How to provide medication therapy management services at a retail pharmacy.

1. Medication Therapy Management (MTM) 12/23/2008 Medication Therapy Management 1 Improving Medication Use. Advancing Patient Care.

2. mission “We will treat each other with respect and dignity and do the same for all we serve. We will offer employees of all backgrounds a place to build careers. We will provide the most convenient access to healthcare services and consumer goods in America. We will earn the trust of our customers and build shareholder value.” 12/23/2008 2 Medication Therapy Management

3. Mission “We will provide the most convenient access to healthcare services and consumer goods in America.” Medication therapy management (MTM) aligns well with our desire to provide convenient access to health care services and provide equity for our shareholders. 12/23/2008 3 Medication Therapy Management

4. 12/23/2008 Corporate Goal #1 4 Medication Therapy Management

5. Corporate Goal 1:Provide the most convenient access to health care services Take Care Clinics Immunization Clinics Diabetes Programs Breast Cancer Awareness Health and Wellness Programs What should we consider next? 12/23/2008 5 Medication Therapy Management

6. Health Care Initiatives Take Care Clinics Immunization Clinics Diabetes Programs Breast Cancer Awareness Health and Wellness Programs Medication Therapy Management (MTM) 12/23/2008 6 Medication Therapy Management

7. Why MTM! 12/23/2008 Medication Therapy Management 7

8. MTM Core Elements Service Model 12/23/2008 Source: Medication therapy management in pharmacy practice: Core elements of an MTM service model (version 2.0). Journal of the American Pharmacists Association , 341-353. 8 Medication Therapy Management

9. Information Technology We will use leading edge software applications to improve clinic throughput. Laptop computer with handwriting capabilities that transform into typed text Laptop will have direct connection to Intercom Plus Pharmacy System database To make access to patient records seamless To capture information and decrease clinic response time To determine customer eligibility for services To speed revenue cycle billing 12/23/2008 9 Medication Therapy Management

10. Time allocation for MTM The following slide reveals a proposed dispersion of time for the pharmacist to perform each task in an MTM clinical setting. 12/23/2008 Medication Therapy Management 10

11. 12/23/2008 11 Medication Therapy Management

12. Action Items 12/23/2008 Medication Therapy Management 12

13. Ten Action ItemsFocus Table 12/23/2008 13 Medication Therapy Management

14. Ten Action ItemsFocus Matrix 12/23/2008 14 Medication Therapy Management

15. Human Resources 12/23/2008 Medication Therapy Management 15

16. Human Resources Each clinic will require 1 new pharmacist. Phase 1 Pilot 5 Stores in Chicago and Tampa markets Recruit and train pharmacist market trainers Phase 2 Implementation in Chicago and Tampa markets. Recruit and train market trainers 15 pharmacist/ 15 stores 12/23/2008 16 Medication Therapy Management

17. Financing 12/23/2008 Medication Therapy Management 17

18. Financing MTM Equity Financing Share Walgreens- Management and pharmacist are given stock options in exchange for purchasing shares. Employee stock purchase plans (ESOP) Cash purchase 10% discount Loan purchase 4 year terms 12/23/2008 18 Medication Therapy Management

19. FinanceShort-term debt Debt financing Use short term debt to finance pilot program in Chicago and Tampa Commercial paper Bank loans 12/23/2008 19 Medication Therapy Management

20. FinanceLong-term debt Use long term debt to roll out nationwide Corporate bonds 20-30 year fixed rate bonds Debentures Advantage: No lien against specific property 12/23/2008 20 Medication Therapy Management

21. Summary Capital structure is a major contributor to business strategy execution. Most companies use a combination of debt and equity financing to fund implementation of new projects. The most important part of a business financial plan is financial forecasting. Financial forecasting components are: An analysis of the business’s current situation A revenue forecast The capital budget The cash budget A set of pro forma financial statements External financial plan An analysis of the firm’s projected financial condition Source: Gapenski, L.C. , Understanding Healthcare Financial Management, 2007 p 501-533 12/23/2008 Medication Therapy Management 21

22. Operations 12/23/2008 Medication Therapy Management 22

23. Operations The Intercom Plus Pharmacy Computer System has the ability to incorporate MTM. Access patient profiles by entering the patients phone number or date of birth Select the MTM button on the applications menu to open data entry screens The pharmacist enters data directly into patients records The quick analysis button reviews patients drug history after all medications, including OTC’s and herbals, are entered, giving pharmacist talking points. 12/23/2008 23 Medication Therapy Management

24. Ethical and Legal Issues 12/23/2008 24 Medication Therapy Management

25. Legal RequirementsHIPAA MTM services should be delivered in a private or semi-private area, as required by the Health Insurance Portability and Accountability Act. What we can do to comply This can be accomplished by using private rooms in our Take Care Clinics. Pharmacist and technician licensed posted Provide patients with a notice of privacy practices Disclaimers given 12/23/2008 25 Medication Therapy Management

26. Ethical Issues MTM closely aligns with the Analysis and Justification (AJ) model of ethical decision making. Making decision in what to tell the patient at clinics will be a matter ethical training programs by the company. This includes Information gathering Creative problem solving Listing of pros and cons Analysis 12/23/2008 26 Medication Therapy Management

27. Ethical Issues Be truthful with the patient about whether the therapy is working. Do not alarm patient with unnecessary information. Do not over charge third party payors to cover losses in other plans. Do not operate a clinic without a license or mal-practice insurance. Maintain the protection of confidential patient conversations 12/23/2008 27 Medication Therapy Management

28. Summary Ethical and legal issues pervade the pharmacy profession and have an indelible impact on MTM. Staying abreast of changes in the licensing and certification issues, along with having a good handle of what therapy regimen is in the patients best interest, will provide value for the organization and customer. 12/23/2008 28 Medication Therapy Management

29. Patient Benefits Personal attention from drug therapy experts Computer generated medication action plan that is easy to follow Improved patient compliance to medications Improved patient health outcomes Improved patient quality of life years Elimination of unnecessary drugs or harmful drug interactions 12/23/2008 29 Medication Therapy Management

30. Contemporary Issues Poly-pharmacy Adverse drug reactions Prescription savings 12/23/2008 30 Medication Therapy Management

31. Poly-pharmacy Many patients who have Medicare Part D insurance are on 4 or more medications. Patients with diabetes, hypertension, glaucoma and arthritis may be on as many as 10 or more medications daily. MTM is a opportunity for pharmacists to help patients manage therapy, by finding the best ways to treat multiple-disease states and minimize adverse drug reactions. MTM will also provide additional revenue for pharmacists through fee for service or third party payor reimbursement. Source: www.Medicare.gov 12/23/2008 31 Medication Therapy Management

32. Adverse Drug Reactions Medication-related problems are a significant public health issue with the health care system. Incidence estimates suggest that more than 1.5 million preventable medication-related adverse events occur each year. Source: Medication therapy management in pharmacy practice: Core elements of an MTM service model (version 2.0). Journal of the American Pharmacists Association , 341-353. 12/23/2008 32 Medication Therapy Management

33. Prescription Savings Pharmacist intervention can provide access to better care by making medication affordable. This is inclusive of generic substitution or therapeutic substitutions which are able to improve patient health and well being. 12/23/2008 33 Medication Therapy Management

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35. Contemporary Issues All medications have or can produces adverse reactions due to allergy, interaction with other medications or food, or due to pharmacologic effect wearing off. Adverse reactions do not decrease according to high cost of medications, therefore, prescriptions savings are a great option for all patients. Adverse reactions are common among patients who take multiple medications, therefore, MTM should help alleviate these effects, and contribute to enhanced quality of life. 12/23/2008 Medication Therapy Management 35

36. Clinic Focus 12/23/2008 Medication Therapy Management 36

37. Targeted Disease States Phase 1 Diabetes Heart disease Cancer pain management Phase 2 Asthma Hyperlipidemia Weight loss 12/23/2008 37 Medication Therapy Management

38. Focus Chart6 Top Prospects for MTM clinics 12/23/2008 38 Medication Therapy Management

39. Focusing Matrix Diabetes Hypertension Cancer pain management Asthma Hyperlipidemia Weight loss The MTM programs we should implement first are for diabetes and hypertension. There has been a three fold increase in the incidence of diabetes in the U. S. since 1980. Obesity is a major contributor to both diabetes and hypertension. Here is an opportunity for the company to expand its influence in providing access to care. Source: www.cdc.gov 12/23/2008 Importance Ease of Implementation 39 Medication Therapy Management

40. Profit Potential According to our chart, diabetes, hypertension and cancer pain management produce about 61% of profit potential for our clinic. A weight loss component to the clinic could improve all health conditions, decreasing blood pressure, lead to better blood glucose control and decrease cancer rates due to decreased fat consumption, and increased consumption of fruits and vegetable. 12/23/2008 Medication Therapy Management 40

41. 12/23/2008 Medication Therapy Management 41 Profit Potential

42. Making Appointments Intercom Plus can identify patients who fit Medicare Part D or private insurance criteria for MTM intervention Pharmacists can indentify patients who would benefit from the service and schedule appointments between 8:30am to 4pm, Monday-Friday. Appointment should be 20 minutes in duration to be profitable 12/23/2008 42 Medication Therapy Management

43. Marketing Plan Product: MTM is designed to be a once a year review of patient’s medication history. The company will introduce MTM as a value added service, to promote patient health and wellbeing, and improve company revenue. Pricing: Introductory fee for service will be $60 for twenty minutes of service. The price is expected to lower as more stores participate in the roll-out. 12/23/2008 43 Medication Therapy Management

44. Marketing Plan Promotion: Sales promotions will be done weekly in the advertising bulletin, on the company website, direct mail and electronic media. Corporate sales persons will negotiate with third party payors to establish revenue generation. Primary target: Senior citizens with Medicare Part D. Place: Chicago and Tampa markets will pilot the program. After this, the plan is to expand to all districts in Eastern and Western Operations 12/23/2008 44 Medication Therapy Management

45. MTM and Ethics 12/23/2008 Medication Therapy Management 45

46. MTM and Ethics The pharmacist in a clinic environment can act ethically by: Maintaining the patients privacy Monitoring the effectiveness of patients therapy Motivating patients to take charge of their health issues Mitigating the affect of drug regimens that are outdated or mal-conceived Maintain and improve the perception of pharmacy practice as a viable and valuable service to experience Source: http://www.hhs.gov/ocr/hipaa/consumer_rights.pdf 12/23/2008 46 Medication Therapy Management

47. MTM and Ethics Prescription medications have assisted many people in living a better life. They have given hope to patients with diabetes, asthma, cancer and hypertension. However, most people will benefit from at least on complete medication review from a specially trained pharmacist, to solve medication problems, dosing parameters and manage drug allergies and other adverse reactions. It is the duty of the pharmacist to keep patients informed about how to best take care of themselves with proper medication understand and usage. 12/23/2008 47 Medication Therapy Management

48. Ethics The role of the pharmacist in MTM is to provide a service that improves the health outcomes of individuals. Information given to the patient must to easy to understand and relevant to individual need. This includes bringing a patients blood sugar under control, blood pressure under control, or controlling pain due to cancer. MTM implementation in the next few years could benefit in cost saving to the health care system by way of decreased hospitalizations due to adverse drug reactions, improved patient compliance and decreased patient out of pocket costs. 12/23/2008 Medication Therapy Management 48

49. Constraint Management 12/23/2008 Medication Therapy Management 49

50. Constraint management Constraints are problems in the MTM system that prevent the goal of offering more services from being reached. Resource constraints- Not having enough pharmacists to open a clinic in a region Market constraint-Competitors can quickly copy the MTM idea. First to market can garner market share Policy constraint- Medicare and other insurers can enact a policy that decreases reimbursement to pharmacies for MTM. This can effect overall profitability 12/23/2008 Medication Therapy Management 50

51. Constraint management Constraints must be managed by the healthcare manager. He must make sure bottlenecks are continually addressed, that constraints are elevated and broken, to make sure business goals are realized. Source: Ronen, B., & Pliskin, J. S. (2006). Focused Operations Management for Health Services Organizations. San Francisco: Jossey-Bass. 12/23/2008 Medication Therapy Management 51

52. Thank You! Medication Therapy Management Improving Medication Use Advancing Patient Care 12/23/2008 52 Medication Therapy Management