VA Pharmacy Conference2008

Consolidated Mail Outpatient Pharmacy Operations

Kenneth SiehrDeputy Chief Consultant-Pharmacy Benefits Management ServiceConsolidated Mail Outpatient Pharmacy OperationsDepartment of Veterans Affairs

Overview

• A little about me• Life of a VA mail out prescription• Outpatient prescription fulfillment system• CMOP today• CMOP history

– How we got to where we are• CMOP of Tomorrow• How does this affect you?

Who Is This Guy?

• 30+ years in Federal Pharmacy– Pharmacy Intern VA Madison 1977

• Army Pharmacist 1978-81• VA Staff Pharmacist 81-82• VA Pharmacy Supervisor since 1982• Chief of Pharmacy 1988• Managed Multiple Services at Medical Center• VISN Formulary Leader (VISN 12) when

positions were established• PBM Manager 2004• Present Position 10/07

The Life of a VA Mail Out Prescription

Awaiting Verification

1 Hour to ?? 10 Hr 12 – 48 Hrs 48 Hrs to ??

Awaiting Transmission to CMOP

CMOP Filling

Delivery to Patient

Provider Orders Medication

Patient Receives

Goal: Delivery to Patient with 10 days of Patient/Provider request

Life of a VA Mail Out Prescription

VHA Outpatient Medication Fulfillment System

Medical Centers CMOP

Contracting and Procurement

Delivery to Patient

Goal: Delivery to Patient with 10 days of Patient/Provider request

Medical Center• Interface between

– Patient and fulfillment system– Provider and fulfillment system

• Ensures right – Medication for patient clinically– Dose, frequency– Cost efficiency

• Dispenses Prescriptions (20%)– Window– Mail

• Responsible for Performance– Chief of Pharmacy, Facility TMT, VFL

CMOP

• Dispenses Prescriptions (80%)– Mail

• Primary Interface – Patient delivery services

• USPS, FedEx• Mail consolidators• Direct to patient vendors

– NAC for outpatient medication contracts– Contractors for direct to patient delivery

• Responsible for Performance– CMOP Director, National CMOP and PBM

Contracting and Procurement• National Pharmacy Benefits Management

Services– Formulary Management– Identifies contacting opportunities– Monitors utilization– Contract compliance

• National Acquisition Center (NAC)– National contracts, BPAs, FSS

• Procurement and Contracting staff at each site and CMOP

• Responsible for Performance– Chief of Pharmacy, CMOP Director– National PBM, NAC

Delivery to Patient

• Window at Medical Centers• To Patient’s Home

– Contracted or third party vendors• US Postal Service• Federal Express or similar vendor

– Mail consolidators• Facilitate and speed process

– Direct to patient contractors

• Responsible for Performance– Contracting Officer for contracted services– USPS

VHA Outpatient Medication Fulfillment System

Medical Centers CMOP

Contracting and Procurement

Delivery to Patient

Goal: Delivery to Patient with 10 days of Patient/Provider request

VA CMOP National SystemVA CMOP National System

TucsonTucson

Dallas

Murfreesboro

Leavenworth

Charleston

Hines Chelmsford

CMOP Today• 7 separate locations• Each highly automated and highly efficient and

successful but with different equipment and software

• Different practices, processes and products– Murfreesboro – Media Mail– Hines – mail manifesting– Various prescription and mailing labels

• Limited national CMOP information system• Beginnings of organizational support structure• Collection of 7 individuals, not an integrated

system

CMOP: Grass Roots Effort

• Grass roots effort– Concept proven at West LA and Leavenworth

• RFP Process– Equipment centrally funded– Medical Centers selected were to provide support

• Facilities Management, Contracting, Human Resources etc.– Medical Centers serviced provided inventory funding

• CMOP Director reported to local Board• CMOP needed and fostered entrepreneurial

culture– Highly successful results

Each CMOP a Contract

• Each CMOP the result of a turn key contract with a vendor– Vendor provided all equipment and software

• Different vendors = different equipment and software not designed to integrate with other CMOPs

Early CMOP Organization

• Each CMOP essentially owned by the Medical Centers it serviced

• Reporting to a Board made up of customers

• Unique equipment and software• Organizational support provided by host

site

CMOP Tomorrow

• 7 integrated locations• Each highly automated and highly efficient with different

equipment but the same software• Standardized practices, processes and products

– Same product list– Centralized customer interface, QA etc.– Patient medications from any CMOP

• Robust national CMOP information system accessible by users– Standardized reports– ProClarity cubes

• Mature and effective organizational support structure

How Does This Affect You?

• Ability to seamlessly shift workload between CMOPs– Equipment breakdown, disaster recovery– Specialty CMOPs– Patient centric, ship from closest CMOP

• More tools– Track Rx and package– Report and trend problems– Track and validate costs

Murfreesboro Zip Code Distribution

How Does This Affect You?

• Standardized product lists– Medical/Surgical supplies– Medications and pack sizes

• Medication event prevention– Screen and identify inappropriate Rx

directions– Rx quantity checks

Get Involved and Work With Your VISN Formulary Leader as We

Transition