MTM IN FQHCS: Improving Chronic Disease Outcomes Objectives Describe successful models of pharmacist engagement with FQHCs. Discuss opportunities and strategies to initiate MTM in FQHCs through engaging with pharmacists to provide care. Share next steps of a coordinated statewide effort to advance Medication Therapy Management in FQHCs and improve chronic disease outcomes for Ohioans. Poll Everywhere Who knows what Medication Therapy Management (MTM) is? https://www.polleverywhere.com/multiple_choic e_polls/SzXzzxnhfFoz1OP# Medication Therapy Management Otherwise known as “MTM” Medication Therapy Management A service or group of services that optimizes therapeutic outcomes for individual patients. The service is provided by pharmacists, the medication experts on the health care team. A PROGRAM GUIDE FOR PUBLIC HEALTH Partnering with Pharmacists in the Prevention and Control of Chronic Diseases. Centers for Disease Control and Prevention, July 2012. Integrated Medication Management Patient Safety and Clinical Pharmacy Services Collaborative supported by HRSA and The Alliance for Integrated Medication Management 2009-2014 10 Elements for Integrated Medication Management Why MTM An estimated 15% of the U.S. population (some 46 million people) are high-risk, high-cost, medically complex patients: multiple chronic health conditions multiple and sometimes dangerous medications multiple health care providers experience barriers to accessing care poorly adhere to medication regimens. The Patient Safety and Clinical Pharmacy Services Collaborative (2011). National Performance Report: Communities Organizing Integrated Delivery Systems With Clinical Pharmacy Services. Retrieved May 1, 2012 from http://pspcnationalperform ancereport.files.wordpress.com/2012/03/pspc-national-performance-report-2011.pdf. Why MTM Uncoordinated medication management accounts for more than 30% of total health care costs. Reform efforts aimed at these high-risk patients could save over $240 billion per year. To Err is Human: Building a Safer Health System, The Institute of Medicine Nov 1999 http://www.IOM.edu Ohio Population Improvement with MTM ADE Project: 5 Ohio Teams, CMS Patients Supporting MTM Caresource Pharmacist Providing Services Direct Reimbursement Healthier Patients Lower Overall Healthcare Spending Shared Savings = PATIENT WINS MTM in Ohio FQHCs Project Overview Role of Public Health in MTM CDC publication released in August 2012 Identified opportunities for public health to engage new partners to improve management of HTN and diabetes In February 2013, CDC issued new RFP to fund state public health chronic disease programs A PROGRAM GUIDE FOR PUBLIC HEALTH: Partnering with Pharmacists in the Prevention and Control of Chronic Diseases 2012 http://www.cdc.gov/dhdsp/programs/spha/docs/pharmacist_guide.pdf Domain 3: Health System Interventions Increase use of team-based care in health systems Increase engagement of non-physician team members, i.e., nurses, pharmacists, and patient navigators, in HTN and diabetes management in the health care system 34% of Ohioans have HTN. Control rates not optimal. Only 50% of diagnosed patients are <140/90. 10% of Ohioans have diabetes; 14% of AfricanAmericans; Prevalence and mortality from HTN and diabetes higher in minority populations Heart disease, stroke and diabetes are among leading causes of death in Ohio Purpose & Goals To expand medication therapy management (MTM) provided by pharmacists to patients cared for in Federally-qualified Health Centers (FQHCs) in Ohio to reduce the burden of chronic disease. Primary aims include increasing the number of FQHC patients with a/an: A1C in control, defined as <9% Blood pressure in control, defined as <140/90 mmHg Diabetes composite control, defined as A1C, BP, and LDL in control Secondary aims include increasing the number of FQHC patients: Seen by pharmacists and details on Medication-related Problems (MRPs), Adverse Drug Events/potential Adverse Drug Events (ADEs/pADEs), including cost avoidance With access or referral to chronic disease or diabetes self-management education programs Project Timeline Dates Activities Fall 2013 • Identify pilot sites • Connect with colleges of pharmacy January 2014 • Gather baseline data from sites • Conduct orientation February-March 2014 • Finalize model at individual sites • Present to individual site staff • Identify patient population April 2014-June 2015 • Recruit and engage patients • Report data monthly to statistician • Participate in monthly conference calls and quarterly in-person meetings Phase II • Share optimized models and data from pilot sites & encourage adoption of these models statewide State Pilot Support Ohio Leading in Integrated MTM Healthy People MTM across Ohio! Phase 2 Expansion Phase 1Pilot Healthy Communities Phase 1 Progress Pilot Sites and Models Name of FQHC Description of Model AxessPointe Faculty practitioner In-house 340B and clinical pharmacy Less than 5 year pharmacy presence Columbus Neighborhood Health Centers Dual-faculty practitioners Contracted 340B; in-house access program Long-term pharmacy presence (>10 years) Health Partners of Western Ohio Staff practitioners In-house 340B and clinical pharmacy Long-term pharmacy presence (8 years) Athens/Southeast Ohio Collaboration with community pharmacy Contracted 340B Currently building relationship and care model Data - Enrollment In six months, enrollment at the pilots sites has increased over seven times the initial enrollment Number of patients enrolled in MTM at pilot locations, March - August 2014 160 140 120 100 80 60 40 20 0 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Data – Diabetic patients By nature of the enrollment criteria, no MTM patients with diabetes were in control* initially In six months, just over 42% of diabetic MTM patients were in control* Diabetic MTM clients not in control* Diabetic MTM clients in control* 100 90 80 70 Number of Clients 60 50 40 30 20 10 0 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 * Diabetes in control was defined as an A1C measurement of less than or equal to 9% Data - Hypertensive patients By nature of the enrollment criteria, no MTM patients with hypertension were in control* initially In six months, nearly 50% of hypertensive MTM patients were in control* Hypertensive MTM clients not in control Hypertensive MTM clients in control 90 80 70 60 Number of Clients 50 40 30 20 10 0 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 * Hypertension in control was defined as an a blood pressure measurement of less than 140/90 Data – Other Highlights In the seven months of intervention: 21 adverse drug events were addressed 82 potential adverse drug events were detected and remedied And 184 instances of clinical pharmacy services Poll Everywhere Who has worked with a pharmacist before to enhance patient care? https://www.polleverywhere.com/multiple_choic e_polls/8cv0cIJFrhu1rA3 Connecting with Pharmacy Identify needs in your population What quality indicators are you missing? Meet with pharmacy representatives about available services Connect with colleges of pharmacy Consider trainees and students Questions and Lessons Learned Alexa Sevin Columbus Jenny Clark & Jamie Bailey Health Neighborhood Health Centers Partners of Western Ohio Magdi Awad AxessPointe Community Health Center Phase 2 Make available resources for integrating pharmacists into FQHC patient care Coordinate training programs for students and residents across the State of Ohio Connect stakeholders to improve quality through enhanced Medication Therapy Management OHIO Consortium Faculty/Colleges of Pharmacy Students, Residents Trainees Pharmacists/Pharmacies MEDICATION THERAPY MANAGEMENT (MTM) FQHCs Ohio Department of Health Programs Community Health Resources Improve Chronic Disease Outcomes for Ohioans What is most useful to you? COP Contact Info Cedarville University NEOMED Bethanne Brown – [email protected] University of Findlay Jen Rodis – [email protected] University of Cincinnati Michael Rush – [email protected] Ohio State University Magdi Awad – [email protected] Ohio Northern University Kelly Wright - [email protected] Lori Ernsthausen – [email protected] University of Toledo Mary Borovicka – [email protected] MTM IN FQHCS: Improving Chronic Disease Outcomes Jenny Clark: [email protected] Jen Rodis: [email protected]
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