Friday, August 10, 2012

Cambria Releases White Paper: Health Care Reform & Star Ratings for Health Plans: How to Manage Through the Murkiness of Medicare’s New Realities

---Terri Bernacchi, PharmD, MBA, Cambria Health Advisory Professionals, Managing Partner at Quo Magis Partners
The entire white paper can be downloaded at the following link:  http://www.sharedhealthdecisions.com/5273/5294.html   This excerpt highlights the “5 Essential Pillars for Success” for Medicare Advantage plans. 

The Five Essential Pillars

Any team can only cope with what they understand.  Breaking the Star Ratings program down into bite-size pieces will make tackling these components more achievable so that challenges can be overcome and measure results maximized.   A manager should delegate specific goals to specific team members, so that no one person must manage it all.  In our estimation, there are five principals that can be applied to this effort.   Without any one of the following components in a fully operational state, a plan cannot hope to improve its rating: 
1.    Cohesive Team Pulling in the Same Direction
·         Plan executives must clearly state the goals, designate team members at all levels of the operation, in every department.  
·         Results should be part of the team and individual incentive /merit program.
·         Redundancy of critical functions should be built into the team, to plan for potential staff attrition in critical places.  An understudy will always be in place and ready for a chance “at bat”.    
2.     Communication-Up, Down, Sideways
·         Tracking results and targets requires careful and consistent communication of initiatives. 
·         In addition to routine meetings, email blasts, and conferences, the program or star manager must be willing to nudge already overworked colleagues to meet milestones and deadlines.
·         Communication requires careful listening to members, providers, technologists, and managers.  Sometimes the challenge itself has been misidentified, requiring a shift in strategy.  Without careful listening, the team could plow on in the wrong direction and completely miss the mark. 
3.    Access to Data- Timely & Accurate
·         Because there are a number of places where data is imported, cross- walked, converted, transferred to vendors or auditors, and later to CMS, any dropped or misaligned data could cost the plan meaningful points on the numerator or denominator.   
·         Processes to assure that the data is complete and accurate from the claims systems, which validate what is supplied to CMS, should be executed at least monthly to confirm the current state. This will also allow managers to tackle the measures which will have the greatest impact or which represent low hanging fruit for achieving results. 
·         Managers and Star Team Members need ready-access to that data so that they can troubleshoot problems or success early.
·         Instill in the team a little dose of “data skepticism” such that they don’t just accept results that “don’t look right”.  Waiting to identify a data process problem may result in a lack of time to act. 
4.    A Means to Navigate:  Technology/ Software
·         Access to data is not enough without a means to manage it.  The executive has a need to identify which providers are helping or hurting; which measures are lagging or improving; which team members are achieving results (or not).  
·         By identifying the challenges, managers can assign the most adept teams to focus on results at the provider, member, data or campaign level.   
·         Software that can capture the data, identify the priorities, and assign the resources to resolving them is an essential tool in achieving results, when implemented into Standard Operating Procedures.  Without such software, a team must rely upon many manual processes that could be costly to manage, with key tasks subject to “slipping through the cracks”.
5.    A Roadmap:  “Hope is NOT a good strategy”
·         Once a plan manager knows where the results lie, and where the gaps are, there is a need for the team to know what to do about it and how to do it.
·         The Roadmaps or “Campaigns” that a plan constructs to address specific measures should identify a strategy for pursuit of the mathematical result, incorporating tactics that may involve the provider community, the staff outreach department or the member himself. 
These campaigns imply an action-orientation whereby one is not just looking at the data, but is deploying resources under a specific program to achieve named and documented targets, perhaps over a short period, or over the whole year. 
More information regarding Valiant Health’s ProActive® Management technology can be found at www.valianthealth.com.
Terri is the founder of Cambria Health Advisory Professionals, and a Managing Partner at Quo Magis Partners. Among her current clients: a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders, a small special needs health plan as a 5 Star Consultant, and several other health related clients. The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Advisory Professional colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.

Monday, August 6, 2012

Managing External Vendors in the New Health Care Industry: Maximize Visibility, Accountability, and Governance

---Terri Bernacchi, PharmD, MBA,  Cambria Health Advisory Professionals and Managing Partner at Quo Magis Partners 
Whether one considers the provider (hospital/medical), pharmaceutical or device industry, or the health plan perspective, today’s health care executive must be more be nimble than ever before in managing strained budgets and people resources, overcoming ever-greater challenges.  As the realities of Health Care Reform (HCR) unwind upon these organizations, managers must deal with new legal requirements and penalties that are still only partially defined.  Health care has always been a bit different from other business sectors because the customer consuming the good or service must rely on others to 1) select the product (e.g., the physician) and 2) still others to assure payment (e.g., insurance companies or administrators).  At the end of the day, however, regardless of what a health related company offers, it is ultimately the consumer who is to be satisfied. 
More than ever before, as costs shift back to the member through higher out-of-pocket cost-sharing or restricted choices, and as coverage rules are tightened in order to squeeze more out of every dollar, health care industry players must focus on how to attract and retain the individual.  A company’s resources will be focused more intensively on how to get to the patient or to smaller local units like the Accountable Care Organization (ACO) or local exchanges as traditional health plan and support vendors (like Pharmacy Benefit Managers and TPAs) consolidate and refuse to cover anything but the minimums. 
Today, getting to market successfully means that some key projects are managed internally, while others must be executed through a variety of vendors that promise lower costs and expedited results.   Managing your own company’s resource is one thing; staying on top of an outside vendor is quite another.    When engaging with any vendor--- after the contract has gone through procurement and the signatures have been applied to the deal---implementation and ongoing execution is the hard part.  Both sides name the business sponsors and managers for the relationship.   Over time, however, the designees are likely to shift and the Governance Plan may be neglected.  Senior executives may be late to realize that something has run amuck where promised results have not materialized or unanticipated snags have cropped up, costing precious resources or results.   
Certainly, if it hopes to be successful in the marketplace, a vendor will do its best to meet promises made to you.  Whether the deal involves a key project requiring executive oversight for an IT outsourcing deal, a business process service need, or (more commonly these days) is focused on a Copay Discount program which is a component of the launch of your product in the US market, the recipe for success is the same.    A few of these are spelled out below: 
1.       Emphasize the expectation for ongoing governance and accountability early in the vendor negotiation process.    This includes spelling out the key performance metrics and the frequency of reporting.
2.       Offer those in your company responsible for the ongoing management the program, assurances that executives are monitoring results, with results reported directly to your Board or senior management team.  Under larger vendor agreements, this designated manager may be responsible for a function that would have previously represented hundreds of employees; executive oversight should be reflective of that degree of resource allocation.
3.       Intervene early if something is going awry (delays, cost-overruns, or poor quality) by tracking key metrics on a routine basis. 
Additional insights for the reader may be gained from the linked research article, Critical Aspects of Governance in Outsourcing: Insights from Industry, by Markus Biehl, et al.  http://www.meritoutsourcing.com/images/Outsourcing_research_paper.pdf
The authors noted the high degree of (>75%) dissatisfaction of the buyer with outsourcing vendor deals; they also cited a strong correlation between governance and oversight capabilities and buyer satisfaction.  Obviously, players in the US health care industry will continue to use of external vendors to manage critical programs or projects because it is efficient.  These deals should be accompanied by a strong, accountable process for executives to measure results and intervene early.

Terri is the founder of Cambria Health Advisory Professionals and a Managing Partner at Quo Magis Partners. Among her current clients: a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders. a small special needs health plan as a 5 Star Consultant, and several other health related clients. The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Advisory Professional colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.  *see: www.quomagis.com

Thursday, July 5, 2012

SCOTUS Decision Lands with a Thud! Now what?

---Terri Bernacchi, PharmD, MBA,  Cambria Health Advisory Professionals 

Now that ACA has been upheld, most parties will be specifically focused on how CMS and other federal agencies will interpret and regulate the day-to-day facets of the law.

The devil is always in the details in these kinds of things (consider, for example, how complex the “Coverage Gap” operational roll out was over the course of late 2010 and 2011.)  Federal and state bureaucrats and those of us who are the workers in the system must now proceed toward implementation of the individual mandate in 2014 and the thousands of rules which are both specific and vague, as laid out in the law.  Reading the fine print will become part of our daily ritual as changes in regulations are developed. 

PriceWaterHouseCoopers has a summarized snapshot of the implications of the forward momentum of the ACA, available for download on the internet. 

In my opinion, it is a thoughtful summary of the impact of the bill on various key stakeholders, including hospitals and providers, payers, employers, and pharmaceutical/device manufacturers.  Unfortunately, the “unintended consequences” of this far-flung regulatory outline are still not going to be understood for some time.  And because of the massive unpopularity of the law, it may end up being repealed.  In any case, health care entities need to forge ahead and become better prepared because the “easy-out” has been removed.  Now the hard work begins.

http://pwchealth.com/cgi-local/hregister.cgi/reg/implications-of-the-US-Supreme-Court-ruling-on-healthcare.pdf

Terri is the founder of Cambria Health Advisory Professionals. Among her current clients: a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders, a small special needs health plan as a 5 Star Consultant, and several other health related clients. The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Advisory Professional colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.

Wednesday, June 13, 2012

Is Electronic Prescribing (ERX) Hitting Its Stride?

---Terri Bernacchi, PharmD, MBA,  Cambria Health Advisory Professionals 

Although some may say, “it’s about time” that the electronic prescribing patterns started to show a real impact on how medicine is practiced, I think it is important for folks to consider how much of a change in process the use of ERX technology requires in the relationship between the physician and patient. 

A common perspective on “over-prescribing” of antibiotics in the past, for example, was that the acutely ill patient had an expectation that they would leave the office with something tangible----whether drug samples, or a written prescription. The physician fulfilled this expectation by writing something that would certainly “do no harm” and which may  produce some emotional or physical benefit.  Thus, if the patient had an expectation of an antibiotic (which may have been the sole reason for the visit), he or she would leave the office unhappy without a prescription. 

But as ERX has made its gains, the patient and physician now may huddle around a computer monitor or over a handheld device as the prescription is selected, the pharmacy chosen and confirmed, and the order issued.  The dynamic is different as some eye-contact is removed from the interaction as the doctor hands over the piece of paper. Yet the expectation may be the same—only with ERX, there is  greater likelihood the patient will actually have the prescription dispensed. 

Whether one welcomes or dreads the adoption of this technology, ERX adoption is growing, and there are fewer doubts that it will become the predominant means of communicating drug orders between prescribers and dispensers of the future.  I will comment more on this in coming months. 

Some key milestones have been met by the technology this past year:  The number of electronic prescriptions in 2011 increased to 570 million, up from 326 million e-prescriptions in 2010. By the end of 2011, an estimated 36 percent of prescriptions dispensed were routed electronically, up from 22 percent at the end of 2010.
http://www.healthcareitnews.com/news/national-report-shows-surge-e-prescribing-among-health-practitioners 

Terri is the founder of Cambria Health Advisory Professionals. Among her current clients: a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders, a small special needs health plan as a 5 Star Consultant, and several other health related clients. The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Advisory Professional colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.

Thursday, May 31, 2012

Drug Reimportation Stemmed As Counterfeit Adderall Warning Issued

       by Terri Bernacchi, PharmD, MBA,  Cambria Health Advisory Professionals  
Although the general public may be in favor of freely purchasing drugs online or from Canada, there are some good reasons why traditional regulatory controls of these products are a reasonable responsibility of the federal government.  That statement is coming from a “free-market” libertarian minded person! 
The problem is that our FDA cannot sufficiently assure that the contents of a tablet are pure and labeled as what they ACTUALLY are.   A tablet full of placebo or active ingredient (or poison, for that matter) may look identical.  Offshore counterfeiters have become very sophisticated. 
Consider two recent stories and make up your own mind: 
“The bogus version was discovered "by a consumer, who noticed misspellings on the fake product packaging," according to Denise Bradley, Teva Pharmaceutical's vice president of corporate communications….

Teva's authentic 30mg Adderall tablets are round, orange/peach in color and are imprinted with "dp" on one side and 30 on the other side of the tablet. The tablets are packaged in bottles. The active ingredients in authentic Adderall tablets are dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate. An analysis of the counterfeit tablets revealed they contained tramadol and acetaminophen, both used to treat acute pain, and they were in blister package.   

Not surprisingly, the ever-compromised Senator McCain completely misses the safety question demonstrated by the first article.  The National Association of Chain of Drug Stores applauded the defeat of the amendment but probably has a bias in perspective. http://drugstorenews.com/article/nacds-lauds-prevention-personal-importation-prescription-medications

The problem about reimportation is not about pricing!  It’s a REAL safety issue!   There are people outside of the reach of our laws and our country that would sell us cow feces and call it Viagra for $4 a pop if they could get away with it. Some structure is necessary to keep the bad guys from hurting us.  This may be one of those structures, in my opinion! 

Terri is the founder of Cambria Health Advisory Professionals.  Among her current clients:  a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders. a small special needs health plan as a 5 Star Consultant, and several other health related clients.  The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Thought Leader colleagues.   Terri has had a varied career in health related settings including:  9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago.   She has both a BS and a PharmD in Pharmacy and an MBA. 

Monday, April 9, 2012

As in the Pharmacy, Message Fatigue Can Be A Key Root Cause of EMR Errors in the Doctor's Office

Terri Bernacchi, PharmD, MBA,  Cambria Health Advisory Professionals 

The International Journal of Medical Informatics in its April 2012 issue has cited a study that I believe is something that practicing pharmacists (in a variety of clinical settings, including retail and hospital), have known for a long time:  the more messages the human brain must handle per hour, the less meaningful the individual messages will be because of a “fatigue factor”.   Indeed, I believe it is one of the key “root causes” of medication errors which get through to the patient despite all of the safety-checks in the pharmacy. Certainly, most retail pharmacy chains modify downward the level of alerts so that pharmacists are not unnecessarily distracted with false-positive warnings as they attempt to do their jobs----these system policies allow only the critical alerts or drug interactions to be pushed to the pharmacist for a traceable response to either override the message or provide an alternate response.   
As physicians are moving into a more fully automated practice of medicine, this phenomenon must also extend to them, by definition.   
The study was supported by the VA Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice.  Dr. Allisa Russ, PhD, of the Richard L. Roudebush VA Medical Center in Indianapolis noted that some alerts don't give enough information and others contradict common clinical practice. 
This link will take you to a summary of the study from MedPage Today:  www.medpagetoday.com/PracticeManagement/InformationTechnology/32006
The key EMR warning of the study is this:  “Unless we improve medication alerts so they contain information that users need to make decisions, the problem of alert fatigue will grow as (electronic medical record) systems expand beyond single hospitals and share more data."

Terri is the founder of Cambria Health Advisory Professionals.  Among her current clients:  a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders. a small special needs health plan as a 5 Star Consultant, and several other health related clients.  The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Thought Leader colleagues.   Terri has had a varied career in health related settings including:  9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago.   She has both a BS and a PharmD in Pharmacy and an MBA.