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By Cory Thornton, MS

Most medical home and specialty medical home agreements have some provisions that link payment to performance (see Sustainability – During & After The Perfect Storm and When You’ve Seen One Health Home, You’ve Seen One Health Home). So where to start with hitting those performance numbers and maximizing possible gainsharing bonuses? Use pharmacy data analytics, according to Carol Clayton, Ph.D., Chief Executive Officer of Care Management Technologies. In her experience, this low cost and reliable data set is a good source of information for predicting future emergency room use; for identifying undiagnosed behavioral health conditions, and for serving as a natural bridge between physical and behavioral health care.

Carol Clayton, Ph.D., Chief Executive Officer, Care Management Technologies

In her session, Population Health Management In A Value-Based Market: Using Pharmacy Analytics To Increase Consumer Engagement & Improve Outcomes, Dr. Clayton’s message of the day was that medication patterns play a big role in both the costs of care and managing that care. She was joined in the presentation by ­Susan Wilson, MPA, Chief Operating Officer, Missouri Primary Care Association; George L. Oestreich, Pharm.D., MPA, President & CEO, G.L.O. & Associates; and Jennifer Kemp-Cornelius, R.Ph., Pharm.D., Consultant at G.L.O. & Associates who discussed the case study of the Missouri pharmacy integration initiative.

Susan Wilson, MPA, Chief Operating Officer, Missouri Primary Care Association

The Missouri Department of Health and Human Services (DHHS) initiated the pharmacy integration initiative to increase prevention of hypertension and diabetes by integrating pharmacists into the care teams at federally qualified health centers (FQHCs). The project was designed as a collaboration between DHHS, the Missouri Primary Care Association, the Missouri Pharmacy Association, and the FQHCs (see Adding Pharmacists to Patient Care Teams in Missouri Federally Qualified Health Centers). Additionally, the FQHCs involved were already participating in the Missouri Quality Improvement Network (MOQuIN) – a health information technology initiative designed to improve patient care and report on clinical quality measures.

George L. Oestreich, Pharm.D., MPA, President & CEO, G.L.O. & Associates

The initial funding for the pharmacy integration initiative came from the federal Centers for Disease Control (see State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health), and as part of the funding the state began the program in 2014 with a five-year pilot program at five FQHCs – with the goal of improving quality and effective care delivery for prevention and management of hypertension and diabetes; and increasing medication adherence. The project is pulling data from the FQHC’s existing electronic health record (EHR) systems and paid claim databases, looking at two primary metrics:

Jennifer Kemp-Cornelius, R.Ph., Pharm.D., Consultant, G.L.O. & Associates
  1. NQF 18 – The percentage of patients 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year.
  2. NQF 59 – The percentage of members 18-75 years of age with diabetes (type 1 and type 2) whose most recent HbA1c level during the measurement year was greater than 9.0% (poor control) or was missing a result, or if an HbA1c test was not done during the measurement year.

How is the model working? Though the program is only in year three, Dr. Kemp-Cornelius noted that so far, they have made positive progress in several areas. The FQHCs were able to increase the proportion of patients with diabetes who are in adherence with medication regimens monitored by a pharmacist by 2.74% over their baseline; and increasing the proportion of patients with hypertension who have their blood pressure under control by 7% over their baseline.


What can other organizations learn from this program? Successful performance management requires not only integration of services – but an integrated approach to the uses of data. By integrating clinical, financial, and administrative data in ways that distill information to provide insight for care management teams (and pushing that analysis out to an extended cross system care team), provider organizations will be able to engage consumers in overall health improvement, reduce unnecessary or avoidable utilization, and maximize their own value.

For more, don’t miss the web briefing on March 15 – Data & Analytics In A Pay-For-Value Market: Strategies For Successful Population Health Management. During this session, Rosa Thomas, the Director of Quality Management of Macomb County Community Mental Health will discuss how Macomb County Community Mental Health is using analytic tools to manage their capitated Medicaid contracts. The free webinar offered by Care Management Technologies and OPEN MINDS, will also feature OPEN MINDS senior associate, George Braunstein, M.S., FACHE, and Michael Croghan, Chief Technology Officer of Care Management Technologies.

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