CMCS Connections

7 C M C S c o n n e c t i o n s 4 t h q u a r t e r 2 0 1 5 Monitor clinical data analytics program is licensed by CMCS to provide information to assist in decision making for health plans including the identification of high-risk, high-cost members who can benefit from proactive interventions. LexisNexis will serve as one of the data sources for this initiative. LexisNexis will provide a monthly analysis of claims data and proprietary forecasted risk clinical data analytics. Additionally LexisNexis may offer scientific review of the data to validate any perceived outcomes of this project. The pharmacist will see the patient between 2 to 4 visits for medication management during the study period. The goal is for patients to complete an initial visit with the pharmacist and at least one follow-up visit within 12 months. The number of follow-up visits or follow-up phone calls with each member based upon the member's identified needs for medication management. Additional appointments may be scheduled on an individual basis. Members who are currently seen by specialists in addition to their primary care provider will be encouraged to keep their appointments at the recommended intervals. Members will earn a $20 gift card for their initial visit with the Pharmacist and one additional $20 gift card for a follow up visit, although they may see the pharmacist more than two times. The pharmacists will assess the m e m b e r 's u n d e r s t a n d i n g a n d adherence with their medications, and based on patient specific needs, will provide the patient with medication and disease state education. The pharmacist will work with the primary care provider or specialists to establish a plan for each member to address and overcome barriers to medication adherence. The pharmacists will provide recommendations to the primary care physician to simplify or optimize medication regimens as appropriate. The pharmacist will also work with the providers and members to improve meeting the standards of care for conditions such as diabetes, hypertension, cardiovascular disease and depression, as defined by selected HEDIS measures. This project was used as part of the testimony to the Indiana State Senate in support of changing the Indiana Pharmacist Practice Act to allow payment for Medical Therapy Management (MTM) services by pharmacists. Anecdotal reports indicate a positive reception for this program and members report a better understanding of their need for medications and improved compliance. CMCS plans to publish the results of this study in a future CMCS newsletter. R e f e r e n c e s : 1. Rosenow, E. (2005). Patients' Understanding of and Compliance With Medications: The Sixth Vital Sign? Mayo Clinic Proceedings, 80(August), 983–987. 2. Thinking Outside the Pillbox: A System- wide Approach to Improving Patient Medication Adherence for Chronic Disease. A NEHI Research Brief – August 2009 3. Sclar DA et al. Antidepressant pharmacotherapy: Economic outcomes in a health maintenance organization. Clinical Therapeutics 1994; 16: 715-30. 4. The National Report Card on Adherence. 2013. ncpanet.org/reportcard 5. Mitchell AJ, Selmes T. Advances in Psychiatric Treatment. 2007. 13(5): 336-346. 6. Steiner J.F., Prochazka A.V. 1997. "The assessment of refill compliance using pharmacy records. Methods, validation, and applications". Journal of Clinical Epidemiology 50:105-106. N C Q A S TA N DA R D S A N D I H C P R E Q U I R E M E N T S By Linda Grosser A n integral part of quality patient care and a positive member experience is making sure patients have timely access to needed medical care. In accordance with the Office of Medicaid Policy and Planning (OMPP) policy and the National Committee for Quality Assurance (NCQA) specifications, health plans establish standards and performance monitors to ensure members receive timely access to providers, specialists and services. The OMPP and NCQA standards are outlined in the special insert on page 8 to address access to emergency, urgent and routine care appointments, after-hours care, physician response time, office appointment wait time, and office telephone answering time. The patient experience is linked as part of the quality ratings of healthcare organizations, and a large percentage of the score is the member experience, including access to care. An integral part of quality care and member satisfaction is timely access to care including primary care and speciality care. The NCQA 2014 Health Plan Accreditation Quality Standards for Accessibility of services became more stringent in 2014. NCQA plans to show evidence of a formal review of member accessibility to appointments including after-hours care needed with both physicians and behavioral health practitioners. See the special insert on the following page for more details on NCQA standards and ICHP requirements. (continued from page 6) Access to Care SCAN ME! To teleport instantly to our website, simply scan this glyph with any QR code reader. The CMCS Newsletter is edited by Linda Grosser and Andy Fry.

• Cover