Using a Novel Two-Pronged Pharmacy Model in a High-Risk Care Management Program to Address Medication Reconciliation and Access Kakoza RM 1, 2, De Leon C 1, McLaughlin K 1, Lamey J 1, Cunningham RJ 1,2 1 Brigham and Women’s Physicians Organization, 2 Harvard Medical School Many primary care-based complex care management teams are led by nurses who manage all aspects patient care across the care continuum. Medication management is a key component of care coordination and quality outcomes. This is especially true during transitions of care, where medication discrepancies are frequent, carry significant potential for harm and are often preventable. And while previous studies have shown that pharmacist involvement in care transitions improves discharge quality and re-hospitalization rates and decreases adverse drug events; how to best integrate and utilize pharmacist and/or pharmacy technicians in complex care management is less clear. OBJECTIVES DESCRIPTION OF INTERVENTION Improve the quality of medication reconciliation during care transitions Facilitate medication adherence by identifying high out-of-pocket medication expenses and providing more affordable alternatives. FINDINGS TO DATE Incorporating a clinical pharmacist and pharmacy technician on a multidisciplinary care management team facilitates comprehensive medication reconciliation and counseling at critical transitions of care while ensuring that financial barriers to medication adherence are identified and alternative options offered. LESSONS LEARNED Incorporating a clinical pharmacist and pharmacy technician on a multidisciplinary care management team facilitates comprehensive medication reconciliation and counseling at critical transitions of care while ensuring that financial barriers to medication adherence are identified and alternative options offered. Patient admitted to BWH Pharm Tech collects refill history PharmD reviews medical record and reconciles meds Assesses of medication adherence/barriers to access Contacts responding clinician re: discrepancies Documents intervention(s) Anticipates and resolves pharmacy access issues with Pharm Tech Provides discharge counseling and med rec Handoff to RNCC at discharge RN identifies medication access issue Refers case to Pharmacy Tech Pharmacy Tech reviews for cost savings opportunities or med access issues Case sent to PharmD PRN for clinical review Pharmacy Tech resolves issue and/or sends recommendation to RN RNCC shares recommendation with PCP STATEMENT OF PROBLEM The Integrated Care Management Program (iCMP) is based at Brigham and Women’s Hospital. iCMP is a primary care embedded, longitudinal, nurse-led multidisciplinary care management program that was established at BWH as part of a Centers for Medicare and Medicaid Services demonstration in 2009 to meet the needs of high risk, medically complex patients. Patient demographics: 61% female Mean age 71 (range ) 65% Medicare and 33% commercial insurance Average 17 home medications In our program, nurses spent significant time on post-discharge medication reconciliation and medication access issues related to cost. This work took away from other important clinical coordination of care activities. To address both of these pharmacy-related needs, we developed a novel two-pronged approach, incorporating both a pharmacist and a pharmacy technician into the care management team: Clinical pharmacist reconciles preadmission medication lists (PAML) and counsels during inpatient admissions and discharges Pharmacy technician proactively identifies high-cost medications and reviews pharmacy plans to identify cost- savings MEASURES OF SUCCESS Identify and resolve medication discrepancies on admission and discharge for patients admitted to the medicine or cardiology services. Identify prescription cost-savings to improve adherence.

INPATIENT WORKFLOW OUTPATIENT WORKFLOW Patient admitted to BWH Pharm Tech collects refill history PharmD reviews medical record and reconciles meds Assesses of medication adherence/barriers to access Contacts responding clinician re: discrepancies Documents intervention(s) Anticipates and resolves pharmacy access issues with Pharm Tech Provides discharge counseling and med rec Handoff to RN at discharge RN identifies medication access issue Refers case to Pharmacy Tech Pharmacy Tech reviews for cost savings opportunities or med access issues Case sent to PharmD PRN for clinical review Pharmacy Tech resolves issue and/or sends recommendation to RN RNCC shares recommendation with PCP Using a Novel Two-Pronged Pharmacy Model in a High-Risk Care Management Program to Address Medication Reconciliation and Access Kakoza RM 1, 2, De Leon C 1, McLaughlin K 1, Lamey, J 1 Cunningham RJ 1,2 1 Brigham and Women’s Physicians Organization, 2 Harvard Medical School OUTPATIENT WORKFLOW