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integration of
medication therapy management
in primary care
wayne pan, md, mba
chief medical officer
santa clara county ipa
how to incorporate
community pharmacists in a
patient-centered medical home
wayne pan, md, mba
chief medical officer
santa clara county ipa
setting
expectations
Have you seen
 ANSWERS?




 6-month old lab mix
  well-trained to do
   old tricks, not so
 good with new tricks
healthplans
healthcareproviders
hospitals
physicians
NO
how will the patient
benefit from this?
    does this make it
      easier for the
           patient?
patient-centered medical home?
patient-centered medical community
patient-centered medical community
why?
patientascostdriver
patientbehavior
see the whole
see the holes
MIND THE GAP
carecoordination
 andtransitions
MEDICATION THERAPY MANAGEMENT
medicationreconciliation
systemsthinking
designthinking
designdoing
what got you here


         marshall goldsmith
won't get you there




           marshall goldsmith
WE
                                                      ARE
                                                      HERE




From: Dan Roam, “American Healthcare: a 4-napkin explanation”
www.slideshare.net/danroam/healthcare-napkins-all
Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en
(Accessed on 14 February 2011).
Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates.
Cumulative Increases in Health Insurance Premiums,
           Workers’ Contributions to Premiums, Inflation, and Workers’
                              Earnings, 1999-2011
    200%




    150%




    100%




     50%




       0%
            1999         2000         2001        2002         2003       2004   2005   2006      2007     2008         2009   2010   2011

                                              Health Insurance Premiums             Workers' Contribution to Premiums
                                              Workers' Earnings                     Overall Inflation


Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,
1999-2011. Bureau of Labor Statistics, Consumer Price Index, U.S. City
Average of Annual Inflation (April to April), 1999-2011; Bureau of Labor
Statistics, Seasonally Adjusted Data from the Current Employment
Statistics Survey, 1999-2011 (April to April).
Exhibit ES-1. Overall Ranking
           Country Rankings
                       1.00–2.33
                       2.34–4.66
                       4.67–7.00
                                              AUS          CAN          GER         NETH          NZ            UK            US

  OVERALL RANKING (2010)                        3            6            4            1           5            2              7

  Quality Care                                  4            7            5            2           1            3              6

           Effective Care                       2            7            6            3           5            1              4

           Safe Care                            6            5            3            1           4            2              7

           Coordinated Care                     4            5            7            2           1            3              6

           Patient-Centered Care                2            5            3            6           1            7              4

  Access                                       6.5           5            3            1           4            2             6.5

           Cost-Related Problem                 6           3.5          3.5           2           5            1              7

           Timeliness of Care                   6            7            2            1           3            4              5

  Efficiency                                    2            6            5            3           4            1              7

  Equity                                        4            5            3            1           6            2              7

  Long, Healthy, Productive Lives               1            2            3            4           5            6              7

  Health Expenditures/Capita, 2007           $3,357       $3,895       $3,588       $3,837*      $2,454       $2,992        $7,290

Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).
Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health
Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund     THE COMMONWEALTH
                                                                                                                                 FUND
Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and
Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).
insanity:
 doing the
     same
thing over
  and over
       and
expecting
 different
    results
patient perspective
on average,
there is a pharmacy
    within 2.5 miles
 of every US resident




           Source: National Association of Chain Drug Stores
Source: Gallop, November 28, 2011-December 1, 2011
get out of the rut?
from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
IPA
hosspital      onsite
discharge       case
 planner      manager



      hospitalist




      patient




 discharge
 planning



            thepatientjourney
hospitalist




                 Rx


               patient




discharge   medication
planning    reconciliation




   thepatientjourney
hospitalist




                                discharge
                               instructions




                              patient




                             outpatient
discharge   medication       physician
planning    reconciliation   follow-up




   thepatientjourney
Rx     discharge
                                                instructions




                                            family




                                            patient




                             outpatient
discharge   medication       physician    discharge
planning    reconciliation   follow-up




   thepatientjourney
failsafe
hosspital
discharge
                 IPA
               onsite
                           hospitalist    hospitalist     Rx     discharge
                                                                instructions

                case
 planner      manager



      hospitalist
                             Rx
                                            discharge
                                           instructions     family




      patient              patient        patient           patient




                                         outpatient
 discharge              medication       physician        discharge
 planning               reconciliation   follow-up




            thepatientjourney
hosspital
discharge
                 IPA
               onsite
                           hospitalist    hospitalist     Rx     discharge
                                                                instructions

                case
 planner      manager



      hospitalist
                             Rx
                                            discharge
                                           instructions     family




      patient              patient        patient           patient




                                         outpatient
 discharge              medication       physician        discharge
 planning               reconciliation   follow-up




            thepatientjourney
from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
brainstorm
hosspital
discharge
                 IPA
               onsite
                           hospitalist    hospitalist     Rx     discharge
                                                                instructions

                case
 planner      manager



      hospitalist
                             Rx
                                            discharge
                                           instructions     family




      patient              patient        patient           patient




                                         outpatient
 discharge              medication       physician        discharge
 planning               reconciliation   follow-up




            thepatientjourney
hosspital
discharge
                 IPA
               onsite
                           pharmacist     hospitalist     Rx     discharge
                                                                instructions

                case
 planner      manager



      hospitalist
                             Rx
                                            discharge
                                           instructions     family




      patient              patient        patient           patient




                                         outpatient
 discharge              medication       physician        discharge
 planning               reconciliation   follow-up




            thepatientjourney
“put hot
triggers in
the path of
motivated
people”
BJ Fogg, PhD
Director, Persuasive Technology Lab
Stanford University
Santa Clara County IPA (SCCIPA)
Medication Reconciliation Pilot Project
     How to find the medication list for patients using AccessExpress

1.   Go to the PPMSI AccessExpress provider portal
     (http://ppmsi.com/accessexpress.html):




2.   Select Santa Clara County IPA:




3.   Enter USER NAME and PASSWORD, click on “SUBMIT”:
Your   SCCIPA doctor wants to help you with
your medications, after you leave the hospital.
                                      Michael Lam, RPh
                                      pharmacist

                                      Samaritan Medical
                                      Center Pharmacy
                                      2505 Samaritan Drive
                                      San Jose, CA
                                      (408) 356-7111

Please visit the Samaritan Medical Center Pharmacy to pick up
your new prescriptions and have a pharmacist review your
medications with you.
                                                          SCCIPA
                                            A Pacific Partners Medical Group
from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
what happened?
failfast
just one more thing....
alignment
engage
it’s
not
just
about
data
it’saboutthepatient
Thank you!
  wpan@ppmsi.com




WWW.SNOOPY.COM

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Integration of MTM in Primary Care 28FEB12

  • 1. integration of medication therapy management in primary care wayne pan, md, mba chief medical officer santa clara county ipa
  • 2. how to incorporate community pharmacists in a patient-centered medical home wayne pan, md, mba chief medical officer santa clara county ipa
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  • 10. Have you seen ANSWERS? 6-month old lab mix well-trained to do old tricks, not so good with new tricks
  • 15. NO
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  • 19. how will the patient benefit from this? does this make it easier for the patient?
  • 23. why?
  • 35. what got you here marshall goldsmith
  • 36. won't get you there marshall goldsmith
  • 37. WE ARE HERE From: Dan Roam, “American Healthcare: a 4-napkin explanation” www.slideshare.net/danroam/healthcare-napkins-all
  • 38. Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates.
  • 39. Cumulative Increases in Health Insurance Premiums, Workers’ Contributions to Premiums, Inflation, and Workers’ Earnings, 1999-2011 200% 150% 100% 50% 0% 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Health Insurance Premiums Workers' Contribution to Premiums Workers' Earnings Overall Inflation Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2011. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2011; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2011 (April to April).
  • 40. Exhibit ES-1. Overall Ranking Country Rankings 1.00–2.33 2.34–4.66 4.67–7.00 AUS CAN GER NETH NZ UK US OVERALL RANKING (2010) 3 6 4 1 5 2 7 Quality Care 4 7 5 2 1 3 6 Effective Care 2 7 6 3 5 1 4 Safe Care 6 5 3 1 4 2 7 Coordinated Care 4 5 7 2 1 3 6 Patient-Centered Care 2 5 3 6 1 7 4 Access 6.5 5 3 1 4 2 6.5 Cost-Related Problem 6 3.5 3.5 2 5 1 7 Timeliness of Care 6 7 2 1 3 4 5 Efficiency 2 6 5 3 4 1 7 Equity 4 5 3 1 6 2 7 Long, Healthy, Productive Lives 1 2 3 4 5 6 7 Health Expenditures/Capita, 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290 Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity). Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund THE COMMONWEALTH FUND Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).
  • 41. insanity: doing the same thing over and over and expecting different results
  • 43. on average, there is a pharmacy within 2.5 miles of every US resident Source: National Association of Chain Drug Stores
  • 44. Source: Gallop, November 28, 2011-December 1, 2011
  • 45.
  • 46. get out of the rut?
  • 47.
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  • 49. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
  • 50. IPA hosspital onsite discharge case planner manager hospitalist patient discharge planning thepatientjourney
  • 51. hospitalist Rx patient discharge medication planning reconciliation thepatientjourney
  • 52. hospitalist discharge instructions patient outpatient discharge medication physician planning reconciliation follow-up thepatientjourney
  • 53. Rx discharge instructions family patient outpatient discharge medication physician discharge planning reconciliation follow-up thepatientjourney
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  • 56. hosspital discharge IPA onsite hospitalist hospitalist Rx discharge instructions case planner manager hospitalist Rx discharge instructions family patient patient patient patient outpatient discharge medication physician discharge planning reconciliation follow-up thepatientjourney
  • 57. hosspital discharge IPA onsite hospitalist hospitalist Rx discharge instructions case planner manager hospitalist Rx discharge instructions family patient patient patient patient outpatient discharge medication physician discharge planning reconciliation follow-up thepatientjourney
  • 58. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
  • 60.
  • 61. hosspital discharge IPA onsite hospitalist hospitalist Rx discharge instructions case planner manager hospitalist Rx discharge instructions family patient patient patient patient outpatient discharge medication physician discharge planning reconciliation follow-up thepatientjourney
  • 62. hosspital discharge IPA onsite pharmacist hospitalist Rx discharge instructions case planner manager hospitalist Rx discharge instructions family patient patient patient patient outpatient discharge medication physician discharge planning reconciliation follow-up thepatientjourney
  • 63. “put hot triggers in the path of motivated people” BJ Fogg, PhD Director, Persuasive Technology Lab Stanford University
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  • 67. Santa Clara County IPA (SCCIPA) Medication Reconciliation Pilot Project How to find the medication list for patients using AccessExpress 1. Go to the PPMSI AccessExpress provider portal (http://ppmsi.com/accessexpress.html): 2. Select Santa Clara County IPA: 3. Enter USER NAME and PASSWORD, click on “SUBMIT”:
  • 68.
  • 69. Your SCCIPA doctor wants to help you with your medications, after you leave the hospital. Michael Lam, RPh pharmacist Samaritan Medical Center Pharmacy 2505 Samaritan Drive San Jose, CA (408) 356-7111 Please visit the Samaritan Medical Center Pharmacy to pick up your new prescriptions and have a pharmacist review your medications with you. SCCIPA A Pacific Partners Medical Group
  • 70. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
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  • 80. just one more thing....
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  • 96. Thank you! wpan@ppmsi.com WWW.SNOOPY.COM