Overview

With the cost of healthcare on the rise, the importance of developing strategies to both increase the quality of care provided while simultaneously reducing expenditures is a key area of effort at Affinia Health Network (AHN). AHN is focused on improving the quality of care for the population and lowering overall healthcare costs using the “big 3 +1” approach:

  • The “big 3”: reduce acute inpatient admissions/readmissions, appropriately utilize SNF facilities and avoid inappropriate ED visits
  • The “+1”: focus on the reduction of inappropriate spend on pharmaceuticals

At AHN we are aware the rising cost of pharmaceuticals is a key driver for the overall rise in healthcare costs. Because of this, the AHN Pharmacy Department is working to support the “big 3 +1” approach using the following strategies:

  • Identifying opportunities for both financial and clinical optimization of medications by leveraging pharmacy data & implementing utilization management strategies
  • Cultivating network-wide pharmacy resource relationships to aid in implementation of pharmacy programming for value-based populations in an effort to improve the appropriate use of medications
  • Creating and maintaining educational tools & resources for network providers and staff to aid in point-of-care medication selection and cost-conscious prescribing

Priority Health Medication Therapy Management PCP Incentive

Get to Know Your MTM Pharmacist!

Julie Earby, PharmD is the pharmacist you would meet with for your MTM visit. Unlike other pharmacists, Julie works directly with your provider and because of this relationship, she has access to your past medical history through the same medical record your provider uses and is able to meet with your provider regularly.

Medication Therapy Management (MTM):

Medication Therapy Management (MTM) is an umbrella term that is used to capture a wide variety of clinical services, typically provided by a pharmacist, varying from medication reviews to chronic disease management.

The Affinia Health Network pharmacy team supports MTM activities by offering a variety of services:

  • Completing medication reviews for high risk patients of the Supportive Care Program, making recommendations to Care Managers and Providers to improve safety and efficacy of therapy selections.
  • Creating regular clinical updates on: newly approved medications, guidelines or changes to therapy recommendations as well as medication utilization strategies to network providers & staff.
  • Managing a network-wide approach to meeting requirements of the Priority Health MTM PIP quality measure in addition to directly providing medication reviews to MTM PIP eligible patients.

High Cost Medication work:

With pharmacy-related costs on the rise, the importance of a focused strategy to reduce costs is more important than ever before.

The Affinia Health Network pharmacy team is dedicated to identifying opportunities to reduce inappropriate spend on pharmaceuticals by leveraging pharmacy data & implementing utilization management strategies.

One such strategy targeted at reducing inappropriate spend on Xyrem (sodium oxybate) was featured in the March 2019 BCBS Value Partnerships Update. Check it out here.

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