Transcript Benefits of using ezDispense

Physician Dispensing
Using ezDispense powered by AHCS
An overview of the software
Ainsley B. Little, Director of Software Development
Benefits of using ezDispense
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Compliance – All dispensing data is automatically reported as required by the
relevant local and or state agencies. Our proprietary rules engines allow for
easy configuration as new dispensing rules are enacted in various states.
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Limits to day supply for meds of concern such as C-II pain meds
Pre-authorization formularies such as referencing ODG guidelines
Patient convenience – Each dispense encounter can be processed in as little
a few minutes. Patients are not subject to long waits at pharmacies or
possibly having to cover some of the cost of their prescribed workers
compensation medications
Benefits of using ezDispense
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Better outcomes - Patients get all their medications each time they see
their physician thereby ensuring they follow the treatment plan as
specified by their physician resulting in returning to work sooner
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Only registered and verifiable medications are available for dispensing in
ezDispense. All meds must be listed in either Redbook, Medispan or First
Databank. All medication suppliers must be licensed in the relevant state
and meet our due diligence criteria. Recommended use of generic
medications unless brand medications are specifically prescribed
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Electronic Billing interfaces – AHCS can submit bills using EDI X12 5010
transaction code sets 835,837,999,997 etc.
Benefits of using ezDispense
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e-Prescribing via Surescripts is available in ezDispense. Users can send
and receive e-prescriptions and process/dispense the medications easily.
The feature also allows for quick, easy searches of patient benefits and
medication history available through the Surescripts network
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AHCS negotiates contracts with several PBMs with rates of reimbursement discounted from the state fee schedule. This makes
ezDispense an in network pharmacy provider for many networks which
benefits the patient, insurers and employers
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Electronic Billing interfaces – AHCS can submit bills using EDI X12 5010
transaction code sets 835,837,999,997 etc.
Compliance
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The ezDispense system is set up to report dispense data to all relevant
local and/or state authorities as required by law
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AHCS currently reports to 28 state Prescription Drug Monitoring
Programs. More are added each year as legislation is passed. Our
configurable software allows us to reconfigure these reports as or when
the vendor, frequency, format, version or protocol might change
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We have implemented formularies for medication pre-authorization such
as using a real time web service to refer to the ODG guidelines and
return pre-auth requirements in a matter of seconds
Compliance
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Days supply limitations can be configured to allow limiting of controlled
medications or meds of concern to the amount allowed by law
◦ In Florida C-II meds can only be dispensed to patients for a 14 day supply if in
connection with a surgery. Our system captures the surgery date, supporting notes and
applies the limit
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These rules can be applied to patients in or out of state. If there is a
conflict of state rules due to a patient being seen in another state for a
Florida jurisdiction workers compensation case then we apply the most
restrictive of the conflicting rules
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Dedicated account managers do routine audits of our clinic partners to
ensure they are maintaining DOH compliant dispensing protocols
Patient Convenience
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ezDispense offers a quick and easy way for patients to receive their
meds in their physicians practice thereby alleviating the need for an
injured patient to make additional stops at a local pharmacy which may
not have the med in stock or may require the patient to return to collect
the medication at a later time
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In some cases patients may be required to pay a portion toward the cost
of the medication and then follow up with their workers compensation
insurer for re-imbursement of their out of pocket costs
Improved Outcomes
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Patients receive all their prescribed medications each time they see their
workers compensation physician thereby ensuring that they follow the
treatment plan as specified by their physician
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This level of adherence to their treatment plan results in faster recovery
time to reach Maximum Medical Improvement allowing the injured worker
to return to work sooner
Medications
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All medications available for dispensing in ezDispense must be verifiable
in either Medispan, Red Book or First Databank depending on what the
requirements for re-imbursement are for the state of jurisdiction
◦ Florida uses Medispan as the basis for re-imbursement so we will only allow dispensing
of meds to Florida patients that are verifiable in Medispan
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Our partner physicians are able to prescribe any medications they prefer
but we advised them to stock and prescribe generic medications in their
regular course of treatment. Brand medications are available but due to
their high cost and AWPs they are only included if the physicians require
them
◦ In Florida we see 83% generic medications and 17% brand medications dispensed
Questions
Physician Dispensing
An Overview of the Practice
Brian S. Bizub, CEO
Credentials
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30 Years in Health Care Industry
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12 Years in Executive Hospital Positions
◦ Tenet Healthcare Systems
◦ Temple University Hospital
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18 Years in Physician Practice Operations, Management, Recruitment,
Contract Management, Reimbursement, Coding, and Billing
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Thomas Jefferson Medical College
Temple University Hospital
Palm Beach Orthopaedic Institute
Flathead Valley Orthopedic Center/Orthopedic Surgical Center
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Strategic Advisory - Mt. Tam Orthopaedics, Larkspur, CA
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Board Member – American Association of Orthopaedic Executives
Physician Dispensing
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Help Patients Receive Medication
Convenience
Patient Communication
Adherence to Treatment
Safety
Clinical Outcomes
Accuracy
Help Patients Receive Medication
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Ensures that patients receive their medication at time of treatment versus
an extra trip to the pharmacy
◦ Injured Patients can have difficulty with Transportation
◦ Confusion about Benefits and Copays – May result in Rx not being filled
◦ Injury affects the ability to wait 20-30 minutes for Rx to be Filled at Pharmacy
 Retail Spend Each Visit is Appx $12
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Ensures Compliance
◦ Monitoring Medication Dispensing helps to reduce risk, fraud and abuse
◦ Diversion of Medications
◦ Refills help to determine compliance to Treatment Plan
Convenience
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Provides the Opportunities
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Patients to Obtain Medication at Time of Visit
Begin Treatment before Leaving the Physician’s office
Improve Compliance and Outcomes
According to the Journal of General Internal Medicine, between 28 percent
and 31 percent of new prescriptions are never filled, leading to serious
health conditions
◦ In-practice pharmacies can also ease problems with over-prescribing. A recent
study found that more than 1 in 100 discontinued prescriptions were filled by a
pharmacy nonetheless.
Patient Communication
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Patient/Physician Proactive Approach
◦ Engage and Educate
◦ Customer Service
◦ Value-Added Services and Resources
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Patients have the opportunity to communicate with the physician
on the following:
◦ Side Effects
◦ Proper Dosage
◦ Interactions of Medications - Medication Reconciliation is mandate by Federal
Regulations
◦ Expectations
◦ Personal Contact with Medication-Related Questions
Adherence to Treatment
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Provides a vehicle to ensure the patient in taking the medication
Progressing through their treatment plan
Opportunity to Communicate on a Monthly basis regarding treatment plan and
medications.
Compliance with Medication
◦ 10% Never Fill Rx
◦ 30% Never Refill Rx
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Opportunity to modify treatment plan
Opportunity to review work status and progress
Nonadherence carries a huge economic burden. Yearly expenditures for the
consequences of nonadherence have been estimated to be in the hundreds of billions
of US dollars
Adherence to Treatment
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Quality healthcare outcomes depend upon patients' adherence to recommended
treatment regimens.
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Patient nonadherence can be a pervasive threat to health and wellbeing and carry an
appreciable economic burden as well.
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In some disease conditions, more than 40% of patients sustain significant risks by
misunderstanding, forgetting, or ignoring healthcare advice. While no single
intervention strategy can improve the adherence of all patients, decades of research
studies agree that successful attempts to improve patient adherence depend upon a
set of key factors.
◦ These include realistic assessment of patients' knowledge and understanding of the regimen, clear
and effective communication between health professionals and their patients nurturance of trust in the
therapeutic relationship.
◦ Knowing the patient as a person allows the health professional to understand elements that are
crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social
supports, and emotional health challenges, particularly depression. Physician–patient partnerships
are essential when choosing amongst various therapeutic options to maximize adherence.
◦ Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and
improves patients' healthcare outcomes.
Safety
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Ensure Medication are Dispensed Appropriately and Timely
Education associated with Risk and Complications (Allergies, Reactions,
Etc)
Triple Check Safety System
◦ Ensure patients are receiving the correct medications
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Adherence to Federal Regulations
◦ Bi-Monthly Reviews of Medications Dispensed
◦ Appropriate Paperwork Completed
◦ Removal of Expired Medications
PBOI is audited on a monthly basis by the Department of Health and has never received a citation or
recommendation for improvement.
Clinical Outcomes
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Physician oversight promotes better clinical outcomes
◦ Monthly Visits with Refill Program
◦ Ability to Lower Dosages and Adjust Medication Depending on Physician Visit and
Progress
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Discussion regarding medications, compliance of treatment plans, interaction
with other medications and side effects
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Diet
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Exercise/Physical Therapy
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Goal is to return to work faster
◦ Decrease Loss-Work Claims for Employer
◦ Decrease Loss-Time Claims for Pharmacy Costs
◦ Improve Outcomes and Limitations and Restrictions
Accuracy
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Predefined medical protocols for disease, acute and chronic injuries and post
surgical care for all patients regardless of financial class
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Prepackaged medication reduced the opportunity for errors and adverse
events
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Dispensing software has triple check safety scans to eliminate errors
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Physicians have past, social and surgical history to ensure medication are
prescribed appropriately from a whole body approach
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Reviewing medication reconciliation at time of service reducing potentially
dangerous contraindications and interactions resulting in an adverse event
Conclusion
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Despite the misconceptions of physician dispensing being tagged as an
enhanced revenue initiative the program has developed and created:
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Standardized Care Protocols
Improved Communication
Convenience – One Stop Shop
Collaboration of Care
Adherence Standards
Safety
Better Clinical Outcomes with Faster Recovery, which result in a decrease in Loss-Work
Claims
◦ Returns the Patient to Normalcy
Questions
Physician Dispensing
An Employers perspective
Scott Clark,
Title Risk and Benefits Officer, Miami-Dade County Public
Schools (Retired)