Building a Community Pharmacy Enhanced Services Network in Utah

1. Building a Community Pharmacy Enhanced Services Network in Utah CPESN Work Group Meeting September 13, 2016

2. What is a CPESN? • A Community Pharmacy Enhanced Services Network or CPESN is a quality improvement initiative focused on integrating community pharmacy enhanced services to optimize coordination of health care services to patients and populations in our state and communities. • Core dispensing services are essential and not diminished in this model but rather are enhanced with workflows and professional services that support medication optimization and preventive services to improve population health outcomes. • Examples: Immunizations, Medication Synchronization with Review, Medication reconciliation after transitions of care

3. Goals of the CPESN • Establish a value-based, quality driven pharmacy representation embedded in the community that provides value to patients, populations, payers, other health care professionals. • Increase both professional satisfaction and business • opportunities for pharmacists as healthcare providers in an • evolving healthcare delivery system. • 3. The network will be prepared to maintain marketing and negotiating ability to secure funding, contracts and participation from payers, accountable care organizations, provider referral networks and others for clinical services and innovative reimbursement opportunities.

4. Who Joins? • The CPESN will seek: • High integrity pharmacies and pharmacists • Demonstrated interest in the delivery of high quality, patient-centered care • Offers valuable patient care services that exceed traditional core dispensing services. • Willing to have enhanced services measured and analyzed across the network for quality improvement efforts

5. THE MEDICAL NEIGHBORHOOD Care Management Team PCP & Clinic Team Specialty Providers HH/Rehab/SNF Hospitals Community Resources Participating Pharmacies CPESN Workgroups CPESN Workgroups CPESN Workgroups CPESN Network Structure Luminaries CPESN Workgroups include: Network Operations & Communications Quality Assurance & Performance Measurement Service Sets Luminaries provide local network leadership to the work groups and other network activities. The Local CPESN provides the support structure for key network functions, including training, credentialing, HIT services and connectivity, population health management tools, etc. CPESN Collaborators & Partners may include state pharmacy associations, schools of pharmacy, local medical societies, care management organizations, and others. Local CPESN CPESN Collaborators & Partners

6. What Does CPESN NC look Like?

7. NC CPESN Distribution Geographic Representation of CPESN Pharmacies as of December 1, 2015

8. NC CPESN Participation Criteria • Current registration with the BOP in good standing • Current NC Medicaid pharmacy provider • A signed agreement with CCNC that defines scope of work and CPESN participation • Use of CCNC’s PHARMACeHOME application • Agreement to provide a minimum set of enhanced services: • Proactive waste management program • Patient counseling and adherence coaching • Assistance with medication reconciliation

9. Types of Enhanced Services

10. The Collaboration Card The Pharmacy Locator Application

11. What Does CPESN Iowa Look Like?

12. CPESN Highlights: Iowa

13. Progress in Iowa Core vs. Optional Service Sets Roles & Responsibilities Participation Agreement

14. Iowa CPESN Participation Criteria • A signed agreement that defines roles & responsibilities with CPESN participation • Current registration with the BOP in good standing • Respect patient’s right to choose their own practitioners and pharmacies • Use secure data platforms and applications, when applicable • Agreement to provide a minimum set of enhanced services • Medication Reconciliation • Clinical Medication Synchronization • Adherence Packaging • Immunizations • Complete Medication Reviews with Chronic Care Management

16. Supporting the Development of Community Pharmacy Enhanced Services Networks (CPESN) Beyond North Carolina Report on the Multi-State Pharmacy Collaborative (MSPC)

17. Multi-State Pharmacy Collaborative (MSPC) • Facilitate expansion of high-performing networks* • Provide a venue to connect pharmacists and other pharmacy stakeholders who have interest in delivery of financially sustainable, patient-centered care beyond traditional dispensing services * High Performing Pharmacy Network to coalesce pharmacies based on the principle of providing value beyond selling drug product to effectuate health trajectory

18. The Big Picture • Form a nationwide “Network of Networks” • Increase, Develop and Sustain High Performing Networks of Pharmacies that provide enhanced services offerings • Create Marketplace Presence of CPESN Networks • Create Marketplace Dependency on CPESN℠ Networks • Facilitate local value propositions to other care team members to establish margin positive referral patterns • Create care team dependency on clinical activities performed by community pharmacies to mitigate against risk narrow networking or reimbursement reductions on product distribution • Establish Relationships and Reimbursement models with Medical Benefit side of payer infrastructure

19. Stages of CPESNLaunch October 2015 December 2015 August 2016 June 2016 CPESN℠ Launched Phase 1 Phase 3 Contact established Phase 2

20. CPESN Highlights: Baptist Memorial Health Care • Large health center covering 3 states (MS, AR, TN) • Expressed interest in collaborative effort between BMHC and CPESNin coverage area

21. CPESN Highlights: Mississippi

22. CPESN Highlights: Kentucky • Wellcare Pilot Program (6 months) • KY CPESN℠ to provide NPI’s of participating pharmacies • Wellcare to provide patient attribution list with highest cost.

23. Making it Happen in Utah

25. Service Sets Needed Services from the Perspective of CCNC Networks: • Adherence packaging and related programs • Medication reconciliation and other transitional care support • Follow up on denied claims • Med synchronization • Medication reviews for complex patients • Interventions on care alerts • Pain management (including CSRS monitoring) • Medication delivery

26. Network Operations & Communications Considerations: • What will you call your network? • Process for participant agreement • Infrastructure needs • Who are potential external partners?

27. Network Quality Assurance Considerations: • Site visits • Accreditation • Learning needs of participating pharmacies • Peer to peer coaching • Handling of complaints from peers or providers

28. Quality Improvement & Assurance • Readiness & baseline characteristics survey • Audit Process • Workflow support • Develop process for informal continuous QI/QA process • Peer to Peer

29. Launching a CPESN

30. Step 1: Determining Interest • Identification of potential participating pharmacies • Webinar, Live Meeting, One-on-one discussion with targeted community pharmacists • Potential luminaries • Organize Voluntary Work Groups • Collectively determine the posture of your CPESN • Schedule live meeting for network decision making

31. Step 2: Develop Network Framework • Determine entity that will organize the CPESN • Non-profit, For-profit entity, CCNC assistance • Determine name of your CPESN • Determine value proposition of your network • Determine intent of pharmacy participation by Letter of Commitmentor Participation Agreement

32. Step 3: Preparing to Launch • Identify Network Administrator • Survey participants to determine enhanced services offering(s) • Finalize minimum participation criteria • Outline required and optional service sets • Inclusion criteria • Engage Potential Partnerships (SOP(s), Vendors, etc.) • Branding/Logo Development • Establish deadline for Letter of Commitment/Participation Agreement

33. Which Level of Support Will Your CPESN Need? Heavy Medium Light

34. CPESN Website Preview

36. Contact Information • Ashley Branham, PharmD, BCACP Director of Network Development, CCNC Director of Clinical Services, Moose Pharmacy ashley@moosepharmacy.com • Joe Moose, PharmD Director of Luminary Development, CCNC VP, Moose Pharmacy joe@moosepharmacy.com