively communicate upstairs

#FSHP2019

Ambulatory Communication

#FSHP2019

CC Retail Pharmacy $ Value 2018

•Store EBIDA• $921,000

•Specialty EBIDA• $3,961,000

•EHP Cost Avoidance• $7,306,000

•Total Value = $12,188,000

#FSHP2019Home Infusion Value

•Net Revenue = $25.3M•EBIDA = $4.2M

#FSHP2019Specialty Revenue

Monthly Trending

$0.0

$5.0

$10.0

$15.0

$20.0

$25.0

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

millions ($)

2017 2018 2019

#FSHP2019Rx Volume Monthly Trending

Ambulatory Pharmacy (no Specialty)

‐

20,000

40,000

60,000

80,000

100,000

120,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec2017 2018 2019

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#FSHP2019Rx Volume: Ambulatory Pharmacy

(no Specialty)

0

20000

40000

60000

80000

100000

120000


EHP 2017 EHP 2018 EHP 2019 Trade 2017 Trade 2018 Trade 2019

#FSHP2019Wait Times

All Ambulatory Pharmacies

0

2

4

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2017 2018 2019 Target

#FSHP2019Bedside Prescription Volume

Main Campus Ambulatory Pharmacies

‐

1,000

2,000

3,000

4,000

5,000

6,000

7,000


2017 2018 2019

#FSHP2019

Bedside Prescription VolumeAll Ambulatory Pharmacies

(Includes Main Campus, Weston FL, Marymount, Fairview, Avon, Medina, Lutheran, Hillcrest, Akron and South Pointe & Euclid locations)

‐

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000


2017 2018 2019

#FSHP2019

Employee Health Plan Communication#FSHP2019

Copay Card Program Cost Avoidance

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#FSHP2019CCHS Plan Performance vs. PBM

Hospital Employer Book of BusinessJanuary through December 2018

Metric CC EHPHospital Employers

Variance

Gross Cost PMPM $101.24 $122.87 (17.6%)

Net Cost PMPM $83.35 $111.11 (25.0%)

Generic Dispensing Rate 87.9% 87.0% 1.0%

Generic Substitution Rate 99.3% 99.0% 0.3%

#FSHP2019

Program Impact

#FSHP2019

$28 PMPM x 12 mo x 100,000 members = $33.6M savingsper year

#FSHP2019

Inpatient Prescription Drug Spending Per AdmissionCompound Annual Growth Rate

4.7%

3.8%

US Community Hospitals* CCF Main Campus

*American Hospital Association: Recent Trends in Hospital Drug Spending and Manufacturer Shortages, 2019

2017 - 20192015 - 2017

#FSHP2019Inpatient Communication

#FSHP2019

2018 CC Pharmaceutical Purchases

Inpatient318

31%

HOP/Clinic386

37%

Specialty156

15%

Ambulatory…

Other74

7%

$ 1.04 Billion

Source: Pharmacy Purchasing Datawarehouse YTD through Q4 2018

Mill

ions

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#FSHP2019

Decreasing Inpatient Pharmacy Expenses

• Formulary Management• Managing additions• Restrictions

• Supply Chain Contracting• Insourcing

#FSHP2019

Rx Cost Reduced by $129 Million since 2010

$0

$5

$10

$15

$20

$25

$30

2010 2011 2012 2013 2014 2015 2016 2017 2018

Annualized Savings (Millions)

Annualized Savings

#FSHP20192019 Pharmacy Cost Savings

$ in Millions

$10.8

$16.5$5.6

$0.0

$2.0

$4.0

$6.0

$8.0

$10.0

$12.0

$14.0

$16.0

$18.0

Potential Savings Captured Savings Remaining OpportunityFormulary & Supply Chain

#FSHP2019

CCHS Medical Staff P&T Formulary Panels/Committee

CCHS Med Staff P&T

Committee

Internal Medicine

Hematology/ Oncology

Children’s Hospital

Critical Care/ Surgery/

Anesthesia

Neurosciences

Cardiovascular

Antimicrobial

Med-Related Policy

Transplant (Main campus/

Florida only)

Emergency Medicine

#FSHP2019Managing High Cost Drugs

• Do not add drugs to Formulary (lack of evidence-based medicine)

• Remove drugs from formulary• Use therapeutic alternative(s)• Convert from brand to generic• Change drug preparation• Modify order sets

#FSHP20192018 CCHS Formulary Activity

4%

45%39%

7%5%

Decisions

Added Added with RestrictionsChanged Restriction DeletedDid not Add N=83

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#FSHP2019

Examples of Cost Avoidance by Not Adding Drug to Formulary

• Angiotensin II (Giapreza®)• Less expensive alternative formulary agents

• Norepinephrine/Vasopressin• Estimated cost per year = $1 million

• Andexanet alfa (Andexxa®)• Less expensive alternative formulary agent: Feiba®

• Estimated cost per year = $3 million

#FSHP2019

Pharmacy Spend vs Vizient Benchmark

Better than Vizient pharmacy contracts in 2018

$70M

#FSHP2019

Cost Savings from Insourcing Compounding

•Annual Savings• Cardioplegia - $1.1M• TPN - $1.1M• Amiodarone - $450K• Florida - $180K

#FSHP2019

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Communicating the Value and Outcomes of the Pharmacy ...€¦ · Cleveland Clinic Abu Dhabi...

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