ALEGRIAALEGRIAA New Generation of Care-Coordination in the

Doctor-Patient-Pharmacy Triad Partnership

November 2014

Caring is our specialty. 1

Alegria(caring is our specialty)Alegria(caring is our specialty)

• Our Pledge: personalized care and service to our patients, providers and the community we serve!

• Who We Are: Our Team

• Kevin Askari, RPH Founder, President

• Raymond Rodriguez, Director, Regional Sales

• Ellen Scharaga, RPH, Consultant

• Michael Yuen, RPH, Chief Clinical Pharmacist

• Jennifer Valentine, CPhT, Supervisor, Pharmacy Technician

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Alegria Care Services ModelAlegria Care Services Model• We are a specialized pharmacy that understands your patient’s individual treatments

• Our Divisions include:o Apothecary Pharmacy

• Traditional oral medicationo Specialty Pharmaceuticals

• Specialty injectables & high risk orals

• Specialty sterile infusions

• Customized topical compoundingo Nursing & Home Infusion

• Individualized assessments, clinical care plans, and on going education

• Nursing, speech therapy, occupational therapy, physical therapy, home health aides o Ambulatory In Office Infusions

• Cost effective environment to receive therapies

• Collaboration with physician, supported by staff knowledgeable in infusion therapy, injectables, and a broad range of disease management

o Health & Wellness Program

• Multi-disciplinary approach to health

• Disease, nutrition, and lifestyle management 3

Our Goals For Those We ServeOur Goals For Those We Serve• Our goal is to improve patient compliance, medication adherence, and patient satisfaction

resulting in successful therapy management

• We aim to eliminate emergency room visits, hospitalizations, and reduce re-admissions

• Increase knowledge and education within our community concerning disease prevention and maintenance for optimal health

• Create a support system for our patients so that they have the necessary tools, education, and assistance to manage their therapy on a day to day basis

• Target patients and specialists may include, but are not limited to, those of the following:

Conditions SpecialistsHIV / AIDS Hepatitis B & C Infectious Disease Gastroenterology

Multiple Sclerosis Pain Mgmt Immunology Orthopedics

Rheumatoid Arthritis Osteoarthritis Neurology Interventional Pain

Organ Transplant Infertility Rheumatology Wound Care

Growth Hormone Podiatry Orthopedics

Gynecology

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Patient Clinical SupportPatient Clinical Support• Bridging the gap between doctor and patient:

o Creating a patient profile which allows the physician to have a full view of the patient’s medication and therapies

o Updating physician, medical staff, and case managers on patient adherence to therapy, side effects, and general well being

• Your patients have access to a patient advocate who would become their liaison to better health. o Our Patient Advocates:

• Financial Assistance: Eliminate financial barriers for patients and administrative burden for physician office staff through our trained reimbursement co-pay specialists

• Access to manufacturer co pay assistance programs and non profit organizations

• Improving patient health is our primary goal. To successfully accomplish this we form a bond with our patient by providing medication therapy management.

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Pharmacy ServicesPharmacy Services• Our medication therapy management program allows us to monitor patients course of

treatment and ensure positive outcomes for the patient and their healthcare team

• Our Pharmacy Service Model includes:o Increased patient contact for patient adherenceo Clinical counseling, education, side effects, & compliance o Dose adjustmento Drug-drug interaction identificationo Medication therapy management and counseling o Building patients profile for all medications & therapieso Schedule deliveries to patient home, physician office, or facilityo Special packaging (blister packs)o Emergency deliverieso Inventory / refill reminders

• Telephonic and email

• Coming Soon: Text messaging

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Clinical Intake & ProcessClinical Intake & Process• Our intake process includes:

o Clinical review of prescriptiono Benefit investigation, prior authorization, and co pay arrangementso Financial assistance and enrollment programs

• Our follow up process includes:o Ensuring the delivery was received, reinforce medication use, storage, and adherence o Streamlined communication between medical practice and a dedicated pharmacy care

coordinatoro Reducing administrative burden for the physician and staff

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Nursing & Infusion ServicesNursing & Infusion Services• By offering a complete portfolio of services, we can safely maintain patients in the home

setting while balancing cost effective home-care services and providing high quality care

• Our Nursing & Infusion Service Model includes:o Individualized clinical care and education plan for each patiento In hospital teaching to facilitate dischargeo First dose ER infusions to eliminate a hospital admission; Continuity of careo First Dose At Home Programo Home health aideso Speech therapy, occupational therapy, physical therapyo Nursing serviceso 24 hour on call nursing and pharmacy supporto Medication reconciliationo Ambulatory infusion suite services

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Home Infusion ProcessHome Infusion Process• Your office or a case manager will contact Alegria to begin the home infusion process for their patient

• Our staff will do a benefits investigation to determine the patient’s insurance coverage and eligibility

• We will coordinate with the physician’s office when therapy will begin as well as schedule the nurse’s first visit with the patient

• Our clinical staff will prepare all of the necessary medication and coordinate delivery

• A delivery technician will bring the medication and supplies to the patient’s home prior to the nurse’s visit

• A nurse will instruct the patient on the basic techniques for the safe administration of the medication or therapy until comfort is demonstrated

• On subsequent visits the nurse will monitor the IV infusion site and evaluate the effectiveness of therapy

• A nurse or pharmacist is available 24 hours a day, 7 days a week to answer questions or concerns

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Ambulatory In Office Infusion ServicesAmbulatory In Office Infusion Services• Our ambulatory infusion services are designed to make the in office infusion process safe,

comfortable, and convenient while providing high quality care and monitoring under the supervision of nursing and medical staff

• Infusionso Antibioticso Anti-Coagulantso Hydrationo Inotropic therapy(Dobtuamine/Dobutrex)o Pain managemento Steroidso TPN

• Injectableso Lupron Injectionso Intra-muscular Injections

• Faslodexo Self Injectables

• Epogen

• Copaxone

• Rebif

• Avonex 10

Alegria Personalized Health & Wellness Alegria Personalized Health & Wellness

ProgramProgram

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Health & Wellness Program Overview:Health & Wellness Program Overview:• Our goal is to create a multi-disciplinary approach to health which encompasses

coordination of care between our internal resources, other health providers, and community programs

• This program is designed to enhance adherence to our patient’s medication regimen, nutrition and health goals, and to promote optimal health

• Based on individual health assessment:o Create a targeted intervention program specific to the patients needso Provide online, telephonic or in person coaching to help patients change the way they

think about themselves, their life and their lifestyleo Provide access to educational resources electronically or in print formo Provide group education program that are convenient either in person or from the

comfort of the patients home which teach simple, personal, motivating principles that are practical

o Allow easy access to communicate with the health team either through a secure electronic portal, by phone or in person

• Target patients may include those with the following chronic conditions:Hypertension Asthma Dyslipidemia

Chronic Kidney Disease Depression COPDCongestive Heart Failure Diabetes

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Personalized Health Program:Personalized Health Program:• The Patient Management Program is based on five (5) core elements:

o Assessment• Provide an individual risk assessment report based on an easy to complete health risk

assessment questionnaire

o Education & Counseling• Create a personalized health improvement plan • Provide on-going education

o Care Planning• Utilize pharmacists, counselors, nutritionists, and health coaches, to keep patients engaged

in following their personal health improvement plan initiated by their physician• Coordination of care between internal resources and other healthcare providers, programs,

and community serviceso Disease Management Programso Nutrition and Lifestyle Management Programso Case Management Programs

o Patient Follow up• Monitoring of patient medication adherence and minimization of the occurrence of adverse

effects• Re-evaluate patients to track improvement through laboratory reports, patient self-reports,

provider reports and referring source report

o Re-assessment• Measure success by evaluating health improvement and progress

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Enhancing HEDIS, NCQA, & other Enhancing HEDIS, NCQA, & other Quality ScoresQuality Scores

• Our Mission: To reduce unnecessary healthcare utilization and increase the value in US health spending

• Integrate Health Risk Assessment with Electronic Medical Records and Personal Health Records

• Incorporate principles of quality improvemento Use pharmacy data as markers for compliance and adherenceo Crosswalk electronic prescriptions and prescription fill data in pharmacy

• Assist in partnership with insurance plans CMS Star Ratingso Adherence to Diabetes, Hepatitis, and cholesterol lowering medicationo Increase generic dispensing rateo Identify diabetic patients without an ACE/ARB interventiono Provide prescription drug data with HEDIS measures and NCQAo Enhance physician “Pay for Performance” financial incentiveso Improving quality measures for the physiciano Increase reimbursement for participating physicians 14

Patient Centered Medical Home InitiativePatient Centered Medical Home Initiative• Our patient centered approach to individualized health management, organizes all medical

and pharmacy services required for a patient under one umbrella

• This collaboration results in patients efficiently serviced while realizing a reduction in unnecessary medical costs

• High risk medicationo Proactive approach to managing possible known side effects and unpredictable adverse

events

• Eliminating avoidable emergency room visits and reducing re-admissionso Referrals to “Physician House Call Program” to treat the patient at home

• Quality improvemento Coordinate data from pharmacy and medical offices in an electronic file so that all

necessary patient information is available for physicians, nurses, and other health care providers

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Why Alegria?Why Alegria?• Over 20 years of experience in specialized care working in close collaboration with patients

and health care providers

• Community based specialty pharmacy and infusion services providing care to patients and providers in all five boroughs

• Alegria is culturally sensitive, serving patients from all over the world through our relationship with the AT&T Language Line

• Our programs encompass a portfolio of services, ranging from traditional pharmacy through intensive nursing and home infusion setting a new standard of care

• The Alegria pharmacy model bridges the gap between the doctor and patient creating a support system to improve patient compliance, satisfaction, and successful therapy outcomes

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What Makes A Great Specialty Infusion What Makes A Great Specialty Infusion

PharmacyPharmacy• Service, Service, Service

• Advocating for our patients to ensure proper treatment, and reduce patient’s financial burden

• Educating our patients and their healthcare team

• Bridging the gap between doctor and patient

• Providing our partners with healthcare analytics through data collection reporting, health outcomes, and transparency

• Enhancing patient engagement while achieving satisfaction

• Creating a multi-disciplinary approach to health to ensure optimal outcomes for our patients

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What Keeps You Up At Night?What Keeps You Up At Night?•What are you missing from your current healthcare provider partners?

•What can we do to meet the needs of your patients?

•Q & A

•Next Steps

18Caring is our specialty.