1. Engaging the C-suite to Advance Pharmacy Practice Providing quality patient care through progressive pharmacy practice Safety, Quality, and the Pharmacy Practice Model Initiative: Aligning for Success Erick Sokn, Pharm.D., M.S., BCPS Manager, Transitions of Care/ED Cleveland Clinic

2. Objectives Provide update since original C Suite series Describe metrics and a process that can be used to measure the quality of change that occurred and ensure that a positive change has taken place Describe how organizations have implemented safety and quality principles in daily practice

3. Projected Impact of Healthcare Reform Affordable Care Act –Increase Access –Improve Quality –Decrease Cost

4. Early Measures of Interest CMS Readmission Reduction CMS Hospital Value-Based Purchasing –HCAHPS –Clinical processes of care –Outcome measures –Efficiency CMS=Centers for Medicare & Medicaid Services HCAHPS=Hospital Consumer Assessment of Healthcare Providers and Systems Hospital Value-Based Purchasing. Centers for Medicare and Medicaid Services. http://www.cms.gov. Accessed 2014 Oct 20.http://www.cms.gov Readmissions Reduction Program. Centers for Medicare and Medicaid Services. http://www.cms.gov. Accessed 2014 Oct 20.http://www.cms.gov

5. Readmissions Impact from CHF, AMI, pneumonia: –Year 1 – 2,217 hospitals penalized for ~$280 million –Year 2 – 2,225 hospitals penalized for ~$227 million –Year 3 – 2,610 hospitals penalized for ~$428 million October 2014, added total hip/knee and COPD

6. Value-Based Purchasing Reduction increases by 0.25% annually, to maximum of 2% in FY17

7. HCAHPS Medication Domain Questions Purpose of new medications explained Side effects described Medication Communication –Composite score based on the percent of patients responding ‘Always’ NEW Transitions of Care domain –Purpose for taking medications at discharge

8. PPMI Alignment B11 and B12 – Prioritize pharmacist interventions (high risk patients) B20 – Medication continuity of care Advancing role of the pharmacy technician Expanded ownership and accountability for quality and access Am J Health Syst Pharm. 2011; 68: 1148-52.

9. Ongoing Efforts at Cleveland Clinic Initiatives align with goals and metrics from Affordable Care Act –Patient experience / HCAHPS –Access to care –Readmissions What’s next?

10. Targeted Counseling

11. For home-going patients: Review discharge prescriptions Ensure clear medication list and instructions for discharge Use electronic health record to prioritize work Med Rec Target: Discrepancies For home-going patients: Education on medication purpose and side effects Reinforce after-hospital medication-related follow up plans Use electronic health record to prioritize work Discharge Counseling Target: HCAHPS For all neurology patients, educate on: Anticonvulsants Antidepressants Antipsychotics Use electronic health record to identify inpatient orders First Dose Teaching Target: HCAHPS

12. Counseling 4-6 patients per day - -~66% capture rate of home discharges Impact - HCAHPS Highest-ever 98 th percentile

13. Bedside Delivery of Medications Bedside delivery option for discharge prescriptions –Program targets discharging patients to improve access to medications and increase compliance –Assures patient has tools necessary to continue medication therapy plan after discharge

14. Bedside Delivery Win-Win Large increases in revenue for pharmacy department –13% return on investment Large patient satisfier –98% would recommend

15. Pharmacy Heart Failure Education Patients with actively managed heart failure (HF) –Multi-disciplinary discharge checklist –Pharmacy education as required element Hard stop in electronic health record if pharmacist education not documented

16. What’s Next? HCAHPS remains a high focus of the enterprise –COPD education –Targeted expansion to high-risk patients using complexity score Medication reconciliation Patient counseling Messaging: No quick fix – follow the data, adjust the focus

17. What’s Next? Patient safety indicators Readmissions Increasing emphasis on hospital acquired infections –Pharmacist role?

18. Questions???