Pharmacy Provider Meeting March 15, 2017 Chris Chan, Pharm.D. Sr. Director Pharmaceutical Services Inland Empire Health Plan

Agenda P4P Milestones P4P Program Results Outstanding Pharmacy/Pharmacy of the Year Award IEHP Pharmacy Home Program Stat 2018 P4P Other Pharmacy Communications

PDC Diabetes 16

PDC Statin 16

PDC RAS 16

High Risk Medication (HRM)

CMC SUD 2016

Opioid High Dose

Opioid Multiple Provider

Opioid High Dose Multiple Provider

Antipsychotic Use In Persons with Dementia - Community

P4P Program Avg Star Ratings

2016 2nd P4P Period Program Results Apr 16-Sept 16 Payment * 407 Pharmacies * 87 Unique Pharmacies * $2,842,733 total amount awarded * Highest single store payment: $37,124

P4P Program Results Star Rating Comparison Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 12 21 30 34 27 23 25 9 8 10 1 533 19 15 11 13 18 51 28 14 4 6 2 109 89 79 43 105 124 327 192 95 135 122 350 297 3 529 261 267 229 291 281 284 888 574 277 295 272 226 536 123 126 186 153 163 148 456 334 176 185 218 66 75 5 342 78 84 94 70 71 210 142 Total Rx 2061 591 601 597 659 665 666 1932 1270 641 638 639 636 624

Pharmacists’ Letter Review P4P clinical resources and earn CE credits!!! http://www.p4pprogramresources.com/

USC APP Course

Congratulations to the Outstanding Pharmacies P4P Performance Awards Congratulations to the Outstanding Pharmacies

Outstanding in Service & Performance WALGREENS PHARMACY 11989 6126 9486 7577

Outstanding in Service & Performance CVS Pharmacy 9849 9648 9654 8436 5958

Outstanding in Service & Performance Inland Pharmacy

P4P Performance Award Pharmacy of the Year

Pharmacy of the Year North Rialto Drug

Pharmacy Home

IEHP Pharmacy Home Program Outcome-based MTM 700+ Active Patients Budget: $5M Annually

IEHP Outcome-Based MTM Program Outcome Measurement Disease State Inclusion Criteria Outcome measurement Outcome Target Documentation Requirement Service Payment (tentative) Diabetes A1C>9 A1C at end of 12 months; number of A1C labs A1C<8 ; 2 labs in last 12 months A1C lab and medication interventions/ education; must have 2 A1c labs in last 12 months $20 per MTM consultation, maximum 1 per month (max $240 per patient) Measure number of care gaps addressed HTN Blood Pressure> 140/90 BP at end of 12 months BP <140/90 BP trends and the last recording Hyperlipidemia LDL >130 LDL at end of 12 months LDL<100 LDL and interventions/education Asthma/COPD Uncontrolled asthma- lack of controllers, lower than 80% adherence rate, or high ratio of short-acting inhaler Rx data Adherence Measure (controller) and number of albuterol fills Claims data

Pharmacy Home

CMR Cases Created vs Cases Completed

Program Activity: CMR Completion Rate IEHP Pharmacy Home Program Data Period: 07/06/2016 Through 02/28/2017 Definitions of Metrics: Section 1: Column Chart CMR Completion Rate: [the patients with a served CMR] / [the number of patient with a CMR]. The numerator groups cases/patients served to date by their completion date. The denominator groups cases/patients created to date by their creation date. * CMR Completion Rate = [# Patients with a Served CMR to date] / [# Patients with CMR to date] 39.39.1

CMR Cases Created vs Cases Completed Jul Aug Sept Oct Nov Dec Jan Feb To-Date Cases Created 2189 3611 5 1 5806 Cases Completed 118 421 233 173 11 1377 Served 92 268 124 121 735 Patient Decline 42 22 15 103 Pharmacist Decline 21 111 275 37 9 539 Admin Closed 1290 2108 134 104 120 4429 Open Cases Care Gaps Generated 1646 2369 74 4293 Adherence 444 801 10 6 1347 Omission 1202 1568 64 2946 Safety Alerts Generated 851 1046 1239 1900 Patient Offer Letters Sent 2372

CMR Case Completion Trends IEHP Pharmacy Home Program Data Period: 07/06/2016 Through 02/28/2017 Definitions of Metrics: Section 1: Pie Chart Total Cases Served At Retail Face to Face: cases served where service is describe as face to face. These are cumulative counts from the beginning of the calendar year. Total Cases Served At Retail Telephonic: cases served where service is describe as over the phone. These are cumulative counts from the beginning of the calendar year. Section 2: Stacked Column Chart and Table ** Date Range of Chart: Chart shows last 12 months of data for cross-over year programs and full calendar year for non-cross-over year programs. Declined - Call Center: Cumulative number of cases declined at Call Center from the start of the calendar year through the end of the month. Declined - Retail: Cumulative number of cases declined at Retail from the start of the calendar year through the end of the month. Served - Call Center: Cumulative number of cases served at Call Center from the start of the calendar year through the end of the month. Served - Retail: Cumulative number of cases served at Retail from the start of the calendar year through the end of the month. Counts shown above each stack column: Cumulative number of completed cases from the start of the calendar year through the end of the month. Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Served – Retail 92 360 484 613 734 735 Served - Call Center Declined – Retail 26 179 476 580 632 642 Declined - Call Center 72.5.1

CMR Cases Created vs Cases Completed TMR Jul Aug Sept Oct Nov Dec Jan Feb To Date Cases Created 12 44 67 117 209 195 96 857 Cases Completed 2 17 28 51 256 93 63 710

CMR Cases Created vs Cases Completed

Program Results: Safety Alerts (Red Flags) Resolution Summary IEHP Pharmacy Home Program Data Period: 07/06/2016 Through 02/28/2017 Pharmacist Documentation of Served Cases Served Cases with Safety Alerts 278 Total Served Safety Alerts 469 Average # Safety Alerts Per Case 1.7 % Resolved: Change in Therapy 6.4% % Resolved: Status Pending 50.1% % Resolved: No Change in Therapy 43.5% Claims Based Results # Drugs Eliminated = 0 Definitions of Metrics: Section 1: Table (Upper Left) Served Cases with Safety Alerts: The number of served cases with 1 or more pharmacist completed safety alerts. Total Safety Alerts: The total number of pharmacist completed safety alerts across all served cases. % Resolved – Change in Therapy: the percentage of cases resolved with the following resolutions: Discontinuation authorized by prescriber Strength/form/SIG change authorized by prescriber Substitution authorized by prescriber and patient % Resolved – Status Pending: the percentage of cases resolved with the following resolutions: Educated patient Prescriber to review/monitor % Resolved – No Change in Therapy: the percentage of cases resolved with the following resolutions: Not an issue for pharmacist No longer applicable Not an issue for prescriber Recommendation declined by prescriber Section 2: Column Chart (Upper Right) Resolution Summary (% of Served Cases): Resolutions of served of cases as a percentage of all served cases with Safety Alerts. Top 6 resolutions are shown. Section 3: Pie Chart (Lower Left) Patients That Have Eliminated At Least One Drug (based on Rx claims data): [# of Patients who eliminate at least one drug associated with a safety alert] / [# of Patients with 1 or more safety alert] Patients are deemed to have eliminated a drug if there are no more refills of the drug 42 days after the current fill’s days of supply is exhausted. Patients That Have Yet to Eliminate One Drug: 1 – [Patients That Have Eliminated At Least One Drug] Section 4: Column Chart (Lower Right) ** Date Range of Chart: Chart shows last 12 months of data for cross-over year programs and full calendar year for non-cross-over year programs. Served Patients by Month vs. Patients with Drug Eliminations: Served Patients are those patients who have a case with a safety alert that has been served. Patients with Drug Eliminations are those patients who have a case with a safety alert that has been served and Rx claims data indicates that a drug associated with a safety alert has been eliminated. The data is aggregated into months by the date that the patient was served. * Drugs are deemed eliminated when they have not been re-filled 42 days after the current active fill’s supply is exhausted. 53.40.1

Total Served Safety Alerts Program Results: Safety Alerts (Red Flags) Resolution Summary IEHP Pharmacy Home Program Data Period: 07/06/2016 Through 02/28/2017 Total Served Safety Alerts # Drugs Eliminated 469 Definitions of Metrics: Section 1: Table Served Cases with Safety Alerts: The number of served cases with 1 or more pharmacist completed safety alerts. Total Safety Alerts: The total number of pharmacist completed safety alerts across all served cases. Average # Safety Alerts Per Case: [# of alerts on served cases] / [# of served cases] % Resolved – Change in Therapy: the percentage of cases resolved with the following resolutions: Discontinuation authorized by prescriber Strength/form/SIG change authorized by prescriber Substitution authorized by prescriber and patient % Resolved – Status Pending: the percentage of cases resolved with the following resolutions: Educated patient Prescriber to review/monitor % Resolved – No Change in Therapy: the percentage of cases resolved with the following resolutions: No longer applicable Not an issue for pharmacist Not an issue for prescriber Recommendation declined by prescriber Section 2: Column Chart Alerts Generated vs. Drugs Eliminated: Alerts Generated counts the number of alerts (there can be more than one per case) by type to date since the start of the program year. Drugs Eliminated counts the number of drugs associated with the alerts that have been eliminated to date since the start of the program year. Patients are deemed to have eliminated a drug if there are no more refills of the drug 42 days after the current fill’s days of supply is exhausted. * Drug are deemed eliminated when they have not been re-filled 42 days after the current active fill’s supply is exhausted. 54.41.1

Program Results: Adherence Care Gaps Summary IEHP Pharmacy Home Program Data Period: 07/06/2016 Through 02/28/2017 Pharmacist Documentation of Served Cases Served Cases with Adherence Alerts 263 Total Adherence Alerts 345 Adherence Alerts Validated As True 224 % of Adherence Alerts Validated As True 64.9% Claims Based Results Median Days to Adherence = 33 Definitions of Metrics: Section 1: Table (Upper Left) Served Cases with Adherence Alerts: The number of served cases with 1 or more pharmacist completed adherence alerts. Total Adherence Alerts: The total number of pharmacist completed adherence alerts across all served cases. Adherence Alerts Validated as True: The total number of pharmacist completed adherence alerts marked as "true" alerts by pharmacists. % Adherence Alerts Validated as True: [Adherence Alerts Validated as True] ÷ [Total Adherence Alerts] Median Days to Adherence: Among patients that achieved 80% PDC, the median number of days after the case served date required to achieve 80% PDC on the medication that generated a true adherence alert (or the first medication if there are multiple medications that generated alerts). Section 2: Column Chart (Upper Right) Interventions Taken (% of True Adherence Gaps): The percentage of each type of intervention indicated by pharmacists on TRUE adherence alerts. Note: "Patient will consult with prescriber" is an aggregate of all reasons beginning with "Patient will consult with the prescriber..." These are: Patient Consult Prescriber For Alternative Drug Patient Consult Prescriber For Regimen Modification Patient Consult Prescriber For Renew Prescription Section 3: Pie Chart (Lower Left) Members Becoming Adherent to at Least One Drug: Among served patients with True Care Gaps, [# of Patients achieving 80%+ PDC on 1 or more drugs that generated a true adherence alert] / [# of Patients with 1 or more true adherence alert] Members Not Yet Becoming Adherent to at least 1 Drug: 1 - [Members Becoming Adherent to at Least One Drug] Section 4: Column Chart (Lower Right) Days Post Session in Which Adherence Was Achieved on at least One Drug: Among patients that achieved 80% PDC, the minimum # of days after the case served date required to achieve 80% PDC on one medication that generated a true adherence alert * Adherence is achieved when a patient has 80% or greater PDC on at least one of their target medications for which they were identified as non-adherent. 56.18.1

Program Results: Omission Care Gaps Summary IEHP Pharmacy Home Program Data Period: 07/06/2016 Through 02/28/2017 Pharmacist Documentation of Served Cases Served Cases with Omission Alerts 603 Total Omission Alerts 767 Omission Alerts Validated As True 523 % of Omission Alerts Validated As True 68.2% Claims Based Results Median Days to Closing Omission = 19 Definitions of Metrics: Section 1: Table (Upper Left) Served Cases with Omission Alerts: The number of served cases with 1 or more pharmacist completed Omission alerts. Total Omission Alerts: The total number of pharmacist completed Omission alerts across all served cases. Omission Alerts Validated as True: The total number of pharmacist completed Omission alerts marked as "true" alerts by pharmacists. True Alerts as % of Total Alerts: [Omission Alerts Validated as True] ÷ [Total Omission Alerts] Median Days to Closing Omission: Among patients that had at least 1 fill for at least one target medication in the period, the median number of days after the case served date patients filled their first target drug. Section 2: Column Chart (Upper Right) Interventions Taken (% of True Omission Gaps): The percentage of each type of intervention indicated by pharmacists on Omission alerts determined to be valid. Note: "Patient will consult with prescriber" is an aggregate of all reasons beginning with " Patient will consult with the prescriber..." These are: Patient Consult Prescriber For Alternative Drug Patient Consult Prescriber For New Prescription Patient Consult Prescriber For Regimen Modification Section 3: Pie Chart (Lower Left) Members Closing at Least One Omission Gap: Among served patients with True Omission Care Gaps, [# of Patients filling 1 or more medicines that generated a true omission alert] / [# of Patients with 1 or more true Omission alert] Members Not Yet Closing Omission Gap: 1 - [Members Closing at Least One Omission Gap] Section 4: Column Chart (Lower Right) Days Post Session in Which Patient Closed Omission Gap on at least One Drug: For each patient closing at least one care gap, the # of days after their case served date until their first fill of the target drug that generated a true omission alert. In case of multiple target meds for a patient, use the lowest # of days. 65.21.1

P4P Concept Dispensing P4P & Pharmacy Home Clinical Services

Program Goals P4P Increase awareness around Pharmacy Quality Management Provide “transition” funding for Pharmacy to “transform” their practice Transformation Workflow efficiency Maximize the use of technology to handle Rx volume and enhance compliance Pharmacy Home Build Clinical model to handle outcome-based MTM or other clinical services

2018 Focusing on Transition Time: Things we are doing as a pharmacist More Specific Guidance Value-based Clinical Services- MTM Prospective and Retrospective DUR Drug dispensing Services

Draft P4P Changes (2018) Current P4P and Pharmacy Home (Ends in Sep 17) New DUR edits (Starts in Apr 17) Tier 1 Display Tier 2 HPPN P4P Extension (Oct-Dec17) Tier 3 POC MTM

Changes At-a-glance Consolidate P4P and Pharmacy Home Programs Current P4P measures will be used as “display” for monitoring purposes Current P4P $ will shift toward Tier 2 HPPN New Tier 2 P4P payment For HPPN based on DUR (appropriate use of medication) Tier 3 POC MTM Pharmacy based on SB493 (APP) provision

Tier 1- IEHP Pharmacy Network Participants: All Pharmacies Qualifier: Meet Program Eligibility Criteria Credentialing Application: Optional Tier 1 is a Qualifier Stage for Tier 2, all Pharmacies should monitor and improve their performance over all measurements. Display Measurements: Adherence score – Diabetes, HTN, and Statins Opioid drug use Asthma # of paid claims with DUR alerts by pharmacy Customer service score

Tier 2- High Performing Pharmacy Network (HPPN) Provision of basic pharmacy services at high performance level (i.e. adherence, appropriate use of drugs) Ensure proper oversight of all Drug Utilization Review (DUR) alerts P4P dollars distributed based on TBD methodology Participants: Pharmacies meeting the qualifiers listed below Qualifiers: Qualifier composite score-Star rating >4 for 6 months; if score is <4 stars, pharmacy may be qualified by offering enhanced services from the IEHP credentialing list Credentialing: Must complete IEHP Pharmacy Credentialing Application and meet Tier 2 Network requirement Measurement: Percentage (%) of total paid claims with Safety Drug Utilization Review (DUR) alerts Tier 2 services: Provide higher level of pharmacy services by ensuring proper Drug Utilization Review (DUR) alerts are resolved. Measurement: DUR %

Tier 3- Point-of-care (POC) MTM Pharmacy Participants: Pharmacies meeting the qualifiers listed below Qualifiers: Qualifier composite score-Star rating>4 and have existing collaborative agreement with IEHP contracted physicians Credentialing: Must complete IEHP Pharmacy Credentialing Application and meet Tier 3 Network requirement Tier 3 services: Provide MTM services for patients covered under the collaborative agreements; MTM services will focus on chronic conditions and monitored through outcomes

Discussion DUR edits Vaccine Network 2017 Pharmacy Strategic Program Academic Detailing Pharmacy Communications- Email Address Credentialing Info Upcoming Total Pain Care Program

Questions?