Prepared by: Julie Earby, PharmD, BCACP, Tiffany Jenkins, PharmD, BCACP
Affinia Pharmacy Key Areas of Focus
- Reduce Inappropriate Pharmaceutical Spend – Identify opportunities & collaborate with care teams to design and implement evidence-based pharmacy cost savings initiatives.
- Enhance Patient Care & Clinical Interventions – Collaborate with in-network clinical pharmacy resources on targeted pharmacy programming to improve Alternative Payment Model (APM) performance.
- Pharmacy Related Educational Efforts – Identify needs, develop tools and maintain resources for network providers and staff on pharmacy-related content. Provide educational opportunities for pharmacy students and residents.
2020 Performance in Review
Medication Therapy Management (MTM)
- Pharmacist provided MTM services have been shown to improve the quality of patient care, reduce health care expenditures and decrease medication-related adverse events.1 Current programming with a key contract (Priority Health) kicked-off in 2019.
- The MTM program has been independently ranked in the top 40% nationally during the first full year of active service when compared with other organizations of comparable size based on a multi-point scale by the OutcomesMTM platform. Within this health system category, our network had the 1st highest number of eligible patients and completed the 4th highest number of successful medication reviews.
- From 2019 to 2020, we have seen the following preliminary impacts on the program including increased medication review visit volume, increased total system revenue and favorable impacts on patient’s total cost of care (TCOC) following visits from 2019:
- For more information on this initiative, please visit https://affiniahealth.com/pharmacy/august-2020-medication-therapy-management-initiative-2020-mid-year-recap/
Improving Medication Adherence
- Dedicated pilot began in Fall 2020 with two APM contracts to improve HEDIS 5 STAR measure2,3 performance. Since initiation, we have seen a 4.7x increase in adherence monitoring check-ins.
- For more information on this initiative, please visit https://affiniahealth.com/pharmacy/february-2021-medication-adherence-initiative/
Medication Assisted Treatment
- BCBS created a funding model for organizations to increase access to care for medication assisted treatment (MAT) services for patients with opioid use disorder.
- Affinia Pharmacy Team collected and submitted required data during submission dates in April and October of 2020. These data submissions allow the network to be eligible for incentive funds which are earned by participating offices.
- Since initiation in the Fall of 2019, the network has increased the number of providers currently prescribing MAT (as available in claims data).
Diabetes Medication Management Workgroup
- Statewide group formed in May 2020. This group’s mission is to support evidence-based prescribing practices & reduce ineffective use of pharmaceuticals in the treatment of diabetes to improve cost of care. 2020 pilot focused on the Colleague Health Plan population and two interventions designed to improve patient outcomes and optimal use of diabetes medications.
- Clinical activity related to these interventions began in February 2021. For more information on this initiative, please visit https://affiniahealth.com/pharmacy/december-2020-diabetes-management-workgroup-interventions/
Health in Practice Vaccination Rebate (Merck)
- Vaccination improvement program (continuation of a similar initiative from 2014-2017) active January 2018 – June 2021 (extended from December 2020 due to COVID) focused on increasing rates of human papillomavirus (HPV) and pneumococcal (PPSV23 specifically) immunization in eligible patients. We work closely with Merck and Mercy Health teams to improve vaccination rates through development of educational content, EHR optimization and care team engagement.
- The network has earned over $61,000 in rebates through June 2020 by increasing HPV vaccination rates 16% and pneumonia vaccination rates 20% since January 2018.
- For information on the updated recommendations for pneumonia vaccination, please visit: https://affiniahealth.com/pharmacy/january-2021-reminder-updated-pneumococcal-vaccine-recommendations/
Anti-VEGF Utilization Review
- Anti-VEGF therapy is used to manage Age-Related Wet Macular Degeneration (AWD) and other ocular conditions. An opportunity to improve cost of care and maintain quality by increasing use of a lower cost treatment option was discovered.
- Annual spend for 4 medications is more than $16 million. One retinal specialist office accounted for 55% of spend. Partnered with the office, provided targeted education and we have seen at 6.9% increase in prescribing of the lower cost alternative.
- We offer a Population Health Pharmacy rotation for first- and second-year pharmacy residents as well as an advanced pharmacy practice rotation for students from Ferris State and University of Michigan.
- The team creates original content monthly that is included in the Affinia Advisor and on the Affinia website. Additionally, we support educational needs of the network by providing dedicated programming on requested topics through venues such as the Mercy Health Family Medicine Grand Rounds.
More Information – Contacting the Affinia Health Network Pharmacy Team
For questions about these initiatives and programming, please contact the Affinia Pharmacy Department at 231-672-3770 or AffiniaPharmacy@mercyhealth.com. One of our pharmacy team members will be happy to assist you!
- Centers for Medicare & Medicaid Services. Center for Medicare and Medicaid Innovation. Evidence Supporting Enhanced Medication Therapy Management. Available at: https://innovation.cms.gov/Files/x/mtm-evidencebase.pdf
- PQA Alliance. Frequently Asked Questions for PQA Measures in the Health Insurance Marketplace Quality Rating System. Available at: https://www.pqaalliance.org/assets/Measures/QRS%20Measures%20FAQs%2020200403.pdf
- Centers for Medicare & Medicaid Services. 2020 Quality Rating System Measure Technical Specifications. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/2020-QRS-Measure-Tech-Specs_20190925_508.pdf