October 2016
Volume: 5  Issue: 8
Visit our website at www.nepho.org
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In This Issue

Quality

What have you done for (AQC) lately?" 
  
(ala. Janet Jackson, circa 1986)
Perhaps you're reading the title to this and asking, "What should I be doing for AQC?"   Your PHO quality team has some suggestions, mostly in the form of the quick pearls for each measure, imbedded in the attached Quality Pearls document. In an attempt to keep it as "pearl-like" as possible, we've only hit the highlights for each measure. So take a quick read, but as always please reach out to any member of the quality team with questions or additional support you need from us. Our contact information is below.
Dr. Louis Di Lillo MD, 978-236-1740, LDiLillo@nhs-healthlink.org ; Liz Isaac, 978-236-1767, EIsaac@nhs-healthlink.org ;Carol Freedman, 978-236-1774, CFreed@nhs-healthlink.org; Alison Gustafson, 978-236-1709,   AGustafs@nhs-healthlink.org , Lucia Kmiec, 978-236-1719, Lucia.Kmiec@nhs-healthlink.org , Jennifer Andersen, 978-236-1747, JAndersen@nhs-healthlink.org ;Laureen Viel, 978-236-1746, LViel@nhs-healthlink.org

Pharmacy Population Medication Management Program
As part of the NEPHO Population Health Medication Therapy Management (MTM) program, a pharmacist and pharmacy tech work collaboratively with Case Management and providers to improve medication management for selected members of our Accountable Care Organization (ACO)/Medicare Population. Goals of the program include improving patient outcomes and reducing readmission rates through provision of the following services:
  • MTM consults (telephonic and/or home visit)
  • Provision of Medication Action Plan and Patient Med List
  • Resolution of patient issues including:
    • Medication Adherence Issues: Intentional, Financial, Complicated Dosing Regimens, Education, Language, Cultural Barriers
    • Reconciliation Issues: Omission, Dose/Frequency/Route, Duplicate Therapies, Polypharmacy
    • Optimization Issues: Need for Medication Education (COPD/ CHF/ DM etc), Drug-Drug Interactions, Regimen Simplified, No Indication, High Risk Medications, Medication Patient Record - medication list needed
  • Polypharmacy / Deprescribing /Tapering Recommendations
  • Mediation alternatives / Formulary information
  • Patient Assistance Programs
  • Medication Adherence Systems - Phone app reminder systems / packaging / delivery

 

  • Referrals can be made via Epic In Basket to Carol Freedman RPh, MAS, CGP cfreed@nhs-healthlink.org  (978 236-1774) and/or Erin Vega PTCB erin.vega@nhs-healthlink.org or 978 236 1728.  Please contact one of us if you have any questions about the program.
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    Medicare Part D Open Enrollment

    October 15th - December 7th

     

    The Medicare Part D open enrollment period will soon be upon us. This is the time for new and existing Medicare patients to evaluate current and Medicare Part D prescription plans that may provide better coverage for patients. Please note this is the only time during the year a change can be made with few exceptions:
      
    Reasons a patient should consider a switch in Medicare Part D Plans: 
    • Brand name med not covered by current plan (investigate if other plans provide coverage)
    • Coverage Gap (donut hole) reached early in the year
    • Local pharmacy or delivery service does not accept current plan (or pharmacy is non-preferred on current plan)
     
    Where to get help in evaluating a Medicare Part D Plan:
      See 2017 Medicare Part D changes below:
    Part D Standard Benefit Design Parameters:
    2017
    2016
    Deductible - (after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit.
    $400
    $360
    Initial Coverage Limit - Coverage Gap (Donut Hole) begins at this point. (The Beneficiary pays 100% of their prescription costs up to the Out-of-Pocket Threshold)
    $3,700
    $3,310
    In 2017 , Part D enrollees will receive a 60% discount on the total cost of their brand-name drugs purchased while in the donut hole.
    Enrollees will pay a maximum of 51% co-pay on generic drugs purchased while in the coverage gap (a 49% discount).
    Out-of-Pocket Threshold - This is the Total Out-of-Pocket Costs including the Donut Hole.
    $4,950
    $4,850
    Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap - Catastrophic Coverage starts after this point.
    $7,425
    $7,062
     
    NEPHO Clinical Newsletter
    Produced by Northeast Physician Hospital Organization
    For more information contact: 
     
    Carol Freedman, RPh, MAS, CGP 
    Clinical Pharmacist NEPHO 
    978-236-1774
    Cfreed@nhs-healthlink.org  
    Louis Di Lillo M.D., Northeast PHO Medical Director 
      

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