PHARMACY 2012: ADDING VALUE TO THE HEALTHCARE SYSTEM MTM Organization 2

MICHAEL WOLNERMAN, RPh, CCIM Dick Pharmacy, Des Moines, Iowa Osco Drug, Chicago, Illinois (Commercial Real Estate Gig) Urbandale Pharmacy, Urbandale, IA Franklin Pharmacy, Des Moines, IA Your-Med LTC, Des Moines, IA Walgreens, Des Moines, IA Education: Drake University

DR. MICHAEL CASE HAUB, PHARMD Hy-Vee Pharmacy, WDM, Cedar Rapids CVS Pharmacy, New York, NY Iowa Health System Iowa Methodist Hospital Department of Clinical Research Penn Medical Pharmacy Iowa Medicaid PA Department Adjunct Faculty: Drake & University of Iowa Education: Drake University PharmD BC-ADM (Board Certified- Advanced Diabetes Mgmt)

Outcomes Company Background Who: Founded by Iowa pharmacists What: Medication Therapy Management Services (MTMS) Outcomes MTM Program Outcomes Targeted Intervention Program (TIP®) When: January 1999 Where: Des Moines, IA Why: Deliver a scalable, Face-to-Face MTM program that improves quality of care and lowers health care costs. MTM Organization 5

MTM Opportunities Expand Exponentially Outcomes Program Progression Researching pharmacist-delivered MTM services and the effects on total health care costs Congresses passes Medicare Modernization Act (MMA) 2010 Call Letter Released MTM Opportunities Expand Exponentially 15K 1 million 2.5 million 5.5 million 1990s 1999 2003 2006 2009 2010 2011 200K 1.5 million 3.7 million Outcomes Pharmaceutical Health Care ® Established Medicare Part D Implementation Significant MTM Changes Required

Client Types Payors Health Plans, Employers, Medicaid PBMs/Claims Processors Outcomes Management Options Fully outsourced – Network delivery Combination Client’s Internal RPhs + Network Geographic Distribution State, Regional, National Size One to 1.5 million covered lives

Types of Pharmacists: BS Pharmacy or Pharm D Retail/Pharmacy Sales Hospital Mail Order Clinical Nuclear LTC/Chemotherapy

Pharmacist/Patient/Prescriber Role of Pharmacist has not changed, it has expanded. Role of the Patient has not changed, well, maybe??!! Prescribers HAVE changed. Pharmacist Complete the Triangle

Jerry Seinfeld Episode

How Does A Pharmacy Make Money? Groomed for the Pharmacy of Today: Inventory Management Prescription Volume Customer Service POS: Point of Sale Vaccines Locale of Pharmacy

Role Of A Pharmacist In Today’s Setting MTM Organization 13

The Role: Transition from dispensing model Fee for service is “dead”, pay for performance is new model Medication Therapy Experts Change in physician centric model

How Does this Affect Plans: HEDIS measures Star Ratings Reimbursement Bonuses Patient recruitment Pharmacist can positively effect vast majority of these measures

Services Provided: Medication Therapy Management Disease state management Transition of care/med reconciliation Medical Home Model

How Is There Enough Time In The Day? Current model= there isn’t time! Current compensation paradigm= not self sustaining Pharmacist filling more RXs Efficiency/workflow

Prioritization Of Responsibilities Utilization of Technology Delegation certified technicians Less focus technical functions, increase on cognitive services Similar to physician clinic model

Medication Therapy Management In Today’s Pharmacy MTM Organization 19

What is Medication Therapy Management (MTM)? Leveraging Pharmacists to address therapy gaps and non-adherence, enhance quality and manage costs.

Real World Patient Example: “Gertrude” Diabetes, elderly, HTN No ACEI/ARB Recommendation to physician “SHUT UP”; “MAKE ME” Dialysis within 6 months Documentation of recommendation Out of court settlement Could have been avoided!!

How Does An Outcomes MTM Program Work? National footprint 50 states, Washington D.C. and Puerto Rico Manages 60,000 Pharmacists through “MTM Centers”

Outcomes MTM Covered Services

Targeted Intervention Program (TIP) Rx/Medical Data Eligibility Data TIP Engine (Clinical Rules) TIP Quality Assurance TIPs Uploaded Online TIPs Mailed to Pharmacies

Online Claim Documentation Documented Savings to the Client Push AND Pull Claims Online Claim Documentation Documented Savings to the Client Client Outcomes Pharmacies $ $

Typical MTM Program Results MTM Organization 26

The Program: 60,000 Commercial Lives in Iowa (2010 Data) $4.2M in saved or avoided costs documented by community pharmacists $1.2M of those savings are accounted for in drug product costs alone $2.44 ROI on prescription drug spend alone 528 Pharmacies participated finding on average $783 in savings per patient served

Questions? Michael Wolnerman, RPh, CCIM Dr. Mike Case Haub, RPh, PHARM D