ASCP Forum
Focuses on
Radical Changes
Needed
PROGRAM HIGHLIGHTS
in
Post-Acute
Care
Bringing Leaders Together... April 27-28, 2015 • Baltimore, MD • ascp.com/forum
“We are facing an unprecedented time. It’s not time for tweaking. It’s time for radical change,” said Robert A. “Mike” Reitz, executive vice president and chief operating officer of Genesis HealthCare, one of the nation’s largest long-term care providers. Reitz opened the American Society of Consultant Pharmacists (ASCP) Forum on pharmaceutical care and postacute care transitions by challenging the crowd of 225 registered attendees to reinvent themselves and take charge of their future. Setting the tone for the Forum held in Baltimore, Maryland on April 27-28, 2015, Frank L. Grosso, RPh, ASCP executive director and chief operating officer, encouraged attendees to meet new people, interact, and “above all, leave inspired.” While the Forum boasted noteworthy educational sessions
about post-acute care’s network-driven marketplace and the value of cost-efficient partners, what took place during the breaks, in the halls, and at the receptions may have been equally as important and valuable to attendees. Participants took full advantage of the time set aside to network, ask questions of speakers, and talk to potential clients and colleagues representing a cross-section of influential players in post-acute care.
A New Day for Post-Acute Care
The post-acute care industry is transitioning from a fee-for-service based model to value-based payments connected to patient outcomes across various post-acute care settings. This payment switch will drastically change the way pharmacists and long-term care pharmacies do business. Instead of being paid by the number of prescriptions or consultant pharmacist service hours, payments will
PROGRAM HIGHLIGHTS
“We are facing an unprecedented time. It’s not time for tweaking. It’s time for radical change.” – Robert A. “Mike” Reitz
be based on the quality and value of care delivered. “The old order of fee-for-service payment is gone,” warned Les Cavicchi, MPA, NHA, executive vice president, Greater Boston Urology, LLC. “The only place you are going to see it is if you take your grandchildren to the Smithsonian.” Long-term care is a major partner in a post-acute care, value-based reimbursement model. “When I first started in long-term care there was no assisted living or home care, there were just nursing homes,” said Reitz. Fueled by a drop in hospital length of stay, the acuity level of patients discharged to longterm care has increased over the past 30 years. Today, skilled nursing facilities look a lot like hospitals did three decades ago, and assisted living facilities look like nursing facilities did back then.
But these sicker patients also return to the hospital more often, and that’s a big problem both clinically and financially, especially for the largest payer, Medicare. “Pharmacists can have a huge impact on this,” Reitz said. “The major contributor to patients being readmitted is a problem with medication administration,” he said. “Who better to manage medications, educate patients at discharge, and help improve clinical outcomes than pharmacists?”
“The old order of fee-for-service payment is gone. The only place you are going to see it is if you take your grandchildren to the Smithsonian.” – Les Cavicchi, MPA, NHA
As the market dictates changes in the use of health care services, and moves away from acute care to more economical models such as skilled nursing facilities and home care, transitions of care pose a huge challenge—in part because of the lack of communication among facilities, individual providers, and even between data systems. “The upside of this changing environment is that it provides a huge opportunity for consultant pharmacists to have an impact on the system,” said Reitz. The goal is the triple aim: improving health of populations, improving the patient experience, and reducing overall cost. Reitz discussed ways consultants can take advantage of this opportunity, including partnering with payers and hospitals to reduce hospital readmissions. He encouraged attendees to see this
as a time to reinvent roles through the lens of the patient, suggesting that the role of a pharmacist as the care manager is not so far fetched. Getting paid for what pharmacists contribute to decreasing hospital readmissions is today’s measure of success. Shorter length-of-stay in skilled nursing facilities is another large part of the equation. Federal regulations require consultants to be notified at every change in condition and census; however, with more frequent admissions and discharges, room for error increases. The inability to receive or share a patient’s full medical record is a potential pitfall. “We can’t be blind after a patient leaves us,” said Reitz. One opportunity for pharmacists: medication reconciliation. “Medication management is the makeor-break solution to these problems,” said Harrison
Brown, a research consultant to The Advisory Board Company. The challenge pharmacists face in this new value-based reimbursement world is to improve the health of patients while at the same time reducing overall health care costs. To meet these goals, pharmacists must work together with other health care professionals: nurses, physicians, social workers, and discharge planners, among others. Every pharmacist needs to ask, “What is a way I can help the nurse, administrator, or planner to be more efficient?” It is also critical that pharmacists influence hospitalists prior to the time they write prescriptions for discharge, and that pharmacists conduct medication regimen reviews at both the time of a patient’s entry and discharge.
Don’t Be Afraid to Negotiate and Take Risks
New models of government reimbursement encourage coordinated care through provider networks, such as accountable care organizations, or through bundled payments based on coordinating care among providers and health professionals. Bundled payments for care improvement (BPCI) Model 3, which rely on curbing hospital readmissions, provide the greatest opportunity for pharmacy. If pharmacists want to get paid for their contributions, they need to understand what’s important to providers, show them how pharmacists can help them achieve their performance goals, then negotiate for part of the bundled payment.
PROGRAM HIGHLIGHTS
Getting paid for what you contribute to decreasing hospital readmissions is today’s measure of success.
“If you can avoid the first readmission you can also prevent the second and third readmission,” explained Troy Trygstad, PhD, PharmD, MBA, vice president of pharmacy programs, Community Care of North Carolina. A home visit is the best way to avoid rehospitalization, he noted. “Combining the input of a consultant pharmacist and home care is ‘magic.’” Noting that negotiating with providers is a risk arrangement—one that consultant pharmacists may not always win—Brown said pharmacists must be a visible part of this interaction. “You need to show providers that you are going to save them money. You must answer the question, ‘Why should I spend money on you?’ This is an opportunity to get recognized and show what you can do.” Jennifer L. Hardesty, PharmD, FASCP, chief clinical officer and corporate compliance officer, Remedi SeniorCare, noted that pharmacists in her organization are taking on more of an executive role, while managing pharmacy care in the postacute care environment. To help contain costs and improve patient care, her organization has dedicated full-time pharmacists within some of their long-term and continuing care facilities. These consultants not only fill a clinical need, but help identify and resolve financial and operational issues within facilities as well.
“Combining the input of a consultant pharmacist and home care is ‘magic.’” – Troy Trygstad, PhD, PharmD, MBA
Setting Goals
The best way to convince providers that you can save them money is to set goals and provide measurable results. “Metrics should be in the future of health care because you are selling your expertise and skills. Show providers that you have saved them money,” said ASCP’s Grosso. “Providers need to understand that a medication you recommend may cost more upfront, but if it keeps the patient out of the hospital, it saves more in the end.” Negotiating with home care providers is also an option. “This is a wide open territory,” said Grosso. He added, “One thing to keep in mind: Try to find out who is getting the bundled payment before you negotiate or you may be negotiating with someone who isn’t getting the payment.”
PROGRAM HIGHLIGHTS
Educating Patients
One way to avoid readmissions is to educate patients, and that’s the role of the pharmacist, said Cavicchi. “Lack of patient compliance costs money in the end. Payers will recognize your expertise if you show them how you can do this.” Although the fundamental process of caring for the patient has not changed, pharmacists need to look at the world differently. “Your knowledge can contribute to the overall success of long-term care,” said Cavicchi. “You are a lot more important than you think you are.”
Looking to the Future
The future of pharmacy holds many clinical as well as economic changes, said Orsula V. Knowlton, PharmD, MBA, president, CareKinesis. The growing use of personalizing medication regimens through pharmacogenetics can decrease adverse drug events. The use of this new process is exploding: The Food and Drug Administration now recommends the use of pharmacogenomics for more than 100 medications. This “person-based” testing influences how the drug is metabolized and stored. It is a prime example of a new technology that is becoming the standard, creating an opening for pharmacists to act as trailblazers before another provider seizes the opportunity. Knowlton said it simply: “Pharmacists need to take the lead on this.”
The major contributor to patients being readmitted is a problem with medication administration. Who better to manage medications, educate patients at discharge, and help improve clinical outcomes than pharmacists?
Sponsors and Social Media
Grosso acknowledged the innovators in the postacute care industry who sponsored this inaugural event. They included platinum sponsors (GeriMed, Managed Health Care Associates, Omnicare, and Pharmerica); ASCP’s gold event sponsors (Advanced Pharmacy, Pharmacy Times, PointRight, and Remedi SeniorCare); and silver sponsors (Avanir Pharmaceuticals, Innovatix, Integra, and QS/1). Grosso thanked them for recognizing the importance of the Forum. Gold event sponsor Pharmacy Times joined ASCP and other attendees in providing continuous live coverage of the event on social media, helping the meeting hashtag, #ASCPforum, to reach nearly 1.8 million impressions on Twitter. In addition to the presence on social media, the event boasted an innovative online social question and answer tool for attendees to use to submit queries to speakers. Attendees connected to the web-based application using their smart phones and tablets, where they entered a new question or voted on questions that others had submitted. The tool was a hit among participants.
Success and Take Aways
The Forum was a success, and attendees considered it an excellent platform for discussion and networking. Robert Flannelly called the Forum “An outstanding event with timely topics and content.” Another attendee, Robert Accetta, summed up the experience by saying, “The Forum was truly a successful gathering intended to jump-start the transition in recognizing the new realities of the health care system and our opportunities going forward.” n Consult Pharm 2015;30:321-8. © 2015 American Society of Consultant Pharmacists, Inc. All rights reserved. Doi:10.4140/TCP.n.2015.321.
PROGRAM HIGHLIGHTS If pharmacists want to get paid for their contributions, they need to understand what’s important to providers, show them how pharmacists can help them achieve their performance goals, then negotiate for part of the bundled payment.
Focuses on
Radical Changes
Needed
PROGRAM HIGHLIGHTS
in
Post-Acute
Care
Bringing Leaders Together... April 27-28, 2015 • Baltimore, MD • ascp.com/forum
“We are facing an unprecedented time. It’s not time for tweaking. It’s time for radical change,” said Robert A. “Mike” Reitz, executive vice president and chief operating officer of Genesis HealthCare, one of the nation’s largest long-term care providers. Reitz opened the American Society of Consultant Pharmacists (ASCP) Forum on pharmaceutical care and postacute care transitions by challenging the crowd of 225 registered attendees to reinvent themselves and take charge of their future. Setting the tone for the Forum held in Baltimore, Maryland on April 27-28, 2015, Frank L. Grosso, RPh, ASCP executive director and chief operating officer, encouraged attendees to meet new people, interact, and “above all, leave inspired.” While the Forum boasted noteworthy educational sessions
about post-acute care’s network-driven marketplace and the value of cost-efficient partners, what took place during the breaks, in the halls, and at the receptions may have been equally as important and valuable to attendees. Participants took full advantage of the time set aside to network, ask questions of speakers, and talk to potential clients and colleagues representing a cross-section of influential players in post-acute care.
A New Day for Post-Acute Care
The post-acute care industry is transitioning from a fee-for-service based model to value-based payments connected to patient outcomes across various post-acute care settings. This payment switch will drastically change the way pharmacists and long-term care pharmacies do business. Instead of being paid by the number of prescriptions or consultant pharmacist service hours, payments will
PROGRAM HIGHLIGHTS
“We are facing an unprecedented time. It’s not time for tweaking. It’s time for radical change.” – Robert A. “Mike” Reitz
be based on the quality and value of care delivered. “The old order of fee-for-service payment is gone,” warned Les Cavicchi, MPA, NHA, executive vice president, Greater Boston Urology, LLC. “The only place you are going to see it is if you take your grandchildren to the Smithsonian.” Long-term care is a major partner in a post-acute care, value-based reimbursement model. “When I first started in long-term care there was no assisted living or home care, there were just nursing homes,” said Reitz. Fueled by a drop in hospital length of stay, the acuity level of patients discharged to longterm care has increased over the past 30 years. Today, skilled nursing facilities look a lot like hospitals did three decades ago, and assisted living facilities look like nursing facilities did back then.
But these sicker patients also return to the hospital more often, and that’s a big problem both clinically and financially, especially for the largest payer, Medicare. “Pharmacists can have a huge impact on this,” Reitz said. “The major contributor to patients being readmitted is a problem with medication administration,” he said. “Who better to manage medications, educate patients at discharge, and help improve clinical outcomes than pharmacists?”
“The old order of fee-for-service payment is gone. The only place you are going to see it is if you take your grandchildren to the Smithsonian.” – Les Cavicchi, MPA, NHA
As the market dictates changes in the use of health care services, and moves away from acute care to more economical models such as skilled nursing facilities and home care, transitions of care pose a huge challenge—in part because of the lack of communication among facilities, individual providers, and even between data systems. “The upside of this changing environment is that it provides a huge opportunity for consultant pharmacists to have an impact on the system,” said Reitz. The goal is the triple aim: improving health of populations, improving the patient experience, and reducing overall cost. Reitz discussed ways consultants can take advantage of this opportunity, including partnering with payers and hospitals to reduce hospital readmissions. He encouraged attendees to see this
as a time to reinvent roles through the lens of the patient, suggesting that the role of a pharmacist as the care manager is not so far fetched. Getting paid for what pharmacists contribute to decreasing hospital readmissions is today’s measure of success. Shorter length-of-stay in skilled nursing facilities is another large part of the equation. Federal regulations require consultants to be notified at every change in condition and census; however, with more frequent admissions and discharges, room for error increases. The inability to receive or share a patient’s full medical record is a potential pitfall. “We can’t be blind after a patient leaves us,” said Reitz. One opportunity for pharmacists: medication reconciliation. “Medication management is the makeor-break solution to these problems,” said Harrison
Brown, a research consultant to The Advisory Board Company. The challenge pharmacists face in this new value-based reimbursement world is to improve the health of patients while at the same time reducing overall health care costs. To meet these goals, pharmacists must work together with other health care professionals: nurses, physicians, social workers, and discharge planners, among others. Every pharmacist needs to ask, “What is a way I can help the nurse, administrator, or planner to be more efficient?” It is also critical that pharmacists influence hospitalists prior to the time they write prescriptions for discharge, and that pharmacists conduct medication regimen reviews at both the time of a patient’s entry and discharge.
Don’t Be Afraid to Negotiate and Take Risks
New models of government reimbursement encourage coordinated care through provider networks, such as accountable care organizations, or through bundled payments based on coordinating care among providers and health professionals. Bundled payments for care improvement (BPCI) Model 3, which rely on curbing hospital readmissions, provide the greatest opportunity for pharmacy. If pharmacists want to get paid for their contributions, they need to understand what’s important to providers, show them how pharmacists can help them achieve their performance goals, then negotiate for part of the bundled payment.
PROGRAM HIGHLIGHTS
Getting paid for what you contribute to decreasing hospital readmissions is today’s measure of success.
“If you can avoid the first readmission you can also prevent the second and third readmission,” explained Troy Trygstad, PhD, PharmD, MBA, vice president of pharmacy programs, Community Care of North Carolina. A home visit is the best way to avoid rehospitalization, he noted. “Combining the input of a consultant pharmacist and home care is ‘magic.’” Noting that negotiating with providers is a risk arrangement—one that consultant pharmacists may not always win—Brown said pharmacists must be a visible part of this interaction. “You need to show providers that you are going to save them money. You must answer the question, ‘Why should I spend money on you?’ This is an opportunity to get recognized and show what you can do.” Jennifer L. Hardesty, PharmD, FASCP, chief clinical officer and corporate compliance officer, Remedi SeniorCare, noted that pharmacists in her organization are taking on more of an executive role, while managing pharmacy care in the postacute care environment. To help contain costs and improve patient care, her organization has dedicated full-time pharmacists within some of their long-term and continuing care facilities. These consultants not only fill a clinical need, but help identify and resolve financial and operational issues within facilities as well.
“Combining the input of a consultant pharmacist and home care is ‘magic.’” – Troy Trygstad, PhD, PharmD, MBA
Setting Goals
The best way to convince providers that you can save them money is to set goals and provide measurable results. “Metrics should be in the future of health care because you are selling your expertise and skills. Show providers that you have saved them money,” said ASCP’s Grosso. “Providers need to understand that a medication you recommend may cost more upfront, but if it keeps the patient out of the hospital, it saves more in the end.” Negotiating with home care providers is also an option. “This is a wide open territory,” said Grosso. He added, “One thing to keep in mind: Try to find out who is getting the bundled payment before you negotiate or you may be negotiating with someone who isn’t getting the payment.”
PROGRAM HIGHLIGHTS
Educating Patients
One way to avoid readmissions is to educate patients, and that’s the role of the pharmacist, said Cavicchi. “Lack of patient compliance costs money in the end. Payers will recognize your expertise if you show them how you can do this.” Although the fundamental process of caring for the patient has not changed, pharmacists need to look at the world differently. “Your knowledge can contribute to the overall success of long-term care,” said Cavicchi. “You are a lot more important than you think you are.”
Looking to the Future
The future of pharmacy holds many clinical as well as economic changes, said Orsula V. Knowlton, PharmD, MBA, president, CareKinesis. The growing use of personalizing medication regimens through pharmacogenetics can decrease adverse drug events. The use of this new process is exploding: The Food and Drug Administration now recommends the use of pharmacogenomics for more than 100 medications. This “person-based” testing influences how the drug is metabolized and stored. It is a prime example of a new technology that is becoming the standard, creating an opening for pharmacists to act as trailblazers before another provider seizes the opportunity. Knowlton said it simply: “Pharmacists need to take the lead on this.”
The major contributor to patients being readmitted is a problem with medication administration. Who better to manage medications, educate patients at discharge, and help improve clinical outcomes than pharmacists?
Sponsors and Social Media
Grosso acknowledged the innovators in the postacute care industry who sponsored this inaugural event. They included platinum sponsors (GeriMed, Managed Health Care Associates, Omnicare, and Pharmerica); ASCP’s gold event sponsors (Advanced Pharmacy, Pharmacy Times, PointRight, and Remedi SeniorCare); and silver sponsors (Avanir Pharmaceuticals, Innovatix, Integra, and QS/1). Grosso thanked them for recognizing the importance of the Forum. Gold event sponsor Pharmacy Times joined ASCP and other attendees in providing continuous live coverage of the event on social media, helping the meeting hashtag, #ASCPforum, to reach nearly 1.8 million impressions on Twitter. In addition to the presence on social media, the event boasted an innovative online social question and answer tool for attendees to use to submit queries to speakers. Attendees connected to the web-based application using their smart phones and tablets, where they entered a new question or voted on questions that others had submitted. The tool was a hit among participants.
Success and Take Aways
The Forum was a success, and attendees considered it an excellent platform for discussion and networking. Robert Flannelly called the Forum “An outstanding event with timely topics and content.” Another attendee, Robert Accetta, summed up the experience by saying, “The Forum was truly a successful gathering intended to jump-start the transition in recognizing the new realities of the health care system and our opportunities going forward.” n Consult Pharm 2015;30:321-8. © 2015 American Society of Consultant Pharmacists, Inc. All rights reserved. Doi:10.4140/TCP.n.2015.321.
PROGRAM HIGHLIGHTS If pharmacists want to get paid for their contributions, they need to understand what’s important to providers, show them how pharmacists can help them achieve their performance goals, then negotiate for part of the bundled payment.
