Comprehensive Transitions of Care Pharmacy …...Goals of Comprehensive Transitions of Care (TOC)...
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Comprehensive Transitions of Care Pharmacy Program Sun Lee-Such, PharmD, FACHE, MBA, BCPS Franciscan Health Administrative Director of Pharmacy Services – Northern Division Andrius Cepenas, PharmD, BCACP Franciscan Health Clinical Pharmacy Manager – Ambulatory Care
Transcript of Comprehensive Transitions of Care Pharmacy …...Goals of Comprehensive Transitions of Care (TOC)...
Comprehensive
Transitions of Care
Pharmacy Program
Sun Lee-Such, PharmD, FACHE, MBA, BCPS
Franciscan Health Administrative Director of
Pharmacy Services – Northern Division
Andrius Cepenas, PharmD, BCACP
Franciscan Health Clinical Pharmacy Manager –
Ambulatory Care
Goals of Comprehensive
Transitions of Care (TOC)
Pharmacy Program
Bridge gaps in care from hospital to home to
decrease readmissions
Fund program through 340b savings
Expand access to medications and patient care
Improve medication safety
Franciscan Health Hammond Hospital
Part of Franciscan Alliance
14 hospital system in Indiana and
south suburb of Chicago
Primarily Provides Acute Care
Hospital Services
100 average daily patient census
Emergency Department
Inpatient Rehab
Disproportionate Share
Hospital (DSH)
High proportion of uninsured and
underinsured patients
DSH hospitals more likely to have
high readmission rates
Franciscan Health: Readmission Crisis
2015: Franciscan Hammond with one of the highest 30-day
readmission rates in Franciscan Hospital System
7.7%
10.2%
11.5% 12%
12.9% 13.4% 13.5%
14.1%
16.5% 16.9% 17%
6%
7%
8%
9%
10%
11%
12%
13%
14%
15%
16%
17%
18%
MV CR MN LE MC CP DY IN HA CH OF
Percentage of patients
readmitted within
30 days
Initiative: Department leaders tasked to establish programs achieving
30-day readmission rates of less than 10% to reduce CMS penalties
Development of Comprehensive
Pharmacy Transitions of Care Program
Government and Health
System Level Local Hospital Level:
Franciscan Hammond
Department Level:
Pharmacy Department
CMS implements Hospital
Readmission Reduction Program
Franciscan Alliance
Readmissions Task Force Created
Penalizes hospitals with high
readmission rates
Identified readmission metric as
high-priority as select Hospitals
not meeting readmission targets
Multidisciplinary staff to identify
readmission causes
Department Leaders tasked to
reduce readmissions <10%
Chart Audits Reveal Readmission
Causes: Disease Recurrence
Medication Non-compliance
Medication Access
Pharmacy Director
Discusses vision to solve
readmission issue with team
Leads team collaboratively to
identify gaps in care
TOC Goals established
Comprehensive TOC Program
Proposal Drafted by Pharmacy
Director Worked with hospital and system
leadership for program approval
funded by 340b savings
Franciscan Health Hammond’s
Readmission Task Force
Franciscan Health Hammond’s Multidisciplinary Readmission Task Force,
an integral part of the Comprehensive Transitions of Care Pharmacy Program. Members (left to right): Claudia Chiaro, Andrius Cepenas, Leigh Martin, Binky Cooc,
Russell Lee, Sun Lee-Such, Sharon Buck-Turner, Susan Hallenbeck, Sandi Kurpela,
Karen Ogle, Dorothy Klapak
Multidisciplinary Approach for
Comprehensive TOC Program Goal: To achieve full success of TOC program, we had to
break down silos of each department
Physicians
Nursing
Ancillary Staff
Listened to concerns of every department
and discussed benefits of TOC program
Understood and addressed challenges to
reduce readmissions
Educated hospital staffs on how TOC program would
help benefit daily workload
Nursing benefit: Medication histories obtained
Physicians benefit: Assist with medication reconciliation
Ancillary staff benefit: Prior approvals obtained, TOC
program to provide free medications when pharmacy
charity criteria met
Full TOC program support
achieved when each
department’s goals
aligned
Comprehensive TOC Pharmacy Program at
Franciscan Health Hammond Hospital
Admission Med History
Q3 2014
•Patient interviewed by Medication Reconciliation Technician (MRT), ED/ TOC Pharmacist
•Most accurate med list obtained from patient, patient’s caregiver, or outside resources
Admission Med Reconciliation
2015
•TOC Pharmacist reviews med list to discuss and/or intervene on med related issues with MD/DO
•Ensures appropriate medical decision making at point of admission
Discharge Medication
Reconciliation
•TOC Pharmacist reviews discharge med list and discusses and/or intervenes on med related issues with MD/DO
•Ensures patient’s new home medication list is reviewed and appropriate prior to discharge
Discharge Counseling
2015
•TOC Pharmacist provides face-to-face counseling prior to patient’s hospital discharge
•Counsels patient on all meds with focus on new medications and high-risk medications
•Opportunity for patient to review meds prior to discharge with TOC pharmacist
Pharmacotherapy Clinic
2016
•Patient follows-up with TOC Pharmacist in ambulatory setting for post-discharge visit and chronic disease management
•Utilizes 340b program to provide low cost medications to patient to prevent readmissions
•TOC Pharmacist resolves or triages any post-discharge issues during clinic visit to prevent readmission
ED/Hospital Admission
Ambulatory follow-up
with TOC Pharmacist Clinical Review by TOC Pharmacist each day of hospital stay
Patient Care Experience by TOC Pharmacy Program
Meds to Bed Program and Pharmacy Patient Assistance Program 2016
•Meds to Bed Program provides bedside medication delivery to patients upon discharge utilizing Franciscan retail pharmacy onsite within hospital
•Pharmacy Patient Assistance Coordinator works with TOC Team to help evaluate patients for medication eligibility, finds medication assistance programs, meets face-to-face with patients for medication assistance paperwork , and identifies optimal medication coverage
Awarded Cardinal Health Medication Safety Grant in 2017
Comprehensive TOC Pharmacy Program at
Franciscan Health Hammond Hospital
Patient interviewed by
Medication Reconciliation
Technician (MRT),
ED/TOC Pharmacist
Most accurate med list
obtained from patient,
patient’s caregiver,
or outside resources
TOC Pharmacist reviews
med list to discuss and/or
intervene on med related
issues with provider
Ensures appropriate
medical decision making
at point of admission
Admission Med History
Q3 2014
Admission Med Reconciliation
2015
ED/Hospital Admission
Comprehensive TOC Pharmacy Program at
Franciscan Health Hammond Hospital
Admission Med History
Q3 2014
•Patient interviewed by Medication Reconciliation Technician (MRT), ED/ TOC Pharmacist
•Most accurate med list obtained from patient, patient’s caregiver, or outside resources
Admission Med Reconciliation
2015
•TOC Pharmacist reviews med list to discuss and/or intervene on med related issues with provider
•Ensures appropriate medical decision making at point of admission
Discharge Medication
Reconciliation
•TOC Pharmacist reviews discharge med list and discusses and/or intervenes on med related issues with MD/DO
•Ensures patient’s new home medication list is reviewed and appropriate prior to discharge
Discharge Counseling
2015
•TOC Pharmacist provides face-to-face counseling prior to patient’s hospital discharge
•Counsels patient on all meds with focus on new medications and high-risk medications
•Opportunity for patient to review meds prior to discharge with TOC pharmacist
Pharmacotherapy Clinic
2016
•Patient follows-up with TOC Pharmacist in ambulatory setting for post-discharge visit and chronic disease management
•Utilizes 340b program to provide low cost medications to patient to prevent readmissions
•TOC Pharmacist resolves or triages any post-discharge issues during clinic visit to prevent readmission
ED/Hospital Admission Inpatient Care and Hospital Discharge
Ambulatory follow-up
with TOC Pharmacist Clinical Review by TOC Pharmacist each day of hospital stay
Patient Care Experience by TOC Pharmacy Program
Meds to Bed Program and Pharmacy Patient Assistance Program 2016
•Meds to Bed Program provides bedside medication delivery to patients upon discharge utilizing Franciscan retail pharmacy onsite within hospital
•Pharmacy Patient Assistance Coordinator works with TOC Team to help evaluate patients for medication eligibility, finds medication assistance programs, meets face-to-face with patients for medication assistance paperwork , and identifies optimal medication coverage
Awarded Cardinal Health Medication Safety Grant in 2017
Comprehensive TOC Pharmacy Program at
Franciscan Health Hammond Hospital
TOC Pharmacist reviews
discharge med list and
discusses and/or intervenes on
med related issues with
provider
Ensures patient’s new home
medication list is reviewed and
appropriate prior to discharge
TOC Pharmacist provides
face-to-face counseling prior to
patient’s hospital discharge
Counsels patient on all meds
with focus on new medications
and high-risk medications
Opportunity for patient to
review meds prior to discharge
with TOC pharmacist
Discharge Medication Reconciliation
Discharge Counseling
2015
Inpatient Care and Hospital Discharge
Comprehensive TOC Pharmacy Program at
Franciscan Health Hammond Hospital
Admission Med History
Q3 2014
•Patient interviewed by Medication Reconciliation Technician (MRT), ED/ TOC Pharmacist
•Most accurate med list obtained from patient, patient’s caregiver, or outside resources
Admission Med Reconciliation
2015
•TOC Pharmacist reviews med list to discuss and/or intervene on med related issues with provider
•Ensures appropriate medical decision making at point of admission
Discharge Medication
Reconciliation
•TOC Pharmacist reviews discharge med list and discusses and/or intervenes on med related issues with provider
•Ensures patient’s new home medication list is reviewed and appropriate prior to discharge
Discharge Counseling
2015
•TOC Pharmacist provides face-to-face counseling prior to patient’s hospital discharge
•Counsels patient on all meds with focus on new medications and high-risk medications
•Opportunity for patient to review meds prior to discharge with TOC pharmacist
Pharmacotherapy Clinic
2016
•Patient follows-up with TOC Pharmacist in ambulatory setting for post-discharge visit and chronic disease management
•Utilizes 340b program to provide low cost medications to patient to prevent readmissions
•TOC Pharmacist resolves or triages any post-discharge issues during clinic visit to prevent readmission
ED/Hospital Admission Inpatient Care and Hospital Discharge Ambulatory Setting
Ambulatory follow-up
with TOC Pharmacist Clinical Review by TOC Pharmacist each day of hospital stay
Patient Care Experience by TOC Pharmacy Program
Meds to Bed Program and Pharmacy Patient Assistance Program 2016
•Meds to Bed Program provides bedside medication delivery to patients upon discharge utilizing Franciscan retail pharmacy onsite within hospital
•Pharmacy Patient Assistance Coordinator works with TOC Team to help evaluate patients for medication eligibility, finds medication assistance programs, meets face-to-face with patients for medication assistance paperwork , and identifies optimal medication coverage
Awarded Cardinal Health Medication Safety Grant in 2017
Comprehensive TOC Pharmacy Program at
Franciscan Health Hammond Hospital
Patient follows-up with TOC Pharmacist in ambulatory
setting for post-discharge visit and chronic disease
management
Utilizes 340b program to provide low cost medications to
patient to prevent readmissions
TOC Pharmacist resolves or triages any post-discharge
issues during clinic visit to prevent readmission
Pharmacotherapy Clinic
2016
Ambulatory Setting
Comprehensive Pharmacy TOC Program at
Franciscan Health Hammond Hospital
Meds to Bed Program and Pharmacy Patient
Assistance Program 2016
Meds to Bed Program provides bedside medication
delivery to patients upon discharge utilizing Franciscan
Retail Pharmacy onsite
Pharmacy Patient Assistance Coordinator works with
TOC team to evaluate patients for medication eligibility,
finds medication assistance programs, assists with PAP
paperwork, identifies optimal medication coverage
Comprehensive TOC Pharmacy Program at
Franciscan Health Hammond Hospital
Admission Med History
Q3 2014
•Patient interviewed by Medication Reconciliation Technician (MRT), ED/ TOC Pharmacist
•Most accurate med list obtained from patient, patient’s caregiver, or outside resources
Admission Med Reconciliation
2015
•TOC Pharmacist reviews med list to discuss and/or intervene on med related issues with provider
•Ensures appropriate medical decision making at point of admission
Discharge Medication
Reconciliation
•TOC Pharmacist reviews discharge med list and discusses and/or intervenes on med related issues with provider
•Ensures patient’s new home medication list is reviewed and appropriate prior to discharge
Discharge Counseling
2015
•TOC Pharmacist provides face-to-face counseling prior to patient’s hospital discharge
•Counsels patient on all meds with focus on new medications and high-risk medications
•Opportunity for patient to review meds prior to discharge with TOC pharmacist
Pharmacotherapy Clinic
2016
•Patient follows-up with TOC Pharmacist in ambulatory setting for post-discharge visit and chronic disease management
•Utilizes 340b program to provide low cost medications to patient to prevent readmissions
•TOC Pharmacist resolves or triages any post-discharge issues during clinic visit to prevent readmission
ED/Hospital Admission Inpatient Care and Hospital Discharge Ambulatory Setting
Ambulatory follow-up
with TOC Pharmacist Clinical Review by TOC Pharmacist each day of hospital stay
Patient Care Experience by TOC Pharmacy Program
Meds to Bed Program and Pharmacy Patient Assistance Program 2016
•Meds to Bed Program provides bedside medication delivery to patients upon discharge utilizing Franciscan retail pharmacy onsite within hospital
•Pharmacy Patient Assistance Coordinator works with TOC Team to help evaluate patients for medication eligibility, finds medication assistance programs, meets face-to-face with patients for medication assistance paperwork , and identifies optimal medication coverage
Awarded Cardinal Health Medication Safety Grant in 2017
Readmission Success:
TOC Pharmacy Program Impact within
Franciscan Health Hammond
16.5%
14.4%
13.1%
6%
7%
8%
9%
10%
11%
12%
13%
14%
15%
16%
17%
18%
2015 2016 2017 YTD
Percentage of patients
readmitted within 30 days at Franciscan
Health Hammond
Franciscan
Hammond
TOC Program
2016-2017 YTD
House wide
Readmission
8%
Comprehensive TOC Pharmacy Program achieved
readmission rate well below <10% target
Readmission Success:
Trend of Housewide 30-day Readmissions
Franciscan Hammond
CMS Penalty
10%
12%
14%
16%
18%
20%
1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9
2015 2016 2017
Readmission Success:
Trend of 30-day Readmissions: Heart Failure
10%12%14%16%18%20%22%24%26%28%30%32%34%
1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9
2015 2016 2017
Franciscan Hammond
CMS Penalty
Readmission Success:
Trend of 30-day Readmissions: COPD
8%
10%
12%
14%
16%
18%
20%
22%
24%
26%
28%
1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9
2015 2016 2017
Franciscan Hammond
CMS Penalty
Readmission Success:
TOC Pharmacy Program Impact within
Franciscan Health Hospital System
-3.0%
-1.6%
+1.7%
-0.8%
-1.3%
-0.3%
-1.7%
-0.2%
-3.4%
-2.9%
-1.4%
-4%
-3%
-2%
-1%
0%
1%
2%
MV CR MN LE MC CP DY IN HA CH OF
Absolute Change
in Readmission
Rate from 2015
baseline to
2017 YTD
Comprehensive TOC Program most successful project to
reduce 30-day readmissions in entire hospital system
Pharmacy Patient Assistance Coordinators
Benefiting Franciscan Health – Hammond, Dyer, Munster campuses and
Calumet, Munster, and Crown Point infusion centers
Patient assistance activities:
Medication co-pay discount card procurement and assistance
Face-to-face patient assistance for free/co-pay medication paperwork
Pharmacotherapy Clinic referral identification and coordination
Free drug procurement assistance through manufacturer program
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Scope of Patient Benefits (March 2016 – March 2018)
At Franciscan Hammond, Dyer, Munster
Unique Patients Benefitted 1,406
Total Dollars Saved for Patients $718,968 Scope of Patient Benefits (June 2017 – March 2018)
At Calumet, Munster, and Crown Point Infusion Centers
Unique Patients Benefitted 186
Potential Total Dollars Saved for
Patients $4,825,769
Lessons Learned and
Future Directions
Important to understand care transition gaps, work
collaboratively with team, and instill leadership principles to
develop Comprehensive TOC Program
Significant readmission reductions achieved with
Comprehensive TOC Program fully implemented
The Comprehensive Pharmacy TOC Program’s patient
assistance services provided over 5 million dollars in
medication assistance to patients
Franciscan Health Hammond Hospital is the training site for
sister hospitals to develop their own Comprehensive
Pharmacy TOC program
Comprehensive
Transitions of Care
Pharmacy Program
Sun Lee-Such, PharmD, FACHE, MBA, BCPS
Franciscan Health Administrative Director of
Pharmacy Services – Northern Division
Andrius Cepenas, PharmD, BCACP
Franciscan Health Clinical Pharmacy Manager –
Ambulatory Care
