Transcript Consolidated Mail Outpatient Pharmacy program

VA Pharmacy Conference
2008
Consolidated Mail
Outpatient Pharmacy Operations
Kenneth Siehr
Deputy Chief ConsultantPharmacy Benefits Management Service
Consolidated Mail Outpatient Pharmacy Operations
Department of Veterans Affairs
Overview
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A little about me
Life of a VA mail out prescription
Outpatient prescription fulfillment system
CMOP today
CMOP history
– How we got to where we are
• CMOP of Tomorrow
• How does this affect you?
Who Is This Guy?
• 30+ years in Federal Pharmacy
– Pharmacy Intern VA Madison 1977
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Army Pharmacist 1978-81
VA Staff Pharmacist 81-82
VA Pharmacy Supervisor since 1982
Chief of Pharmacy 1988
Managed Multiple Services at Medical Center
VISN Formulary Leader (VISN 12) when
positions were established
• PBM Manager 2004
• Present Position 10/07
The Life of a VA Mail Out
Prescription
Life of a VA Mail Out Prescription
Provider Orders
Medication
1 Hour to ??
Awaiting
Verification
Patient
Receives
10 Hr
12 – 48 Hrs
48 Hrs to ??
CMOP
Filling
Awaiting Transmission
to CMOP
Delivery to Patient
Goal: Delivery to Patient with 10 days of Patient/Provider request
VHA Outpatient Medication Fulfillment System
Contracting and Procurement
Medical Centers
CMOP
Delivery to Patient
Goal: Delivery to Patient with 10 days of Patient/Provider request
Medical Center
• Interface between
– Patient and fulfillment system
– Provider and fulfillment system
• Ensures right
– Medication for patient clinically
– Dose, frequency
– Cost efficiency
• Dispenses Prescriptions (20%)
– Window
– Mail
• Responsible for Performance
– Chief of Pharmacy, Facility TMT, VFL
CMOP
• Dispenses Prescriptions (80%)
– Mail
• Primary Interface
– Patient delivery services
• USPS, FedEx
• Mail consolidators
• Direct to patient vendors
– NAC for outpatient medication contracts
– Contractors for direct to patient delivery
• Responsible for Performance
– CMOP Director, National CMOP and PBM
Contracting and Procurement
• National Pharmacy Benefits Management
Services
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Formulary Management
Identifies contacting opportunities
Monitors utilization
Contract compliance
• National Acquisition Center (NAC)
– National contracts, BPAs, FSS
• Procurement and Contracting staff at each site
and CMOP
• Responsible for Performance
– Chief of Pharmacy, CMOP Director
– National PBM, NAC
Delivery to Patient
• Window at Medical Centers
• To Patient’s Home
– Contracted or third party vendors
• US Postal Service
• Federal Express or similar vendor
– Mail consolidators
• Facilitate and speed process
– Direct to patient contractors
• Responsible for Performance
– Contracting Officer for contracted services
– USPS
VHA Outpatient Medication Fulfillment System
Contracting and Procurement
Medical Centers
CMOP
Delivery to Patient
Goal: Delivery to Patient with 10 days of Patient/Provider request
VA CMOP National System
Leavenworth
Hines
Chelmsford
Charleston
Tucson
Tucson
Murfreesboro
Dallas
CMOP Today
• 7 separate locations
• Each highly automated and highly efficient and
successful but with different equipment and
software
• Different practices, processes and products
– Murfreesboro – Media Mail
– Hines – mail manifesting
– Various prescription and mailing labels
• Limited national CMOP information system
• Beginnings of organizational support structure
• Collection of 7 individuals, not an integrated
system
CMOP: Grass Roots Effort
• Grass roots effort
– Concept proven at West LA and Leavenworth
• RFP Process
– Equipment centrally funded
– Medical Centers selected were to provide support
• Facilities Management, Contracting, Human Resources etc.
– Medical Centers serviced provided inventory funding
• CMOP Director reported to local Board
• CMOP needed and fostered entrepreneurial
culture
– Highly successful results
Each CMOP a Contract
• Each CMOP the result of a turn key
contract with a vendor
– Vendor provided all equipment and software
• Different vendors = different equipment
and software not designed to integrate
with other CMOPs
Early CMOP Organization
• Each CMOP essentially owned by the
Medical Centers it serviced
• Reporting to a Board made up of
customers
• Unique equipment and software
• Organizational support provided by host
site
CMOP Tomorrow
• 7 integrated locations
• Each highly automated and highly efficient with different
equipment but the same software
• Standardized practices, processes and products
– Same product list
– Centralized customer interface, QA etc.
– Patient medications from any CMOP
• Robust national CMOP information system accessible by
users
– Standardized reports
– ProClarity cubes
• Mature and effective organizational support structure
How Does This Affect You?
• Ability to seamlessly shift workload
between CMOPs
– Equipment breakdown, disaster recovery
– Specialty CMOPs
– Patient centric, ship from closest CMOP
• More tools
– Track Rx and package
– Report and trend problems
– Track and validate costs
Murfreesboro Zip Code Distribution
How Does This Affect You?
• Standardized product lists
– Medical/Surgical supplies
– Medications and pack sizes
• Medication event prevention
– Screen and identify inappropriate Rx
directions
– Rx quantity checks
Get Involved and Work With Your
VISN Formulary Leader as We
Transition