Safety, Quality, and the Pharmacy Practice Model Initiative: Aligning for Success

Scott Knoer, M.S., Pharm.D.Chief Pharmacy Officer

Cleveland Clinic

Objectives

• Describe metrics and a process that can be used to measure the quality of change that occurred and ensure that a positive change has taken place

• Describe how organizations have implemented safety and quality principles in daily practice

A Case Study at the Cleveland Clinic

• Impacting metrics that count- HCAHPS medication scores- HF readmission reduction

Insured Payor Mix

53.2 53.1 52.8 52.5 52.6

68.2 71.2 74.2

46.8 46.9 47.5 47.4

31.8 28.8 25.847.2

52.547.5

0

10

20

30

40

50

60

70

80

2010 YTDJune

FC11 FC12 FC13 FC14 FC15 FC16

Governmental CommercialGovt. No Huron Coml. No Huron

Note: Based on gross charges. Excludes strategic projects in forecasted period.Detail

%

Exchange

-$96

-$118-$129

-160

-120

-80

-40

02014 2015 2016

Detail

$Millions

Projected Impact of Healthcare Reform

HCAHPS Scores

• Hospital Consumer Assessment of Healthcare Providers & Systems

• Measures patients’ perceptions of their hospital experience

• Tied to hospital reimbursement

Why Do HCAHPS Scores Count?

• Publically reported measures • Beginning this year, government

reimbursement is directly tied into HCAHPS Scores

• Underperformers will get less money

Medication Domain Questions

• Purpose of new medications explained • Side effects described • Medication Communication

- Composite score based on the percent of patients responding ‘Always’

HF Readmissions• Unplanned readmissions cost Medicare

$17.4 billion a year, and HF is the most frequent reason for rehospitalizations (Jencks et al., 2009).

• Reducing readmission rates has the potential to lead to significant cost savings

• You get paid less if you have high readmissions

http://www.medscape.com/viewarticle/722234

Ask 3, Teach 3

• Ask 3• Patients will be encouraged to "Ask 3"

so they understand the name, purpose and possible side effects of their medications 

Ask 3, Teach 3

• Teach 3: System wide pharmacy competency- The name of the medication - Describe the purpose of the

medication - Explain possible side effects (Note:

It’s important to use the words possible side effects in the conversation)

Pharmacy HF Education

• Every Cleveland Clinic patient discharges with a primary diagnosis for HF receives discharge education from a pharmacist

• System competency

Bedside Delivery of Medications

• Bedside delivery option for discharge Rx for all HF patients- Tech driven literacy survey- iPad education pilots

Summary of Projects

• Patient Experience- Bedside discharge delivery- HF education- Ask 3, teach 3 education

Enterprise Medication HCAHPS Scores

Enterprise 30-Day HF Readmissions

Future

• Expand discharge delivery option to all patients- Leverage technology

• iPads•Portable credit card readers

• Expand RPh education to selected groups

• Manage the continuum

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