Transcript Healthy People, Healthy Communities (cont’d)

Bringing medicine, patients, and community-based services together
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High Tech in Support of
High Touch Care at Home
HSAG University of Best Practices
November 21, 2014
Partners in Care Foundation
Sandy Atkins, VP, Institute for Change
Partners in Care Foundation
Who We Are
• Partners in Care serves as a catalyst for shaping
a new vision of healthcare by partnering with
organizations, families and community leaders
in the work of changing healthcare systems,
changing communities and changing lives—
focusing on home and community care
• We evolved from the VNA of Los Angeles to be
a nimble force for change.
The Problem
Medication Errors are:
Serious:
Costly:
Common:
Preventable:
Over 700,000 people go to ED each year for
adverse drug events
Drug-related morbidity/mortality $170
billion – in Y2K dollars!
ER, hospital/readmissions, SNF etc.
Up to 48% of community-dwelling elders
have medication-related problems
At least 25% of all harmful adverse drug
events are preventable
Home visits uncover many “secrets”
that providers may not know
• OTCs – Over-the-counter medications
• Prescriptions from other other providers
• Adverse effects such as falls, dizziness, confusion
• Adherence issues
• Out of system meds: Drugs from other countries,
borrowed, Wal-Mart $4
HomeMedsSM Improves Med Safety
• Home visit by social worker, CHW, etc.
– Collect comprehensive medication information
– Assess for possible adverse effects & discrepancies
– Screen through software to find potential problems
• Pharmacists review & resolve problems, educate
• Original Model: Find a home visit—add HomeMeds
• Emerging Models
– Targeted home visits for high-risk patients
– Add to care transitions, CDSMP, caregiver support, etc.
– Part of comprehensive fall prevention initiative
HomeMeds:
What it Is & How it Works
“Any symptom in an elderly patient should be considered a
drug side effect until proved otherwise.” (Gurwitz et al. 1995)
Core Components
Collect comprehensive medication list
Note how each drug is being taken
Record BP/pulse, falls, uncharacteristic confusion,
symptoms, and indicators of adverse effects
Use evidence-based protocols to screen for
risks
Computerized risk assessment and alert
process
Consultant pharmacist addresses problems
with prescribers, seniors, families & staff.
Risk-Screening Protocols
HomeMeds is a TARGETED intervention addressing a limited group
of medication related problems identified by national expert
consensus panel ¹
• Targets problems that can be identified and resolved in the home.
• Chosen to produce positive response by prescribers
• Minimize “alert overload”: based on signs/symptoms.
 Limited to only these medication-related problems
1. Unnecessary therapeutic duplication
2. Use of psychotropic drugs in patients with a reported recent fall
and/or confusion
3. Use of non-steroidal anti-inflammatory drugs (NSAID) in
patients at risk of peptic ulcer/gastrointestinal bleeding
4. Cardiovascular medication problems -High BP, low pulse,
orthostasis and low systolic BP
¹A model for improving medication use in home health care patients . Brown, N. J., Griffin, M. R., Ray, W. A.,
Meredith, S., Beers, M. H., Marren, J., Robles, M., Stergachis, A., Wood, A. J., & Avorn, J. (1998). Journal of the
American Pharmaceutical Association, 38 (6), 696-702.
The first and most important step…
• Treasure hunt – find “hidden” meds
• Transcribe accurate information from the bottle/box
• Adherence Inquiry – For each medication ask client:
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What they take it for
How and when they take it,
How much they take
What happens when they take it (Is it effective? Side effects?
• Assess for common side effects
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Falls
Confusion
Dizziness, shakiness, feeling light headed
BP/pulse
Roles of the Pharmacist
• Screen alerts to confirm
problems
• Communicate with
prescribers
• Consult with care manager
• Identify problems beyond
protocols
• Assist with complex cases
– simplify med regimen
• Educate staff
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Typical Problems
In Community-Dwelling Elders:
• Patient w/ mild cognitive impairment taking all
medications – including sleeper & 3 doses of BP
meds – in a.m.
• Patient with dizziness taking 2 beta blockers
• Patient >80 taking 3 medications that increased risk
of GI Bleed
• Patient who fell w/ 5 meds that increased risk of falls
• Patient taking 4 narcotic pain killers
• Avg. 11 meds – many with 28+!
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HomeMeds-Plus
HomeMeds-Plus: What is it?
Home
and Needs Assessment
• 2 hour Evaluation
home visit
– HomeMeds comprehensive medication risk assessment
– Home Safety and Fall Risk evaluation
– Functional and Psychosocial assessment
• PHQ 2/9
• Mini mental
• ADL/IADL
– Advance Directive education and assistance
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Pharmacist follow-through on medication problems
Develop community service plan with member
Coordination of community resources
Collaboration with plan/medical group case managers
HomeMeds-Plus: Who Benefits?
Who is it for?
• Adults with 2+ chronic conditions and other risks:
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Recent history of ED visits or unplanned hospitalizations &/or
5-9 prescribed meds &/or
Some functional impairment &/or
Mild to moderate cognitive impairment &/or
Possible caregiver needs or social challenges &/or
Live Alone &/or
Self-management issues (significantly off goal for chronic
diseases)
Value Proposition 1 - ROI
• Compared to patients who met referral criteria but
did not receive the intervention
– 12.8% lower rate of ED use
– 22% lower readmission rate (9.1% readmitted vs. 11.6%
readmitted)
– 50% ROI
• Compared to overall readmissions for the medical
group at the same hospital
– 40% lower readmission rate
– $224,000 cost avoidance on $88,000 investment
• 90% Uptake on qualified referrals
Value Proposition 2 - Quality
• Addresses HEDIS measures
– Fall risk management
– Medication reconciliation post-discharge
• Required by NCQA for Health Plans
– Potentially harmful drug-disease
interactions
– Blood pressure control
– Antidepressant medication management
– Health Plan all-cause readmissions
"No risk factor for
falls is as
potentially
preventable or
reversible as
medication use.
(Leipzig, 1999)
Star Ratings – Medicare Advantage
• Yearly review of all medications/supplements
– % 65+ who fell or had problems with balance or walking
in past 12 mo. who received fall risk intervention
• Controlling blood pressure
– Medication adherence for hypertension: Taking meds as directed
• Plan members 65+ on high-risk drugs, when there may be
safer drug choices
• Reducing risk of falling
• Readmission to a hospital within 30 days of discharge
• Yearly pain screening or pain management plan
Bonuses for 4 & 5 Star Plans – growing!!
Fall Prevention = Savings
Inpatient: Fx Hip & Thigh Bone
$53,247 (7 days)
Shoulder, Wrist, Hand (JPS)
Rehabilitation: (HealthSouth)
$17,187 (10 days)
Total Cost = $70,434
Costly Mistakes
$31,148 (2 days)
HomeMeds: Software, Startup
Web-based: Use with PC or Tablet
HomeMeds Software: Dashboard
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HomeMeds Software: Risk Assessment
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HomeMeds Software: Medications
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Sample Medications List
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Conclusion
HomeMeds is a proven tool for improved medication
safety, health and well-being for older adults.
It is an affordable, evidence-based program that is a
perfect bridge for partnerships between community
agencies and healthcare.
Contact Information
• Sandy Atkins, VP: [email protected]
• Phone: 818.837.3775
• Partners in Care Website: www.picf.org