Important Concepts for Exam 3

HEDIS

• focused on the Practitioner and Organization quality for reimbursement

• standardized performance measures

• utilized by 90%+ of US health plans

Star Ratings

• focused on helping the “consumer” evaluate health plan selection based on quality

• developed to help patient choose Medicare health plan based on quality of care

• standardized performance measures

Cost Minimization Analysis

• compares costs between interventions with assumed EQUAL outcomes

• ex. compare drugs within same class with negligible clinical differences

Cost Effectiveness Analysis

• most common in pharmacy

• compares total cost with total clinical effectiveness

• cost vs outcome (single clinical end-point)

• help determine if cost is worthwhile

• ex. cost of eliquis vs warfarin in stroke reduction

Trade-offs in cost effectiveness

• more costly, more effective

• less costly, less effective

Cost utility analysis

• subset of CEA → cost per QALY

• NOT disease specific → can compare costs of interventions across different disease states

• ex. comparing empagliflozin vs standard treatments for T2DM for cost/QALYs

Cost benefit analysis

• compare financial cost to financial benefit

• expressed as benefit to cost ratio (treatment is economically beneficial if over 1)

• ex. cost of pharmacist in hospital vs monetary benefit

Models that can be used for ROI calculation

• CEA

• CBA

• also accepted → CUA?

Decision Trees

• graphical representation of decision and consequences

• useful for short-term, straightforward analyses

Markov Modeling

• graph used to represent different health conditions and transitions between these states over time

• ideal for chronic diseases and long-term processes

• more complex to construct

Monte Carlo Simulations

run model numerous times to generate range of possible outcomes

Sensitivity Analysis

• ensures model’s conclusions aren’t overly dependent on specific assumptions

• helps understand range of possible outcomes

• enhances study credibility

Cost Avoidance

• identifies potential saving without considering cost

Budget impact

• mostly used to measure impact of adding new drug to formulary/service to operations

Lowest level of risk to provider

fee-for-service

Highest level of risk to provider

capitation

Transitional Care Management → High complexity

7 day follow-up

Transitional Care Management → Moderate complexity

14 day follow-up

Mandatory Reporting Systems

• VAERS

• EFORSCE

Voluntary reporting systems

Medwatch

Organizational Structure provides for

• specialization of labor and departmentalization

• chain of command

• authority

• power

• DOES NOT PROVIDE → job description

Upper-management responsibilities/skills

• setting long term goals, products, markets, business organizing, vision, mission, and values

• conceptual skills

Middle management

• interpret plans and set actions

• requires human with some conceptual and technical skills

Lower management

• responsible for implementing plans

• technical skills required

Chain of command

1. Leader

2. Manager

3. Supervisor

4. Staff

Objectives should be

• reasonable

• achievable

• measurable

Goals should be

outcomes-based

Reason and Direction determined by

mission and vision statementsR

Roadmap to success determined by

strategic plan

Vision statement

• mental image of future

• guides toward where organization is headed

• provides motivation, inspiration, and focus → gives meaning and purpose

• keeps “end result” in leader’s mind

Primary function of meeting

contribute to efficient operation of organization

What is key to a successful meeting?

contribution and participation of each member

Purpose of performance appraisals

• documentation

• development

• strategic

• NOT discipline

Appraisal methods

• judgement-based (most common)

• objective based

• behavior based

Best time to address disciplinary or corrective action

immediately following an event

How do leadership and management differ?

the way people are motivated to work and follow

Leader responsibility

setting vision, values, direction, and results of an organization

Manager responsibility

overall accountability for a department, section, or organization; execution

Supervisor responsibility

seeing that daily work gets done efficiently, but do not have overall accountability for the entire operation

Key concepts of leadership

• influence, inspiration, motivation, growth, vision

• setting up new goals, vision, or planning new strategies

Key concepts of management

• position, procedure, adherence, analysis

• controlling the group and organizing it to achieve pre-set goals/objectives

Organizational Justice

• decision fairness

• information sharing

• outcome concern

Emotional Intelligence: Personal Competence

• self awareness

• self management

Emotional Intelligence: Social competence

• social awareness

• relationship management

Pharmacy informatics

• scientific field that focuses on medication-related data and knowledge within the continuum of healthcare systems - including its acquisition, storage, analysis, use and dissemination in the delivery of optimal medication-related patient care and health outcomes

• use and integration of data, info, knowledge, tech, and automation in the med use process for the purpose of improving health outcomes

Major driver for informatics adoption in healthcare

HITECH act

Steps of MMP with most errors

• prescribing

• administering

PIMS

• pharmacy information management system

• backbone of medication use process technologies

• ideally integrated with other systems

Limitations to CPOE

• alert fatigue

• over-reliance on CPOE

• selection of incorrect product

Barcoding can be used in healthcare to

• package/repackage unit dose meds

• automation

• patient-specific data

• improve safety at point of care

• reduce med errors

• improve billing accuracy

• can be used for storage, dispensing/delivery, administration

ADC

• automatic dispensing cabinets

• can maintain inventory and audit trails

• allow override functions

• may include bar coding

Smart pumps

• tools used to ensure parenteral meds are given safely to patients

• contains drug libraries with dose limits, clinical alerts, soft/hard limits

• may run several lines with pump

• may integrate with eMAR

EMR

• electronic medical record

• health info on individual created and managed WITHIN ONE healthcare org

EHR

• electronic health record

• health info on individual created and managed ACROSS MORE THAN ONE health org

PHR

• personal health record

• health data/info related to the care of a patient MAINTAINED BY PATIENT

Structured data

• allows for data retrieval/mining but can be cumbersome/frigid

• ex. diagnosis, medications

Free text data

• does not allow for easy data retrieval

• more freedom of documentation for provider

• ex. chief complaint, care plan

Pharmacy practice is comprised of

• pharmacy operations

• administration services

• clinical services

Medication Profile

• the primary record that pharmacists use to document patient medications

• used during order transcription or verification of the MMP

340b drug pricing program

• covered entities can save 25-50% savings

• only applicable to meds administered in an OUTPATIENT covered entity → ambulatory clinics, surgery, emergency center, dialysis unit, diagnostic imaging/radiology

Formulary Management Factors

1. Efficacy

2. Safety

3. Cost (tie breaker)

Organization that requires drug use evaluations

The Joint Commission

Parts to prescribing

1. decision → based on result of assessment of patient issue

2. informing → other members of care team of decision by legal order (manual or electronic)