Module 2: Pop Health

Population Health

• study and improve health outcomes of specific group rather than individual

• aligned with the public health model

• emphasizes prevention, health promotion, and addressing social determinants of health

Populations defined by stakeholders

• payers (insured vs uninsured)

• health system (hospitalized vs outpatient)

• community (area, risk factors, conditions)

Primary prevention

• prevent disease

• ex. administering HPV vaccines to adolescents according to CDC guidelines

Secondary prevention

• detect disease early through screening

• ex. performing A1c screenings in adults with risk factors for diabetes

Tertiary prevention

• manage diseases to reduce morbidity/mortality and improve quality of life

• ex. providing medication management and adherence counseling to prevent HF readmissions

Population health management

• optimize preventive services

• identify high-risk patients

• improve disease management strategies

• goal: cost containment at population level

Pharmacists role in PHM

• form strategic partnerships with providers

• develop alternative payment models

• manage costs and improve health outcomes

Pharmacists’ services in population health

• patient education/engagement

  • health fair screenings

• medication optimization and management

  • conversion of 30 day fills to 90 day fills to improve adherence and reduce cost

  • providing discharge counseling

  • developing and completing MUE

• interdisciplinary team collaboration

• addressing health disparities

• data analysis and improvement

• technology and care model innovation

Patient education and engagement

• health promotion

• health fairs

• wellness screenings

• immunizations

• medication counseling

Medication Optimization and Management

• MTM

• CMM

• Chronic disease management

• prescription optimization

• formulary management

• MUE

Interdisciplinary team collaboration

developing and executing care plans with physicians, nurses, etc

Addressing health disparities

targeted interventions based on social determinants, health-related social needs, culturally competent care

Data analysis and improvement

• claims data analysis (proportion of days covered)

• quality improvement initiatives

• cost containment strategies

  • optimized medication use and reduce healthcare spend

Technology and Care Model Innovation

• leverage technology for data and metrics that improve care coordination and outcomes

• PCMH

• ACO

Population Health Management Settings

• community

• ambulatory

• acute

• managed care

Community Population health

• immunizations

• direct furnishing laws

• MTM

• emergency/disaster prep/response

• tele-pharmacy

Ambulatory Population health

• health screening

• self-management education

• chronic care management

• TOC

• discharge f/u

• tele-pharmacy

• CPA

Acute care population health

• formulary management

• medication use poligices

• MUE

• med rec

• TOC

• readmission prevention

• tele-pharmacy

Managed care population health

formulary management

tiered drug coverage

DUR

Clinical Pharmacy Services (CPS)

• improve patient outcomes and reduce med-related injury

  • 5-10% of admissions are d/t drug-related problems; 60% preventable

• collab with multidisciplinary teams

• optimize medication by identifying, correcting, and averting drug-related problems from meds prescribed in hospital

Clinical pharmacist interventions (CPI)

• actions initiated by pharmacist that directly result in a change in patient management or drug therapy (have pop health implications)

• review patient’s chart from admission to discharge, identify potential DRPs, intervene if needed, optimize evidence-based pharmacy care plan, f/u and evaluate

Consequences of failed healthcare prevention strategies

• increased urgent/emergency care visits, hospitalizations d/t unmanaged diseases, and hospital readmissions

• decreased med adherence, quality of life

Value-based care model

• focus on quality care, provider performance, and patient experience

• healthcare is transitioning into this era

Value proposition

• clear statement that explains the benefits a company offers to its customers

• why should a customer choose your product over others?

Quality measures

• quantifiable standards

• measure quality of health care provided

• high emphasis on quality of care → improved health outcomes in value-based model

• role of pharmacy in improving quality measures is constantly evolving w expansions of CPAs

  • reductions in preventable hospital readmissions and ED visits

  • improvements in chronic disease outcomes

  • reductions in healthcare costs

Hospital level quality indicators

• support internal quality improvement, monitoring, and assessment of adverse events related to patient safety

• inpatient quality of care, flags for potentially avoidable complications

• inpatient mortality

• over/under/mis-use of inpatient procedures

Geographic/Area level quality indicator

• identify and evaluate access to outpatient care

  • includes post-discharge and follow-up care

• identifies avoidable admissions

• “screening tool” flagging potential healthcare access problems or population health concerns in a defined area

Medication-related quality measures in primary and ambulatory care clinics

• patient/caregiver experience

• care coordination/patient safety

• preventative health

• at-risk populations

Patient/Caregiver experience quality measures

• shared decision making

• health status/functional status

Care coordination/patient safety quality measures

• hospital readmissions (general)

• med rec at discharge (transitional care management)

• use of high-risk medication in elderly

• polypharmacy

Preventative health quality measures

• immunizations

• smoking/vaping cessation

At risk population quality measures

• comprehensive care management

• focus on at-risk populations (diabetes, HTN, HLD, HF, COPD, asthma)

  • HF readmissions

HEDIS

• healthcare effectiveness data and information set

• standardized performance measurement of health plans

• maintained by NCQA

• evaluate health plan quality, patient care, and service performance in 6 core domains

HEDIS Core domains

1. effectiveness of care

2. access/availability of care

3. experience of care

4. utilization and risk adjusted utilization

5. health plan descriptive info

6. measures collected using electronic clinical data systems

HEDIS clinical measures

• prevention measures

• treatment measures

HEDIS prevention measures

• proportion of eligible members who received preventive services

• childhood immunization status

• flu shots for adults

• breast cancer screening

• controlling high blood pressure

• statin therapy for patients with diabetes (primary prevention)

HEDIS treatment measure

• proprotion of eligible members who recieved recommended care for certain conditions

• pharmacotheraepy management of COPD exacerbation

• pharmacotherapy for opioid use disorder

• osteoporosis testing and management in older women

• Statin therapy for patients with cardiovascular disease

CMS Star Ratings

• rates quality of medication advantage and medicare prescription drug plans (part C and/or D)

• 1-5 stars

• medicare adv plan payments/rebate amounts are tied to quality ratings

• aligns with “meaningful measures” framework

CMS meaningful measures framework

• person-centered care

• equity

• safety

• afforability and efficiency

• chronic conditions

• wellness and prevention

• seamless care coordination

• behavioral health

CMS Star Rating Measures

• outcomes

• intermediate outcomes

• patient experience

• access

• process

CMS Star rating: outcomes

• reflect improvements in health

• ex. better health status for diabetic

CMS star rating: intermediate outcomes

• actions that can assist in improving a beneficiary’s health status → predict future outcomes

• controlled blood glucose in diabetes care

• medication adherence for diabetes meds

CMS star rating: patient experience

• reflect beneficiaries’ perspectives of the care they received

• patient surveys/rankings

• member rating of health plan customer services

CMS star ratings: access

• reflect processes and issues that can create barriers to receiving needed care

• ability of patients to obtain needed services

• getting needed prescription drugs

CMS Star ratings: process

• capture the health care services provided to beneficiaries which can assist in maintaining, monitoring, or improving health status

• specific actions taken to deliver care

• ex. statin use in persons with diabetes, annual CMR completion rate