Partnering to Deliver Solutions: A forward thinking approach in addressing health disparities Date: April 5, 2016 Lily Higgins, MD – Market Chief Medical Officer, Keystone First Lavdena Orr, MD – Market Chief Medical Officer, AmeriHealth Caritas District of Columbia Heather Ruszin – President and CEO, Stellar Pharmacy Natashia Sanders – Regional Director, PerformRx
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Partnering to Deliver Solutions - PerformRx · 2016-04-13 · Partnering to Deliver Solutions: A forward thinking approach in addressing health disparities Date: April 5, 2016 Lily
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Partnering to Deliver Solutions: A forward thinking approach in addressing health disparities
Date: April 5, 2016
Lily Higgins, MD – Market Chief Medical Officer, Keystone First
Lavdena Orr, MD – Market Chief Medical Officer, AmeriHealth Caritas District of Columbia
Heather Ruszin – President and CEO, Stellar Pharmacy
Natashia Sanders – Regional Director, PerformRx
Table of Contents
• How Innovation Happens
• The B.E.S.T. Cabinet & Program Overview
• The B.E.S.T. Program in Pennsylvania
• The Care Now Cabinet – The Next Challenge & Solution
• Care Rewards Program
• Key Takeaways
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How Innovation Happens
1. Identify Need – A key business (Patient Care) need, challenge or
obstacle is recognized.
2. Identify Potential Solutions – Thought leaders brainstorm and identify
potential people, process and/or technology strategies and solutions.
3. Prioritize Patient Safety and Outcomes – Patient safety and improved
patient outcomes are prioritized as part of the solution development.
B.E.S.T Program Overview Providing Timely Care Directly to the Patient
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Physician Dispensing At Point of Service
Patient Therapy Starts Immediately
Patient leaves office with inhalers, spacers and masks
Refills of Medication and Supplies delivered to the patient’s home each month free of charge.
B.E.S.T Program Overview Results to Date
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-21.30%
-36.80%
17.20%
-40.00%
-30.00%
-20.00%
-10.00%
0.00%
10.00%
20.00%
Inpatient Admissions Inpatient Days Outpatient Visits
March 2013-March 2016 29 Sites in PA
5 Sites in DC
Total Members 7674
Total New Rx 18974
Total Refill Rx 5792
Total Fills 24766
2014 6-month Pre & Post Asthma Study of Participating Members
B.E.S.T.
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13
14
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Expansion to Family Planning program
Improvement of pre-conception health
Includes medications and devices-LARC
CARE NOW
Care Rewards Program Another Innovation in Fulfillment
• AmeriHealth Caritas DC has partnered with Stellar Rx to implement our Care Rewards gift card incentive program to improve results for several HEDIS measures
• $20 Walmart Gift Cards will be awarded to all member completing the following eligible exams or screenings
o Diabetic Exams and Screenings
o Adolescent Well Child Exams
o Post Partum Visits
• Other popular gift cards, e.g. Chipotle and DTLR, are being contemplated to further motivate specific age groups to complete the prioritized HEDIS and EPSDT measures
• Stellar Rx provides the following services to help make the program a success o Member eligibility verification
o Member phone call handling (includes fielding member calls and answering questions related to the program)
o Mail request processing (includes reviewing and tracking mailed member incentive requests)
o Validation of exam (includes outbound calls to providers to verify exam completion)
o Incentive fulfillment and tracking (includes mailing of gift cards to those members meeting the requirements and tracking the fulfilment of the member request)