Transcript Member & Provider Communications

Provider and Member Education
in Managed Care Pharmacy
Presentation Developed for the
Academy of Managed Care Pharmacy
Updated: February 2015
Objectives
• Describe strategies used in provider and
member education related to managed care
pharmacy
• Discuss important considerations in education
• Describe the benefits and role of the
pharmacist in provider and member education
programs
Provider Education Goals
Enhance
knowledge
Change
behavior
& culture
Promote
best
practices
Motivating Factors for Providers
► Improve quality of care
► Increase positive outcomes
► Reduce adverse events
► Avoid organizational penalties
► Maintain prestige among colleagues
► Respond to patient demands
► Increase potential revenue
Provider Education
Types
Newsletters
Content
Formularies
Administrative policies
updates
Seminars
New products/pipeline agents
Web-based tools
New treatment guidelines or
protocols
Academic detailing
Report cards (utilization
audits)
Letter campaigns
Results from utilization audits
Patient-specific utilization
patterns and history
Member Education Goals
Improve health
and preventative
health behaviors
Enhance
member
satisfaction
Increase
awareness of
benefit and
cost structure
Motivating Factors for Members
► Decreased out of pocket costs
► Self care education
► Empowerment in maintenance of personal
health
► Realization of disease control
► Support systems
► Incentives for self care
Types of Member Education
Types
Mailings & phone calls
Seminars or individual
appointments
Content
Drug information
(benefits of therapy, adverse
events, formulary status, etc)
MTM programs
Preventative health
behaviors
Disease management
programs
Tools for medication
adherence
Pay-for performance
incentives
Cost savings tips
Important Considerations
Plan
Do
Check
Adjust
• Who is your audience for education initiative?
• What are your education/intervention goals?
• Who are your stakeholders and what is meaningful to them?
• Perform outreach/education/intervention
• Engage stakeholders to determine what was meaningful?
• What did you learn during the intervention/education that would make your
outreach/education more meaningful?
• Determine what changes need to be made in education approach
• Implement changes and repeat cycle of education continuum
Additional Considerations
• Health literacy
– Format
– Content
• Focus groups
– Gather input from audiences through surveys or
discussions
– Incorporate feedback to make programs more meaningful
Pharmacist Role in Education
Types
Mailings & phone calls
Seminars or individual patient and
provider appointments
MTM programs
Disease management programs
Provider detailing
Drug Use Evaluations
Case Management Team member
Content
Drug information expertise
Preventative health education
Medication Adherence tools
Cost savings tips and
formulary alternative
recommendations
Quality Initiative
implementation
Education Role of a Pharmacist
• Pharmacists are accessible
– Patients trust information provided
– Providers value input from a member of the
healthcare team (i.e. medical home)
Summary
• Provider and member education enhances
knowledge and changes behavior
• Educational programs help maintain high
quality of care
• Educational programs help reduce overall
health care costs
Thank you to AMCP member
Kat Wolf for updating this
presentation for 2015