DCPro

Sandra Bollinger, Pharm.D., FASCP, CGP, CDE, CPT, CFts, MCMP-II

Goals and Objectives

1. Explain the difference between MTM and MTS.

2. Discuss requirements for DCPro participation.

3. Recognize how efficiencies in workflow can enhance the completion rates of DCPro encounter opportunities.

4. Describe what is meant by a “clinical role”.

5. Recognize the roles of a technician in assisting pharmacists with providing clinical services (MTM, DCPro, etc.)

6. Identify the regulatory limitations of technicians in a “clinical” environment.

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Disclosure:

Sandra Bollinger does not have any potential conflicts of interest in relation to this presentation.

Xerox Internal Use Only3

Medication Therapy Management (MTM)

• A service or group of services that optimize therapeutic outcomes for individual patients.

• Include medication therapy reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness programs and many other clinical services.

• Provided to help patients get the best benefits from their medications by actively managing drug therapy and by identifying, preventing and resolving medication-related problems

Medication Therapy Services (MTS)

Missouri’s Rule 20 CSR 2220-6.060(1)(F)1 defines “medication therapy services” as “the designing, initiating, implementing, or monitoring of a plan to monitor the medication therapy or device usage of a specific patient, or to enhance medication therapeutic outcomes of a specific patient, by a pharmacist who has authority to initiate or implement a modification of the patient’s medication therapy or device usage pursuant to a medication therapy protocol.”

Pharmacist Educational Requirements

To receive an MTS certificate, pharmacists must have a current and active Missouri pharmacist license and must hold, or have completed, one of the following:

• A PharmD degree from an ACPE accredited school; OR

• A post-graduate medication therapy certificate course or program accredited or granted by ACPE, ASHP, ASCP, or APhA; OR

• A current certification from the Board of Pharmaceutical Specialties, the Commission for Certification in Geriatric Pharmacy, or the National Certification Board for Diabetes Educators; OR

• A qualifying post-graduate medication therapy certificate course.

DCPro Participation Requirements

• Current MO HealthNet Provider

• Performing provider must be a licensed pharmacist with an active provider ID

• Medication Therapy Services (MTS) designation on pharmacist license from MO Board of Pharmacy.

Clinical Opportunities

• 11 clinical areas currently targeted:– Asthma– Diabetes,– Hypertension– Hyperlipidemia– Heart Failure– COPD– GERD– Osteoporosis– Falls in the Elderly–Multiple Sclerosis– Depression

Rules engine identifies patients for interventions based on presence of these diagnoses in claims history. Gaps in care are also identified.

DCPro- Encounter Opportunities

Challenges of Providing MTM

• Lack of patient understanding of value/purpose

• Lack of pharmacy staff understanding of value/purpose

• Workflow

• Time constraints

• Cumbersome documentation systems• Poor access to medical information

• Lack of staff

9/1/16

DCPro Pharmacist Participation Barriers

• Building MTM into Existing Pharmacy Workflow• Lack of Participant Interest• Lack of Participant Ability to have face to face time with

Pharmacist• Only payable for 60 minutes per participant per month• MO HealthNet enrollment barriers

Participant Participation Barriers

• Must be done face-to-face• Must meet eligibility and clinical criteria requirements• Not incentivized• Participants unfamiliar with program or do not understand

benefit

9/1/16

Core Elements of MTM

• Medication therapy review (MTR)

• Personal medication record (PMR)

• Medication-related action plan (MAP)

• Intervention and/or referral

• Documentation and follow-up

Barriers for Pharmacists to Implement MTM Services Include:

a) Poor access to medical information

b) Burdensome documentation systems

c) Lack of additional staffing

d) All of the above

Overcoming Barriers Associated With Providing MTM services

• Team Based Approach

• Delegate responsibilities

• Redesign workflow

• Utilize an IT friendly platform

CyberAccess – Retrospective Alerts

CyberAccess – Paid Drug Claims

CyberAccess – Paid Medical Claims - Diagnosis

DirectCarePro – Patient Care Information

DirectCarePro – Encounter Notes

DirectCarePro – Intervention Questions

Immunization Documentation and Billing

DCPro also functions as a method by which pharmacists can document immunizations and send an 837 claim for immunizations:

• 837 medical claim can contain Administration Fee alone or Administration fee + Drug Component

• Pharmacies would use the POS pharmacy system if they needed to bill for Drug Component alone.

DirectCarePro – Select Vaccine and fill in Data Fields

Overcoming the IT Barriers

• DCPro Platform• Access to Medical history

• Access to Pharmacy claims

• Easy to use documentation platform

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Question:

IT solutions should save time not cost time.

1. True 2. False

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Improving Workflow

• Implement Team-based approach• Practice Good Communication Skills• Measure outcomes• Provide a process for continuous quality improvement

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Principles of Team-Based Health Care

1. Shared goals

2. Clear roles

3. Mutual trust

4. Effective communication

5. Measurable processes and outcomes

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Definition of Technician Clinical Role

To work more effectively with pharmacists to offer safe and effective patient care and services

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Clinical Roles of Pharmacy Technician

• Patient appointment scheduling andfollow-up• Measuring and recording patientlaboratory values• Documenting medication adherenceinformation• Third party insurance coordination• Pharmacy training coordinator• Quality assurance• Patient safety officer

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Question:

While a pharmacy technician was assisting a patient with completing his health questionnaire, the patient asked if it would be ok to take an OTC medication for GERD. If the technician knows that that it would be safe for the patient to take the medication the technician could reply that it would safe to do so.

1. True2. False

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Question:

A pharmacy technician can support pharmacists with their clinical efforts by:

1. Having a clear understanding of the technician’s role, responsibilities and limitations

2. Putting together patient charts3. Teaching a patient how to use a blood pressure machine4. All of the above

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How to Get Started

Call the Xerox Help Desk•888-581-9797•Pharmacist will be directed to the appropriate Xerox Provider Outreach Representative (POR)

•POR will provide details and assistance with the enrollment process

In Summary

To improve efficiency to allow incorporation of clinical services in a pharmacy setting:

1. Utilize a pharmacy team-based approach2. Share goals3. Establish clear roles4. Create team Trust5. Provide effective communication6. Incorporate measurable processes and outcomes

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Post-test Question 1

All of the following will help pharmacists overcome barriers associated with providing MTM and/or clinical services EXCEPT:

1. Re-designing workflow2. Utilizing an IT friendly documentation platform3. Incorporating a pharmacy team based approach4. Pharmacist retaining most of the responsibilities

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Post-test Question 2

In order for pharmacists to fully maximize the time needed to offer MTM and/or clinical services they should:

1. Charge for their services2. Properly educate and train pharmacy technicians to

assume active roles in assisting with the provision of services

3. Make certain that the patient has a clear understanding of the value/purpose of the service

4. All of the above

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Post-test Question 3

The role of a technician in a clinical type pharmacy environment is similar to that of support staff found in a physician’s office.

1. True2. False

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Questions?