CCM services include recording patient health information in the EHR, developing an electronic, accessible care plan encompassing all health issues, collaborating with external practitioners, providing access to care management services and managing transitions of care.

For practices and accountable care organizations (ACOs) with 500 Medicare beneficiaries enrolled in CCM services—this represents more than $200,000 of potential annual income while also impacting clinical outcomes.

But why have physicians hesitated to opt in? After all, most physicians are already providing abridged CCM services in the form of phone calls and care management outside of office appointments—but are not billing for them.

So what’s the issue?

Billing departments are tripping over red tape. The cumbersome reimbursement procedures weigh heavy—office infrastructure has to be developed, processes fortified and personnel hired and trained. Practices with outdated technology do not meet Medicare’s Electronic Health Record (EHR) requirements, therefore do not qualify for reimbursement.  

Research illustrates patients with chronic conditions benefit from CCM services; yet, CMS reports only 100,000 reimbursement requests for approximately 35 million eligible beneficiaries.

CCM Services have become a priority of the Center for Medicare and Medicaid Services (CMS) for good reason—approximately two of three Medicare beneficiaries have multiple chronic conditions, which consume the lion’s share of healthcare spending. Some examples of chronic conditions include alzheimer’s disease and related dementia, arthritis (osteoarthritis and rheumatoid) asthma, atrial fibrillation, autism spectrum disorders, cancer, cardiovascular disease, chronic obstructive pulmonary disease, depression, diabetes, hypertension, infectious diseases such as HIV/AIDS.  

Partnering with a third party administrator—such as PharmD Live®—

can improve patient outcomes, cut administration costs and drive revenue—and prevents the need to hire additional practice staff. Practice physicians simply explain the benefits of CCM services during the annual wellness appointment and provide patients the option of enrolling. Once enrolled, PharmD Live® creates customized care plans for each patient, provides 365/24/7 telephonic and virtual access to board-certified pharmacists, shares information securely with other providers and prepares billing reports for practices.

Some CCM services have an associated co-payment, which Medicare supplemental plans and Health Savings Accounts (HSAs) may cover.

The Medicare Access and CHIP Reauthorization Act (MACRA)—effective in 2019—presents a Merit-Based Incentive Payment System (MIPS) for Medicare Part B providers. A provider’s MIPS score—based on quality (30%), Resource Use (30%), Clinical Practice Improvement (15%), and Meaningful Use of Compliant EHR (25%)—will determine a provider’s Medicare reimbursement. MIPS score—ranging from 0 to 100—will determine whether the reimbursement is positive, negative or neutral.

PharmD Live®’s collaborative model improves patient outcomes, cuts costs, optimizes reimbursements, and drives practice revenue. To learn more about incorporating PharmD Live® solutions into your practice or accountable care organization, contact Ellery Plowman for a consultation.

The post The Triple Win: How CCM Benefits Patients, Practices And Bottom Lines appeared first on Pharmdlive.

Because complex chronic conditions, such as diabetes, require significant care between office visits—developing a comprehensive patient-centered care plan, care coordination, transitions of care management and increasing access to care via telehealth and 24/7/365 clinician availability are elements of CCM.   

PharmD Live®’s CCM services were designed to prevent acute care stays through effective management of the chronic condition. Here’s how PharmD Live®’s CCM services are implemented:  

A dedicated clinical PharmD Live® pharmacist collaborates with the physician to create a comprehensive care plan, using a patient-centric approach. Patient education and disease-state management plays a paramount role in care. The clinical pharmacist addresses the patient’s ongoing adherence to the care plan, ensures referrals are made to specialists for diabetes-related care (such as podiatrists for foot exams), identifies root cause of shifting bloodwork trends, addresses impact from social determinants of health and ensures diabetes supplies are stocked. Clinical pharmacists rely on PharmD Live®’s software, with an advanced clinical rules engine which ensures consistent, timely care and real time communication with practice electronic health records (EHR). PharmD Live®  pharmacists provides services virtually, telephonically or via home visit.

PharmD Live® tracks quality metrics and provides streamlined billing reports to practice administrators. PharmD Live®, a telehealth company committed to improving patient outcome and helping physicians earn quality bonus payments and avoid financial penalties, serves as a seamless extension of physician practices. To fortify your value-based care strategy, schedule a capabilities presentation with Ellery Plowman.

The post Leveraging Pharmacist-Led Chronic Care Management (CCM) Services To Decrease Acute Care Stays For Diabetic Patients appeared first on Pharmdlive.

The system is less equipped to provide care to people with long-term chronic conditions. 

The statistics are alarming.  These patients “...account for 81% of hospital admissions; 91% of all prescriptions filled; and 76% of all physician visits”

The “Silver Tsunami”, as the aging of Americans has been coined, refers to the 80 million Baby Boomers becoming eligible for Medicare within the next ten years. 

“Approximately 85 percent of older adults have at least one chronic health condition, and 60 percent have at least two chronic conditions, according to the Centers for Disease Control and Prevention (CDC).” 

This is an immediate problem, as the increase in chronic cases is already putting a strain on our healthcare system.

Such high rates of chronic conditions are a financial drain on Medicare. 

Because of the demographic shifts, primary care doctors would have been overwhelmed with appointments.

In 2011, the nation’s 76,000 pharmacists were activated to perform patient care and ease some of the crisis.   

In view of the escalating health challenges of the chronically ill, as well as spiking costs, Medicare was compelled to act.

Medicare set out to create a program to improve health, manage costs and address the realities of the aging Baby Boom.

In 2015, Medicare created Chronic Care Management (CCM) to incentivize physicians to provide additional services to patients with more than one chronic illness.

These services included additional communication, coordination of providers, monthly check-ins, and help with medication.

Patient engagement could be by phone, virtually via telehealth, the latter two, as attempts to improve efficiency.

Medicare set $40 billion aside for CCM claims, and physicians were instructed to bill CCM time under new CPT Codes (See Below).

Further defined, CCM is a Medicare program that provides extra attention to patients with two or more chronic conditions. 

Patients are typically elderly and are at high-risk for Adverse Drug Events (ADEs) and disease care gaps. 

They benefit from practitioner contact, apart from office visits, where extra attention can be paid to their conditions and their medication regimen. 

Patients remain on regular Medicare but benefit from these additional services. Only one provider may initiate a CCM relationship per patient. 

In other words, CCM programs allow for only one Medicare billing relationship per patient. 

CCM encourages care coordination between a physician and the patient’s ancillary practitioners, such as cardiologists, endocrinologists, labs, etc.

Given the vulnerable state of this population, CCM programs are important and life-extending.  

CCM creates an expanded provider relationship, where the provider oversees a case in all facets, creates a Care Plan with specific medical goals, and, most importantly, manages the patient’s disease state and medications.

CCM incentivizes additional patient/provider communication, in an effort to stave off medical emergencies and improve patient outcomes.

Patients are able to contact their CCM provider to discuss their health issues, and symptoms or receive prescription assistance. 

The central goals of CCM programs are to create more patient oversight by qualified practitioners and to ensure care continuity. 

An obvious danger is that these patients may not be able to medically care for themselves.

CCM addresses that concern by providing a heightened check-in strategy, through compensated medical intervention.

Medicare maintains a list of qualifying conditions on the Centers for Medicare & Medicaid Services site (www.cms.gov), as well as reimbursement codes for activities in the care of CCM patients (see CPT codes, below). CCM also provides financial incentives for well-run CCM programs.

A provider can be reimbursed for spending time on the patient’s case, consulting, reviewing their medications, etc.

While CCM has been known to be complicated and difficult to implement, the financial advantages to practice are significant.

CCM helps improve quality measures, which positions physicians and practices for quality bonus payments up to 9% for FY 2021.

Who initiates CCM? 

Most often, a Primary Care Physician sets up and administers the CCM program.

However, a physician in a specialty can be the ‘point person’ for a patient, setting up the CCM, and billing Medicare accordingly.

For instance, a Cardiologist or an Endocrinologist with ties to the patient might establish the CCM relationship.

CCM agreements are routinely administered by nurse practitioners, registered nurses or other qualified health care professionals or clinician staff. 

Usually, 20 minutes per month is spent on the patient’s care (although depending on the risk assessment of the patient, it can be up to 40 or 60 minutes per session and 2-3 times per month). 

This might take the form of calling other providers, checking lab work, or examining a medication list.  Providers may bill all of this time to Medicare, using the appropriate codes.  

The Five CPT Codes for CCM Services Include

• CPT 99490 – non-complex CCM is a 20-minute timed service by clinical staff to coordinate care across providers.
• CPT 99439 – each additional 20 minutes of clinical staff time spent providing non-complex CCM, directed by a physician or a qualified health care professional (billed in conjunction with CPT 99490).
• CPT 99487 – complex CCM is a 60-minute timed service by clinical staff to establish or substantially revise a comprehensive care plan that involves moderate to high-complexity medical decision-making.
• CPT 99489 – is used for an additional 30 minutes of clinical staff time, spent providing complex CCM, as directed by a physician or other professional (report in conjunction with CPT code 99487; cannot be billed with CPT 99490).
• CPT 99491 – CCM services are provided personally by a physician or other qualified health care professional for at least 30 minutes.

The many steps involved in setting up a CCM program and the time to manage a patient’s illnesses can become overwhelming. 

CCM is complex and difficult for offices to adopt.

This explains why many physicians have declined to implement it. 

CCM can be a welcome revenue stream for physicians, but if not managed well, can become a burden to the practice.

For example, programs that are not fully set up can become a drain on resources, where CCM staff expenses are not met, due to a lack of patients. 

Practices have also reported CCM putting a strain on nurses who still had room responsibilities, and felt like they were pulled in two different directions; regular patient care and CCM care. 

In those cases, practices felt that they should not sign additional CCM patients. 

These are good examples of incomplete ‘homemade’ implementations of CCM.         

Medicare probably did not foresee physicians forfeiting additional CCM revenue, due to the complexity of implementation.

From program inception, providers have enrolled approximately less than 5% of eligible patients in CCM programs! 

This is due to a combination of factors: a lack of CCM awareness, lack of staff to start a program, a dearth of technology (e.g. telehealth), lack of time and training, and the general sense that CCM is complicated.  

CCM patients can receive remote care through telehealth, or other technology, from doctors, APRNs, and other healthcare practitioners.

Because practices have elected to opt out of implementing their CCM programs, a number of companies have emerged, offering to outsource. 

The companies serving this market all have different approaches to staffing.

For example, PharmD Live® has an approach that is unique to the industry.

PharmD Live® is the only CCM company, that uses a network of clinical pharmacists as care providers.

For more than a decade, pharmacists have served outside of the confines of a pharmacy to attend to direct patient care.

Pharmacists are highly-trained in medication management and are skilled at keeping patients safe from ADEs.

PharmD Live® also arms its clinical pharmacists with proprietary Artificial Intelligence technology, which can predictively seek out impending ADEs and disease care gaps. 

Since medication is the cornerstone of chronic care, our staff and technology are focused on improving medication management and adherence.

The chronically ill typically take multiple medications, often prescribed by different doctors for their chronic conditions.

This is part of a looming crisis, especially as there is an 82% risk of an ADE when patients are placed on 7 or more medications. 

Increased medical oversight for these patients is clearly indicated because ADEs is such a major problem.

In fact, they are the fourth-leading cause of death in the U.S. 

Many of these senior patients suffer ADE’s for two primary reasons:  either multiple providers double up on prescriptions, and/or the patient is sadly incapable of taking the correct regimen.

The underdosing, overdosing, and unintended mixing of good medications in this population is a profound risk to health and risk for the hospital admission. 

Medical prescribers do not have perfect information and, in many cases, the patient may not remember prescriptions or recent medical visits.         

PharmD Live® approaches the inherent problems with this patient population with pragmatism and confidence. 

We think where there are crucial medication-related problems, a Clinical Pharmacist is a strong candidate to oversee Medication Management. 

Clinical Pharmacists have the training and understanding to assist, where prescription medicine compliance can mean life or death. 

They can also help manage conditions and symptoms, often eliminating unnecessary trips to the hospital. 

CCM patients, engaged with PharmD Live® pharmacists, can contact these professionals with medical issues or medication questions, 24/7. 

PharmD Live®’s CCM solution complements and reinforces the physicians’ treatment plan and instructions to their patients. 

Our CCM goals are to improve patients’ health and cement their ties to their own physicians.     

CCM patients receive monthly phone engagement, initiated by the practitioner. 

Conversations center around general health, symptoms, or prescriptions. 

The practitioner will also create a Care Plan for the patient, including health goals. 

In theory, the practitioner can contact all the patient’s other doctors or diagnosticians, effectively coordinating all care for their patient. 

Computer time and research for the benefit of the patient are also reimbursable.

CCM practitioners are trained to listen for changes in the patient’s state of health and can verify and reinforce which drugs are being taken by the patient. 

All of the activities we have just described are telehealth/telemedicine benefits and can be billed to Medicare. 

In sum, these activities are critically life-preserving and enable the patient to spend more time with their loved ones at home.  

Practices that provide CCM services can benefit both from a financial and a liability standpoint, especially if the program is sizable and professionally run. 

Practices find that having records of contact with their most vulnerable patients is beneficial.  

Numerous studies have found that CCM creates better medical outcomes and is a life-preserving program.

When professionally run, CCM means an additional profitable revenue stream for practitioners. 

With Covid19 and MRSA,  hospital stays – even ER visits – present risks of infection.

Today, keeping your vulnerable patients out of the hospital IS critical care.

In times when the hospital doesn’t always mean safety, the telehealth trend is keeping providers and patients safer. 

Setting up a CCM program requires extreme diligence in contacting patients and considerable administrative time.

It can take up to a month, and sometimes more, to implement a Chronic Care program. 

So with a great deal of time and effort, you can provide this care for your patients. 

In most cases, the better business decision is to have a CCM company set up and administer your program. 

A CCM business partner has all the tools, forms, and procedures to sign up most of your target patients. 

Some can also handle patient-facing communications, creating a self-contained program. 

In the case of PharmD Live®, our patient-facing staff is clinical pharmacists, the recognized experts in medication management and drug interactions.

Our CCM pharmacists leverage industry-leading medication risk-management technology that enables early detection and prevention of medication complications. 

Our clinicians provide 24/7 oversight and support via telemedicine for your Medicare patients.

This sets PharmD Live® apart from other chronic care companies and positions our offering as the most comprehensive and robust in the nation. 

PharmD Live®’s 24/7 telehealth solutions are powered by a proprietary AI-Driven platform. 

Predictive analytics and side-effect profiling algorithms enable the identification and prevention of potential medication risks and gaps in chronic care and generate actionable business and clinical intelligence reports. 

PharmD Live®’s technology is HIPAA-compliant and our solution seamlessly integrates with most EHRs, to enable a bi-directional patient data flow in real-time. 

PharmD Live® sees a significant opportunity for practices to expand care and increase practice revenue with telehealth in CCM for Medicare patients. 

According to the Center for Medicare and Medicaid Services (CMS), effective CCM improves overall health and reduces the costs of care. 

But there are significant advantages for practices that choose to enable CCM with the help of PharmD Live®:

Delivering Results For Your Practice:

• Alleviate physician workload and burnout
• Additional revenue stream (direct & indirect)
• Improves 88 MIPS/APMS quality measures
• Improve patient satisfaction and loyalty
• Seamless EHR integration
• Decreases non-billable time for you and your staff

Delivering Results For Your Patients:

• Access to pharmacist 24/7/365
• Decreased medication-related events
• Improved disease self-management
• Reduced healthcare costs
• Decreased hospitalizations, ER visits and readmissions!
• Better quality of life

Improved Quality Measures and Transition to Value-Based Care:

• 88 MIPS measures impacted
• 19 ACO measures impacted
• Focus on Quadruple AIM

PharmD Live® serves physicians, ACOs, and hospitals, using our multi-pronged approach: clinical pharmacists, medication management, disease management and AI-driven technology.

Our implementation team is highly-experienced, technically savvy, and can set your CCM up with the minimum disruption.

If you are thinking about limited time, limited resources, worries over red tape, CMS rules, technology investment, or uncertain financials, PharmD Live® can help. 

We provide the answers to these concerns with efficiency, experience, and the right telemedicine solutions. 

Consider teaming with PharmD Live® if you are seeking an experienced CCM partner who makes the process easy!

Learn more about how PharmD Live® can help you implement a CCM program, to better manage your chronically ill patients and generate new revenue for your practice.

The post Why Should Physicians Participate in Medicare’s Chronic Care Management? appeared first on Pharmdlive.

CMS launched the Chronic Care Management program in 2015 to address this growing Medicare problem. New CPT codes were created and reimbursement rates, that are based on the amount of time spent during patient encounters, were meant to serve as an incentive for doctors to provide these needed services. The amount of work required to meet CMS regulations, and the level of reimbursement for the few new services covered, has not proven to be a sufficient incentive for doctors to provide CCM services. However, when managed correctly, shifting to a value-based chronic care solution creates a model that works better for everyone, and we explain why. Here are our top 10 reasons why you should consider CCM for your practice:

1. CCM Delivers Optimal Care for Chronic Patients

The first, and probably most important reason why you should consider a value-based CCM program is it allows practices to have the capacity to improve clinical outcomes and quality of life for patients with two or more chronic diseases. One of Medicare’s CCM requirements is requiring the use of telehealth technology to provide care for patients in between their doctor visits. Supplemental access to a care provider during gaps in care provides consistency to treatment, which is key to managing chronic diseases. Depending on a  patients’ risk evaluation, a care provider could work with patients for 20 minutes, 40 minutes, or even 60 minutes, as needed.

2. The Number of Patients with Chronic Diseases is Growing

There are currently 140 million people living with chronic diseases in the United States. For the elderly, the situation is even more dire. 3 out of 4 people aged 65+ are afflicted with two or more chronic illnesses who require care. This is already a serious situation and will only get worse as chronic cases will increase in the coming years, putting a terrible strain on our healthcare system. By 2025, a staggering 49% of the population will have at least one chronic illness. This number is projected to increase by more than one percent each year through 2030.

3. Decreased Workload and Non-billable Time

Implementing a CCM program in your practice, especially if you consider partnering with a company that can handle the CCM care delivery for you, means no longer having to follow-up potentially up to 60 minutes a month per chronic patient. Not only does that free up a lot of time for you and your staff to focus on other things, but it also translates into a reduction in non-billable time for your practice.

4.  Generate New Revenue for Your Practice

Implementation of an efficient CCM program will mean achieving quality measures in-patient experience of care, care coordination, patient safety, and preventative health. Achieving these measures will yield significant population health revenue for your practice.  The amounts reimbursed by Medicare will depend on the number of patients enrolled in the CCM program and your ability to reach specific thresholds.  Reimbursement amounts by Medicare can become quite lucrative, with providers earning upwards of $100,000 in additional revenue. One caveat for consideration: a lot of administrative time needs to go into preparing the Medicare documentation which is why partnering with a company providing CCM services is highly recommended.

5.  Increased Patient Engagement in their Own Care

The essence of value-based care is patients assert greater control over their health and health care. Open and transparent communication between the patient and the CCM provider, consistent patient engagement and proactive monitoring are key drivers of patient empowerment

6.  Continuity of Care for Your Patients

CCM provides a baseline for continuing and maintaining quality care for your patients since patients are being cared for in between their office visits with you. Care consistency and patient empowerment are at the core of value-based care and are key in producing optimal health outcomes that are better for the patients, better for the provider, and better for the industry overall. Reliable CCM provided by established companies assures your patients of continuous attention and better outcomes

7. CCM Care is Proactive Care

Value-based care means taking a proactive approach to care management to avoid complications and eliminate problems that may exacerbate a patient’s conditions before they have a chance to appear or cause harm.  Addressing gaps in care is the core goal of a CCM program and a preventative measure to keep your chronic care patients healthy and away from the hospital.

8.  Actionable Real-time Clinical Intelligence 

CCM increases visibility and insight into your patient’s overall health during gaps in care.  Some CCM companies offer 24/7 bi-directional telehealth as a tool to capture patient-specific clinical intelligence, enabling physicians to provide better and more timely care.

9. Improved Patient Satisfaction and Loyalty

A patient’s holistic care experience has a direct bearing on loyalty to your practice. When it comes to CCM, patients seeing improvements in their conditions will develop a sense of trust, stability and satisfaction in a service like CCM. This will reflect favorably on your organization. Also, the personalized attention that a CCM program provides will not only result in a better patient-practice relationship, and it will also help improve patient loyalty and happiness

10.  Availability of Companies Providing CCM Services

There are a number of companies like PharmD Live® who you can partner with to establish an effective and efficient CCM program. Each of them has a different business model on how they administer chronic care, so you may want to research your options before selecting the ideal partner for you.  For example, PharmD Live® is the only company providing CCM solutions through its network of board-certified clinical pharmacists because they are among the best suited for this role thanks to their clinical preparedness in disease management and their unique expertise as medication experts. Medications are the first line of therapy for most chronic care patients, and when not used as prescribed, adverse drug events are common. Having a clinical pharmacist to help manage and monitor a patient’s medications makes the patient feel safer and it will make you feel more at ease knowing your patient is in the care of a clinical professional.

PharmD Live® is a company offering premium chronic care management services to all types of healthcare organizations. Our focus is on delivering an optimal chronic care experience for your patients and providing a greater level of efficiency, cost savings, and additional revenue for your organization.

The post Top 10 Reasons Why Your Practice Should Consider Chronic Care Management (CCM) appeared first on Pharmdlive.

But first, why embark on this?  Changing US healthcare is akin to turning a battleship.  The US spends the most on healthcare of all developed nations and yet has significant morbidity and mortality in our patient populations.  Our healthcare system has undertaken one impactful investment in order to control costs and streamline care delivery.   Realistically, the US did not have the means to redesign the healthcare system, but could begin targeted improvements.  Value-Based Care, as the new payment and reimbursement model, seeks to wrestle control away from Fee For Service and, in short, establish a “pay-for-quality” system.  This is partly to slow down the furious pace of short office visits, which are clearly not beneficial for the provider or the patient.  In the case of patients 65+, imagine your actions could begin to slow the churn, the ER visits and the Adverse Drug Events (ADEs), that are currently at a crisis level.   VBC programs, like Chronic Care Management (CCM), encourage the use of data to understand what is next for the patient.  “Risk stratification is a technique for systematically categorizing patients, based on their health status and other factors. “¹  Risk stratification informs CCM by directing clinical efforts by way of comparative data.  

Risk stratification as a value-based approach, allocates finite resources to make the largest dent in our disease burden and cost of care.   “Risk stratification, in all true sense, is a catalyst in developing successful population health management plans. Only an effective implementation of risk stratification combined with communication and monitoring will guarantee appropriate patient-centric care.”²  From a practical standpoint, risk stratification separates cases into similar categories, and eventually, into smaller groups to understand their likelihood of larger medical events, including heart attack, stroke or hospitalizations.  Looking at larger, older studies provides reliable data on the incidence of disease.  “Proactive management”, above, refers to the more intensive treatment for a patient heading toward a statistically-predicted crisis.  Using this method, patient care is reallocated and hospitalizations, ER visits and ADE’s can be avoided.  You can imagine the aggregated effect if all practices operated this way.      

How does Chronic Care Management (CCM) relate to Value Based Care and risk stratification?  The short answer is that CCM makes use of risk stratification, and in short, “Risk stratification helps practices to better focus on their sickest patients, reduce costs, and improve care.”³  In 2015, Medicare responded to an enormous wave of Baby Boomers, 65+ patients who had more than one chronic condition.  Not only did Medicare need to provide healthcare for this wave, it needed to do a better job of controlling spiraling health care costs.  Medicare’s answer was CCM.  These patients were approved for telehealth visits, advice and medication management – between their regular doctor visits.  This was and is a great idea and has been lengthening and improving patient lives and re-engaging patients in their own care. 

Risk stratification and CCM help us understand the threats that patients are under.  Accordingly, doctors are allocating more resources to higher-risk patients and fewer to low-risk patients.  What is the outcome?  Risk stratification puts practitioners in a mode of protecting the weak and ‘trusting’ the strong.  In this way, patient classes that previously suffered poor outcomes are saved from them.  So an 85 year old does not make a trip to the ER and is not moved to a hospital room – both, at that age, are significant risk factors for ADEs and/or mortality.  The practice’s quality scores improve because of lower morbidity, hospitalizations and re-hospitalizations, not to mention fewer ADEs.    

Under CCM, practices with significant elderly populations will: 

-Talk to their patients once a month anywhere from 20 to 60 minutes (virtual visits via telehealth or by phone).

-Ensure medication lists are accurate.

-Ensure the patient is medication compliant.  

-Perform risk stratification – to identify patients who need more care.

-Coordinate care with any other offices and labs. 

-Inform other providers of patient changes (and encourage same).

-Bill Medicare for the CCM services by CPT Code.

Per Medicare, there is only one CCM physician allowed for reimbursement.  Many of these 65+ patients with two chronic illnesses are both vulnerable to and overwhelmed by medicines.  Medication Management is critical as they are often not compliant or are double-scripted by double physicians.  We know this population has a dangerously high incidence of Adverse Drug Events.  From whatever source, attention to their medications can be a life saving/improving effort.  We know that many scripts are written for the elderly.  In fact, 76% of US pills are prescribed for them.  On top of the out-of-control prescribing, these patients will probably have difficulty reading dosages and have limited dexterity and memory.  They have even reported injuries from repetitively trying to open all their medicines.  CCM is the right thing to do for these patients.  The additional care they can receive not only makes them safer but tends to get them interested in their care.

Under VBC, Quality measures and MIPS Scores are quickly becoming the basis of reimbursement for the practice.  Having a significant elderly population exposes your practice to metrics around morbidity, hospitalization and drug events.  According to Medicare, CCM programs help make that patient class more safe.  Having a CCM program can allow your practice to improve its scores for the chronically ill and go to work on the next group.  CCM then, can improve your scores, and yes, your patient and practice revenue.  The drawback to CCM is that it can be labor intensive, especially at the outset.  CCM partners have arisen in recent years – companies who specialize in eldercare and Medicare.  Having a partner can make a lot of sense, as they have skills in setting up and delivering CCM and in case management.  To a practice, this can mean increased revenue, increased scores, a labor reduction and, most importantly, better health for their patients. 

We mentioned earlier that medication management was critically important for the chronically ill.  One CCM company, PharmD Live®, approaches care from a pharmacological perspective.  Unique to the industry, PharmD Live® utilizes clinical pharmacists in all of its patient care.  Remember that ADEs are rampant among the chronically ill, and a risk factor for hospitalization and mortality.   It simply makes sense to address the population’s greatest need first and address it often.  PharmD Live® employs data-driven predictive analytics in order to look for future patient drug events.  Using statistics, patient history, proprietary software and risk stratification, PharmD Live®’s clinical pharmacists are actively improving disease states for patients, remotely.  The quality of contact that PharmD Live® is able to achieve, provides patients with a familiar voice, more trust in their medications and less fear of the unknown.  As we mentioned before, CCM programs re-engage the patient in their own care and provide a renewed sense of self-determination.                  

The patient benefits are significant.  The practice benefits run all through this article, things like predictive assessments via risk stratification, improved MIPS scores, bottom-line benefits and even reductions in physician burnout.  At this point in our blog, we urge you to take a step and find out more about PharmD Live®.  Visit our site or call now to speak with a knowledgeable associate.  PharmD Live® is confident in our skills and we hope to answer questions about your practice – with no obligation.  Thank you, and we look forward to connecting with you!

The post Chronically ill Patients Thrive With Chronic Care Management & Risk Stratification appeared first on Pharmdlive.

In early 2001, I was a soldier in the Army when a new advertisement showed up on TV featuring Corporal Richard Lovett as a hard-charging soldier running in the desert and making the statement, “… I am an Army of one.”¹

The problem was that as good as he was alone, he was alone.

He could not complete Special Forces training,² at least in part, because that requires teamwork.

There is an African proverb, “If you want to go fast, go alone. If you want to go far, go together.” 

You most likely are a great doctor, as hard-charging Lovett was in the commercial.

But through patient care, documentation, regulatory requirements, and physical time limitations, you do not have the ability you would like to work with your colleagues to benefit any given patient.

In addition, physician resources are spread thin.

To be one, can leave you feeling very alone.

Enter teamwork and Chronic Care Management (CCM). 

The Centers for Medicare and Medicaid Services (CMS) offer financial incentives to encourage physicians to participate in Chronic Care Management for enrolled patients.

The program is designed to benefit patients—and physicians. 

The presence of two or more chronic conditions (co- or multimorbidities) is required to enroll in the program.

Adherence is measured by selected Merit-based Incentive Payment System (MIPS) quality measures related to patient outcomes, appropriate use of medical resources, patient safety, efficiency, patient experience, and care coordination.

There is an incentive to do well and an incentive to avoid the risk of penalty for not meeting specific metrics.

Also, the government has programs encouraging additional value-based care programs such as Remote Patient Monitoring. 

On the one hand, taking on MIPS financial incentives creates a new revenue stream, when the physician’s team works well with the care coordinator to help the patient control the comorbidities.

Doing it alone can put you in the same spot as Lovett.

In the words of the African proverb, go far by going together.

Everyone has been hit hard by the pandemic and subsequent effects this past couple of years.

These value-based initiatives are coincidentally good timing—allowing physicians to resume being clinicians instead of “moving meat” on the fee-for-service treadmill program.

PharmD Live® helps support your patient’s best health.

The pharmacists are a dedicated squad ready to combine PharmD Live®’s proprietary artificial intelligence software with their knowledge of medications and potential interactions and side effects.

They are highly trained to troubleshoot patient issues with medication and complex health conditions. 

Beyond the improved patient care aspects of decreased ER visits and hospitalization for heart failure³, among other conditions, the right chronic care management program and coordination partner can take you to the upside while mitigating the downside risk of the CMS quality measures.

Medicine is a team environment.

Our pharmacists are experts in assisting with medication management because of their extensive education.

They help relieve the burden of chronic care management by taking a more active role in patients’ health as coordinators.

Additional help is especially relevant because the healthcare industry is facing a shortage of primary care physicians.

Just as important, clinical pharmacists have an opportunity to develop relationships with patients to better understand how to optimize and adhere to their medications and further analyze and adjust care plans that directly benefit patients’ health outcomes.

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About the author

Dr. Eidenberg is a board-certified emergency medicine physician interested in trauma, improving efficiency and flow, and wellness in the community and healthcare settings. He graduated with a bachelor’s in Biology from Western Maryland College and earned his medical degree from the Philadelphia College of Osteopathy.  Dr. Eidenberg additionally received a Healthcare Management MBA from Walden University.

Sources:

1 Dao, J. (2001, January). Ads now seek recruits for an army of one. New York Times. https://www.nytimes.com/2001/01/10/us/ads-now-seek-recruits-for-an-army-of-one.html. Accessed 20 April 2021

2 Army commercial star leaves training. (2001, July 27). Washington Times. https://www.washingtontimes.com/news/2001/jul/27/20010727-024452-1274r/. Accessed 20 April 2021

3 Ballo, P., Profili, F., Policardo, L., Roti, L., Francesconi, P., & Zuppiroli, A. (2018). Opposite trends in hospitalization and mortality after implementation of a chronic care model-based regional program for the management of patients with heart failure in primary care. BMC health services research, 18(1), 388. https://doi.org/10.1186/s12913-018-3164-0

The post Chronic Care Management vs. the Army of One appeared first on Pharmdlive.

A 3.75% cut in the 2022 Medicare conversion factor, which calculates reimbursement for procedures under fee-for-service, is mandated under a budget neutrality provision and comes after a pay bump from Congress that expires in 2022. Meanwhile, quality performance pay is increasing. CPA healthcare analysts at the Tennessee firm PYA calculated the pay differences in 11 categories of reimbursement for CCM, Complex CCM, and PCM. The average of the increases is 49%.⁴

2. Virtual care a boon for underserved chronic care populations

Virtual care, normalized by the pandemic, is now common practice for providers and patients, especially at the primary care level–a boon in 2021 for underserved chronic care populations. In 2019 and 2020, there is a measurable difference in how televisits increased in underserved populations, specifically Medicaid, Medicare and minorities.²

3. Aduhelm earns FDA approval

Aduhelm was approved by the FDA in 2021 with clinical trials outcome data indicating the potential to slow the accumulation of amyloid plaques. Practitioners are cautious about its effectiveness, and Medicare has not decided whether to include it in its formulary. With an annual price per patient of nearly $56,000 per year, patients’ families are looking for solutions for their loved ones–with a huge price tag.³

4. Medications approved in 2021 for chronic care: 

PharmD Live®’s Chronic Care Medication Update Webinar covers the latest FDA-approved medications. See it here. Among the approved medications are:

• Gemtesa (vibegron) for Overactive Bladder (OAB); 
• Verquvo (vericiguat) Heart Failure with reduced EF;
• Kerendia (finerenone) for prevention of kidney disease and cardiac complications in type 2 diabetes patients

5. Insulin turns 100, remote monitoring takes off

Insulin, first introduced in 1921, 100 years later, 2021, diabetes monitoring devices are added to Medicare’s durable medical equipment list coverage. Remote patient monitoring of devices improve patient adherence to therapy. Diabetes mellitus has been a known condition for centuries. The term Diabetes was coined in the 2nd Century, AD, by Aretaeus of Cappadocia, with mellitus (for the sweetness found in urine) added in the 17th Century by Thomas Willis.⁴

6. New Standard for Blood Pressure in Chronic Kidney Disease

The target of a systolic BP is set for chronic kidney patients at <120 mmHg (previously <140 mm Hg). PharmD Live® urges remote patient monitoring targets to keep patients within boundaries. Kidney efficiency is critical to quality of life, and blood pressure monitoring has a direct relationship.

7. American Diabetes Association revises standards of care

For people with diabetes, the ADA makes new recommendations and strategies for classes of care, age and type, strategies to prevent or delay onset of T2 diabetes.⁵ 

Diabetes is prevalent in older adults, but the circumstances of when it developed versus when it was diagnosed account for making the group heterogenous at best. 

Treatment goals for glycemia, blood pressure, and dyslipidemia in older adults with diabetes are now individualized depending on the patient’s ability to follow therapy plans. Adherence is vital, but the value must be considered with the entirety of trade-offs.

8. Study reveals physicians want telehealth continued in multiple areas

Covid-19 Telehealth Impact Study released by The COVID-19 Healthcare Coalition indicates physicians want to see telehealth continued in these five areas: chronic disease management (73%); Medical management (64%); care coordination (60%); preventive care (53%); hospital or ED follow-up (48%).⁶

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Resources

1. https://www.pyapc.com/insights/2022-medicare-physician-fee-schedule-final-rule-increased-reimbursement-for-care-management-services/
2. Ellen B. Franciosi, Alice J. Tan, Bina Kassamali, Nicholas Leonard, Guohai Zhou, Steven Krueger, Mehdi Rashighi, and Avery LaChance.Telemedicine and e-Health.Aug 2021.874-880.http://doi.org/10.1089/tmj.2020.0525
3. https://www.pharmdlive.com/blog/aduhelm-the-new-alzheimers-drug-and-its-coverage-implications-with-alzheimers-disease/?&utm_source=EmployeeRef&utm_medium=Social&utm_campaign=BlogSupport&utm_term=AduhelmNewDrug&utm_content=EmployeeShare
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707300/ Milestones in the history of diabetes mellitus: The main contributors:Marianna Karamanou, Athanase Protogerou, Gregory Tsoucalas, George Androutsos, and Effie Poulakou-Rebelakou  Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
5. 12. Older Adults: Standards of Medical Care in Diabetes—2021
   American Diabetes Association
   Diabetes Care Jan 2021, 44 (Supplement 1) S168-S179; DOI: 10.2337/dc21-S012
6. https://www.ama-assn.org/practice-management/digital/patients-doctors-telehealth-here-s-what-should-come-next

The post 2021 Highlights of Chronic Care Medicine appeared first on Pharmdlive.

By Marshall Eidenberg, OD

Chronic care services managed by a doctor of pharmacy, PharmD, is a critical addition to a medical practice, but they are not widely engaged with these responsibilities. With the challenging number of diagnoses and medications that Medicare patients take, it is essential to have a team member whose primary function is to rapidly review patients records, give informed advice on any side effects to watch out for, and give medication interaction alerts to the rest of the care team. 

The author is a residency-trained, board-certified emergency medicine physician and offers a different perspective. Like many physicians, he prescribes around 300 medications regularly and with a great deal of comfort knowing their mechanism of action, interactions, and side effects. According to the FDA, there are over 20,000 medications approved. He admits he does not have the time or capacity to know each of these and is confident most clinicians are in the same place. Fortunately, there was a pharmacist in the emergency department at several of the hospitals in which he served. They were and are valued partners.

For example, during resuscitation, the pharmacists were preparing the next round of medication or had the vasoactive drip ready when it was needed. They advised on starting doses of weight and renally dosed medication, so the patient received the correct medication within the appropriate therapeutic window. Pharmacists do not prescribe, but they can keep the doctor from causing harm by inadvertently prescribing medicines that do not go well together. As the author’s practice has evolved and the past two years of COVID-19 have shown, there is no capacity in our country’s EDs. By partnering with pharmacists, we can keep patients out of the ED for preventable interactions, making everyone’s lives a little bit better–and that little bit has significant results in the aggregate.

A PharmD dedicated to knowing approved medications and understanding the medical situations in which they are applied is critical to caring for and reducing risk to the aged and vulnerable Medicare patient population. This population generally has more comorbidities and can have numerous medications, complicating medication management and adding time-consuming investigation. A team pharmacist can save time and provide confidence in decision-making because of their expertise and experience. 

In the physician’s office, when you put electronic health records (EHRs) with algorithms and artificial intelligence into the hands of your team pharmacist, you have an overwhelming opportunity to improve clinical benefits and even greater opportunity to improve patient care. Chronic care services managed by a PharmD provides increased interaction with patients between regular visits with the primary care provider. It stands to reason that if the EHR makes records more readily available at the point of care, then the same EHR in the hands of a PharmD/chronic care coordinator who has this kind of AI software can deliver better care between visits and further benefit the practice. Adverse drug events are avoided. Patient health improves, as do satisfaction scores and CMS reimbursements. 

A survey cited¹ by HealthIT.gov says with sources dating 2008-2012 and reviewed in 2019 says:

• 94% of providers report that their EHR makes records readily available at the point of care.
• 88% report that their EHR produces clinical benefits for the practice.
• 75% of providers report that their EHR allows them to deliver better patient care.

Comorbidities and Medicare patient risk

The aging population sees more specialists. PharmD chronic care managers monitor the additional medications for various comorbidities and ensure the primary physician knows these medications. 

Obesity is rising in the more sedentary aging population, an extra layer of risk for Medicare patients. Diabetes 2, low quality of life, cardiac-related illnesses, osteoarthritis, and more are caused or exacerbated by obesity. A pharmacist who can review the additional added medications and ensure no adverse reactions are expected, and no drug interactions considerably lowers the risk to this population. With a PharmD managing chronic care services, communication and knowledge sharing are facilitated between all providers. All involved on the patient’s care team are informed and up-to-date on the medication changes made by different team members. 

The variety of circumstances that can be defined as chronic care management supports the prospect of having coordination centered around medication. Clinical pharmacists who become board-certified have medical training that is often underestimated. One newly-minted PharmD was floating among various stores in an Ohio retail pharmacy chain. She noticed a concerning mole while giving a flu shot and encouraged the patient to see her doctor. She talked the patient through her resistance and learned some months later that the patient indeed had melanoma and a very aggressive one.² 

B. Joseph Guglielmo, PharmD, dean of the UCSF School of Pharmacy, has long advocated elevating the role of PharmDs in educating patients regarding medications.³ As a matter of public health, the more patients understand what medicines they take, and why, outcomes will improve. Because over the past few years, the PharmDs potential scope of practice has been widened, it further supports the value of adding a PharmD to a practice’s immediate team. Again, as care coordinators in the Medicare group, they can take the needed time to provide counsel to patients–activity patients have always valued, given the availability of the pharmacist at the local drug store, especially with those who have extended public hours. Under the right circumstances, these most valuable practitioners will enjoy greater career satisfaction while empowering patients. The potential to recognize their training with greater compensation and grow medical practice success while improving patient quality of life is most valuable, indeed.

About the author

Dr. Eidenberg has made his mark as a chief medical officer in harsh conditions. Marshall is a board-certified emergency medicine physician interested in trauma, improving efficiency and flow, and wellness in the community and healthcare settings. He graduated with a bachelor’s in Biology from Western Maryland College and earned his medical degree from the Philadelphia College of Osteopathy. Dr. Eidenberg additionally received a Healthcare Management MBA from Walden University.

1. Improved Diagnostics and Patient Outcomes – https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/improved-diagnostics-patient-outcomes

2. During a Routine Flu Shot, a Pharmacist Saves a Patient’s Life Lisa Boylan|Mar-22-18|Categories: Article|Tags: Pharmacy_Value https://www.nacds.org/news/during-a-routine-flu-shot-a-pharmacist-saves-a-patients-life/

3. Let pharmacists empower patients and save lives – B. Joseph Guglielmo, PharmD. Dean, Troy C. Daniels Distinguished Professor of Pharmaceutical Sciences. School of Pharmacy UC, San Francisco https://pharmacy.ucsf.edu/news/2017/04/let-pharmacists-empower-patients-save-lives

The post PharmDs – Crucial to Chronic Care Management Services: A Doctor’s Perspective appeared first on Pharmdlive.

COVID-19 has profoundly changed the world we live in today and will continue to leave an indelible mark long after the pandemic has ended. One area of concern for both health care providers and their patients is the long-term effect of COVID-19 infection on patients with chronic diseases. 

Acute cardiac injury has been a well-documented feature of infection with SARS-CoV-2, which causes COVID-19 among patients requiring hospitalization. 

Heart failure, myocardial infarction, acute cor pulmonale, cardiogenic shock, myocarditis, multisystem inflammatory syndrome, cardiac arrhythmias, and sudden cardiac arrest have all been reported in patients with COVID-19 infection. 

A lingering question is whether these sequelae of the acute infection will lead to worsening clinical outcomes over time and potentially a chronic disease state.

Pre-existing heart disease such as heart failure, coronary artery disease, cardiomyopathies, and possibly high blood pressure can lead to more severe courses of COVID-19 and, in many cases, increase the risk of death. Retrospective analyses of hospitalized patients indicate that better control of these pre-existing issues before infection with COVID-19 may reduce the risk of mortality and indicators of worsening COVID-19 disease such as ICU admission or mechanical ventilation. 

More study is needed to understand the exact relationship between chronic disease control and COVID-19 infection. However, patients who have better control of many chronic illnesses, including diabetes, hypertension, hyperlipidemia, COPD, and heart failure, have lower risks of future disease and adverse clinical outcomes unrelated to COVID-19, such as MI, strokes, cardiac arrhythmias, etc.

Primary care doctors have an essential role in mitigating COVID-19 by taking steps towards improving the health of their at-risk patients. One way to approach this is by implementing a Chronic Care Management (CCM) program that focuses on the ongoing care coordination, treatment, monitoring, and follow-up of patients with chronic heart diseases. 

There is significant evidence that well-applied telehealth interventions, including CCM, can improve blood pressure, lipid levels that serve as a biomarker for cardiac event risk, and other clinical measurements such as hemoglobin A1C, a measure of diabetes control. 

Clinicians can and should work with patients to discuss and set goals for meaningful health-related behaviors, including lifestyle modifications and dietary changes, that lead to meaningful behavioral changes by patients.  

Leveraging the well-established relationship between diet, exercise, and cardiac health is critical for any successful chronic care program treating heart disease patients. Over-reliance on medical therapy alone has led to a generally worsening healthcare landscape for our most at-risk patients as well as the aging population as a whole. PharmD Live®’s approach to Chronic Care Management incorporates a holistic perspective to health that empowers patients to become more involved in their healthcare decision-making and take ownership of their health. Patient involvement is critically important in reducing the overall burden of chronic diseases and specifically those regarding chronic heart disease due to the overwhelming effect of the patient-specific variables previously mentioned.

It is important to note that one of the main mechanisms of organ damage by SARS-CoV-2 is clotting, including microvascular clotting. Studies of anticoagulant and antithrombotic use in critically and non-critically ill hospitalized patients effectively reduces the risk of complications, including mechanical ventilation, organ support, and mortality. 

It is unknown whether COVID-19 infection in patients who do not require hospitalization causes microvascular clotting of clinical significance. However, using aspirin to treat patients upon confirmed infection is a reasonable strategy for those without contraindication during the acute phase of infection. 

While the recent RECOVERY trial concluded that aspirin offered no additional benefit to hospitalized COVID-19 patients and is frequently cited as a reason to avoid the use of aspirin in COVID-19 patients, it is essential to note that by the time of the trial, use of antithrombotic treatment for hospitalized COVID-19 patients, either through full or prophylactic dosing of low molecular weight heparins or heparin, had become the standard of care. Indeed over 93% of patients in this trial were treated concurrently with an antithrombotic agent, limiting the applicability of such data to outpatients who are not on such therapies currently. 

This highlights the importance of considering the use of aspirin and potentially other anticoagulant therapies in patients with confirmed COVID-19 infection, especially among those who have other risk factors for coagulopathy. The clotting caused by SARS-CoV-2 is likely multifactorial. Though antiplatelet therapy alone may not prevent all clotting, a simple screening by providers to exclude patients who are most likely to suffer harm from the use of aspirin, such as patients over 85 years old, those who are already taking an anticoagulant, those with a history of GI bleeds or intracranial hemorrhage can reduce the risk of an adverse effect.

The coming years will answer whether or not patients who have recovered from acute COVID-19 will face an increased risk of future heart disease. It is well understood that patients who experience acute cardiac events or chronic uncontrolled hypertension are at a significantly increased risk of developing heart failure, for example. However, there has not yet been enough evidence to positively correlate between mild-moderate COVID-19 infection and future risk of heart diseases. Post-recovery use of aspirin or anticoagulants is likely unnecessary for these patients. Further research can determine any potential clinical benefits and the prevalence of these conditions in those who have recovered from COVID-19 infection to determine what increased risk these patients face.

Primary care providers face fundamental challenges in the acute and post-acute management and treatment of COVID-19 patients. The effect of COVID-19 on heart disease and the known risk factors for severe COVID-19 infection indicate that, as always, prevention and mitigation of chronic heart disease will pay significant dividends in reducing the overall disease burden on patients and physicians and the healthcare system as a whole. 

A well-operated and comprehensive Chronic Care Management program is one of the easiest and most effective measures providers can take to improve their patients’ clinical outcomes and become more empowered and engaged in their own healthcare decisions. PharmD Live® can help your practice implement a CCM program that will deliver superior results for your patients with pre-existing heart disease as well as for those with other chronic conditions. 

Our board-certified clinical pharmacists take time to understand the individual challenges each patient faces in their health care journey. They work with them to develop a tailored care plan while also holding them accountable for their progress towards personal health goals. Contact us today to learn how we can help your practice.

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About the author

Dr. Korecky is committed to engaging patients in their health care and empowering them to care for their chronic health conditions. He is a clinical pharmacist and the Director of Clinical Pharmacy for PharmD Live®. He explores novel technology uses and believes pharmacists will be the key to coordinating care as healthcare evolves. Dr. Korecky also holds an MBA in Health Care Management from the University of Baltimore. He is a member of the American Society of Consultant Pharmacists.

Bibliography

1.Sayed Ahmed HA, Merrell E, Ismail M, Joudeh AI, Riley JB, Shawkat A, Habeb H, Darling E, Goweda RA, Shehata MH, Amin H, Nieman GF, Aiash H. Rationales and uncertainties for aspirin use in COVID-19: a narrative review. Fam Med Community Health. 2021 Apr;9(2):e000741.Retrieved from Internet Feb. 4, 2022 https://pubmed.ncbi.nlm.nih.gov/33879541/

2. Son, Minkook MDa; Noh, Myung-giun MDa; Lee, Jeong Hoon PhDb; Seo, Jeongkuk MDc; Park, Hansoo MD, PhDa; Yang, Sung PhDa,d,∗ Effect of aspirin on coronavirus disease 2019, Medicine: July 30, 2021 – Volume 100 – Issue 30 – p e26670 Accessed Jan. 29, 2021

doi: 10.1097/MD.0000000000026670

3. Berwanger O. Antithrombotic Therapy for Outpatients With COVID-19: Implications for Clinical Practice and Future Research. JAMA. 2021;326(17):1685–1686. doi:10.1001/jama.2021.17460 Accessed Jan. 29, 2021

4. Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial,The Lancet, Volume 399, Issue 10320, 2022, Pages 143-151,ISSN 0140-6736. Accessed Jan. 29, 2021

5. Carfi A, et al. Persistent symptoms in patients after acute COVID-19. JAMA. 2020. Accessed Jan. 29, 2021

6. Yancy CW, et al. Coronavirus disease 2019 (COVID-19) and the heart — Is heart failure the next chapter? JAMA Cardiology. 2020.Accessed Jan. 29, 2021

7. Mitrani RD, et al. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors. Heart Rhythm. 2020. Accessed Jan. 29, 2021

8. Saeed S, et al. Coronavirus disease 2019 and cardiovascular complications: Focused clinical review. Journal of Hypertension. 2021. Accessed Jan. 29, 2021

9. Post-COVID-19 conditions. Centers for Disease Control and Prevention. Accessed Feb. 6, 2022.

10. The ATTACC, ACTIV-4a, and REMAP-CAP Investigators. Therapeutic Anticoagulation With Heparin in Noncritically Ill Patients With Covid-19. N Engl J Med 2021;Aug 4.

Accessed Feb. 6, 2022

The post Chronic Disease Solutions: Spotlight on COVID-19 and its Impact on Heart Disease appeared first on Pharmdlive.

By Marshall Eidenberg, DO, MBA

As one has the privilege to get older, chronic conditions will go up. Typically, one per decade after one’s 30s. Each situation typically involves one or more medications for each chronic health condition. And with more medicines, the risk of interaction and adverse drug events increases. A key component of improving lifespan and healthspan is managing these combined effects. Using a Chronic Care Management service (CCM), particularly one focusing on medications, can improve health outcomes and decrease cost across the healthcare spectrum. 

As a young physician training in emergency medicine, I had a patient present with confusion, GI symptoms, vision changes where lights had a greenish tint, and a slow heart rate. The patient’s history included cardiac disease and a recently diagnosed cancer. Ultimately, the person was diagnosed with digoxin toxicity due to renal complications of their newly diagnosed renal cancer and taking herbal preparation for cancer rather than chemotherapy. If the patient had a CCM service available, including pharmacists, I would not have cared for that patient in the ER that day. Since this patient had multiple conditions, they would have qualified for CCM benefits. Discussing what was going on with a pharmacist may have identified a complication earlier and prevented the patient’s hospitalization and death later that day.  

In January 2015, the Centers for Medicare & Medicaid Services (CMS) introduced Chronic Care Management (CCM) service. In a report by Schurrer et al. (2017)³, there were multiple good outcomes found from CCM. These include improved patient adherence to medication therapy, decreased hospitalizations and ER visits, and increased efficiency in the daily clinical practice. Because the more complex patients had multiple touchpoints between visits, they were less likely to backslide between appointments. The downside to this was while there was some payment, the reimbursement was not adequate for the CCM work required. Today a turnkey solution like PharmD Live®^® can benefit your patients and practice. You can do good for your patients and do well financially by eliminating startup and administration costs.

Looking at the healthcare system as a whole, in a study by Al-Qudah et al. (2019)¹, by using clinical pharmacists to prevent Treatment-Related Problems (TRPs) leads to the benefit of almost 6 times the cost of the program because of intervention and avoiding preventable Adverse Drug Events (ADEs). The use and value of pharmacists has long been known. Even back in 1997, before CCM started, a study by Hanlon et al.² discussed “predictable ADEs are common in high risk older outpatients, resulting in considerable medication modification and substantial healthcare utilization.” Adverse events can result from age-related changes in pharmacodynamics and pharmacokinetics, leading to more orthostatic hypotension, more falls, more gastrointestinal or intracranial bleeding, and more delirium events. 

By using a CCM service, especially one based on pharmacist intervention, a clinic can improve patient engagement by supporting self-care management. Medicine is a team activity focused on the patient. When patients are made aware of the interplay of their specialists, medications, and how their actions affect their health, their pharmacist’s brief and recurring touchpoints can improve their quality of life. 

In conducting standard coordination services offered through CCM, activity updates with one specialist are reviewed against all, and a pharmacist coordinator can assess and alert all if these treatments conflict. Further, the CCM process can increase the use of community-based services because of increased recognition of unmet needs, reducing the use of acute care services. And the longer one is receiving CCM services, the greater the benefit. The study by Schurrer et al. (2017)³ saw dramatic decreases in hospitalization and ER visit rates, along with outpatient and inpatient Medicare expenditures, when comparing 18 months vs. 6 months of CCM services.

PharmD Live® Chronic Care Management Services works toward better compliance with your therapeutic interventions. Enter a cost-effective partnership with us for your delivery of care. 

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Dr. Eidenberg has made his mark as a chief medical officer in harsh conditions. Marshall is a board-certified emergency medicine physician interested in trauma, improving efficiency and flow, and wellness in the community and healthcare settings. He graduated with a bachelor’s in Biology from Western Maryland College and earned his medical degree from the Philadelphia College of Osteopathy. Dr. Eidenberg additionally received a Healthcare Management MBA from Walden University.

Sources

1. Al-Qudah, R. A., Al-Badrriyeh, D., Al-ali, F. M., Altawalbeh, S. M., Basheti, I. A. (2019). Cost-benefit analysis of clinical pharmacist intervention and preventing adverse drug events in the general chronic diseases outpatients. Journal of Evaluation in Clinical Practice. https://doi.org/10.1111/jep.13209. 
2. Hanlon, J. T., Schmader, K. E., Koronkowski, M. J., Weinberger, M., Landsman, P. B., Samsa, G. P., Lewis, I. K., (1997). Adverse drug events in high-risk older outpatients. Journal of the American Geriatrics Society, 45:945-948. Retrieved from https://www.researchgate.net/publication/13963053_Adverse_Drug_Events_In_High_Risk_Older_Outpatients on 18 February 2022.
3. Schurrer, J., O’Malley, A., Wilson, C., McCall, N., Jain, N. (2017). Evaluation of the diffusion and impact of chronic care management (CCM): Final report. Mathematica Policy Research. Retrieved from https://innovation.cms.gov/files/reports/chronic-care-mngmt-finalevalrpt.pdf on 15 February 2022.

The post Improving Quality of Life through Chronic Care Management appeared first on Pharmdlive.