Provider and Member Education in Managed Care Pharmacy Presentation Developed for the Academy of Managed Care Pharmacy Updated: February 2015

Objectives Describe strategies used in provider and member education related to managed care pharmacy Discuss important considerations in education Describe the benefits and role of the pharmacist in provider and member education programs

Provider Education Goals Enhance knowledge Promote best practices Change behavior & culture Prospective programs – Provide information before medical decisions are made. Concurrent programs – Provide information at the time a therapy is prescribed. Retrospective programs – Provide information after medical interventions have already been made.

Motivating Factors for Providers Improve quality of care Increase positive outcomes Reduce adverse events Avoid organizational penalties Maintain prestige among colleagues Respond to patient demands Increase potential revenue Providers often have different motivators for focusing on quality initiatives – while some motivating factors are clinically driven, and focused on improving care, new initiatives focus on incentivizing providers to improve performance linked to increased health-plan reimbursements or ‘pay for performance’. The Patient Protection and Affordability Act (PPACA) of 2010 has increased the focus on improving quality through evolving physician reimbursement methods (http://www.heritage.org/research/reports/2013/11/what-obamacares-pay-for-performance-programs-mean-for-health-care-quality).

Provider Education Types Content Newsletters Formularies Seminars Web-based tools Academic detailing Report cards (utilization audits) Letter campaigns Content Administrative policies updates New products/pipeline agents New treatment guidelines or protocols Results from utilization audits Patient-specific utilization patterns and history Newsletters, formularies, letter campaigns and report cards are written educational programs. Formularies are provided to influence the prescribing of formulary drug products, which are clinically appropriate and cost-effective. Seminars and academic detailing are done in-person, but may also include written materials. Utilization audits provide physicians with their prescribing patterns and compare their performance to their peers.

Member Education Goals Improve health and preventative health behaviors Increase awareness of benefit and cost structure Enhance member satisfaction Member education empowers members and allows them to take on a more responsible, active role in their health care. Through education, members will be able to make informed health care decisions and reduce costs by taking better care of themselves.

Motivating Factors for Members Decreased out of pocket costs Self care education Empowerment in maintenance of personal health Realization of disease control Support systems Incentives for self care

Types of Member Education Mailings & phone calls Seminars or individual appointments MTM programs Disease management programs Pay-for performance incentives Content Drug information (benefits of therapy, adverse events, formulary status, etc) Preventative health behaviors Tools for medication adherence Cost savings tips Letters are the most benign type of program. This can be targeted to a specific disease state or general to a book of business or zip code. The mailings can also include coupons, in some cases. Services that are administered through a nurse, pharmacist, or other health care provider are more costly, but have a greater impact. Through direct contact with a clinician, members receive individualized care and feel important. Disease state management programs vary in complexity from basic (letter campaigns) to enhanced (which may be comprised of letters, more detailed pamphlets, phone contact, on-site seminars). Compliance and formulary/copayment education programs are usually implemented via mailings.

Important Considerations Plan Who is your audience for education initiative? What are your education/intervention goals? Who are your stakeholders and what is meaningful to them? Do Perform outreach/education/intervention Check Engage stakeholders to determine what was meaningful? What did you learn during the intervention/education that would make your outreach/education more meaningful? Adjust Determine what changes need to be made in education approach Implement changes and repeat cycle of education continuum

Additional Considerations Health literacy Format Content Focus groups Gather input from audiences through surveys or discussions Incorporate feedback to make programs more meaningful Format - includes layout, design, and graphics Content- Is the material written at an appropriate level for the audience? (e.g., 6th grade reading level for members) Focus groups – engaging patients/members to find out what interventions are most meaningful to the target audience. Engaging your stakeholders often results in a more meaningful patient education intervention.

Pharmacist Role in Education Types Mailings & phone calls Seminars or individual patient and provider appointments MTM programs Disease management programs Provider detailing Drug Use Evaluations Case Management Team member Content Drug information expertise Preventative health education Medication Adherence tools Cost savings tips and formulary alternative recommendations Quality Initiative implementation Letters are the most benign type of program. This can be targeted to a specific disease state or general to a book of business or zip code. The mailings can also include coupons, in some cases. Services that are administered through a nurse, pharmacist, or other health care provider are more costly, but have a greater impact. Through direct contact with a clinician, members receive individualized care and feel important. Disease state management programs vary in complexity from basic (letter campaigns) to enhanced (which may be comprised of letters, more detailed pamphlets, phone contact, on-site seminars). Compliance and formulary/copayment education programs are usually implemented via mailings. MTM programs are a Medicare required intervention that has varying levels of success based on levels of member engagement.

Education Role of a Pharmacist Pharmacists are accessible Patients trust information provided Providers value input from a member of the healthcare team (i.e. medical home)

Summary Provider and member education enhances knowledge and changes behavior Educational programs help maintain high quality of care Educational programs help reduce overall health care costs

Thank you to AMCP member Kat Wolf for updating this presentation for 2015