University of Michigan Health System

Transitions of Care Medication Access and Meds-to-Beds Services

Submitted by Lindsey Clark, PharmD, MBA, DPLA

Site Description

The program has been implemented at the Taubman Ambulatory Care Pharmacy, located within the University of Michigan Health (UMH)- Academic Medical Center. This pharmacy serves a diverse population of adult and pediatric patients receiving care at UMH hospitals, emergency departments, and ambulatory clinics and surgery centers, in addition to University of Michigan employees, retirees, and their dependents. The Taubman Ambulatory Care Pharmacy serves as the discharge pharmacy for the health system, in addition to filling clinic prescriptions.

Service Description

The patient experience, medication access, and affordability are improved through our Transitions of Care Medication Access and Meds-to-Beds Pharmacy Services:

• The Transitions of Care (TOC) discharge medication access team strives to make the transition from hospital discharge to home as seamless as possible for patients. The team, which consists of four pharmacy technicians, performs insurance coverage checks to assure the affordability of medications, submits prior authorizations, appeals rejected prior authorizations, identifies preferred formulary alternative medications, and more. These technicians noticeably increase patient satisfaction during the stressful transition between hospital and home. There is also extensive partnership with social work and case management to improve the coordination of care for patients.
• The TOC discharge meds-to-beds team includes four bedside delivery technicians and one pharmacy intern involved in coordinating adult and pediatric inpatient discharge medications and their delivery via the MiRxExpress meds to beds service. The discharge team currently provides services to patients discharging from the Adult Hospitals, Children and Women’s Hospital, Adult and Pediatric Hematology/Oncology and Bone Marrow Transplant Services, Pediatric Endocrinology Service, and the Adult Emergency Services Department.

Policies and Procedures

Workflows for the Transitions of Care Medication Access and Meds-to-Beds Programs are established in written work procedures.

The Transitions of Care Medication Access team receives consult orders from interdisciplinary team members in the electronic medical record. The consult order contains information on the medications for which copay check assistance is being requested. Based on the outcome of the copay check, the team will work with the medical team to identify a covered formulary alternative, submit a prior authorization or appeal letter, and/or explore any other available coverage options. The Transitions of Care Medication Access Pharmacy Technicians document their findings in the electronic medical record, and send a secure message to the interdisciplinary team within the electronic medical record as well. This helps to foster streamlined and transparent communication. We are able to obtain workload volume data based on the number of consult orders submitted.

The Transitions of Care Meds-to-Beds Team also receives consult orders from the interdisciplinary team members who would like to enroll the patient in the meds-to-beds program, within the electronic medical record (Epic). Upon receipt of a consult order, the Meds-to-Beds Pharmacy Technicians contact the patient or caregiver and their nurse to confirm they would like to enroll in the Meds-to-Beds program, and coordinate a delivery time and payment. The Meds-to-Beds Team then processes, fills, and delivers the medication to the bedside. We strive to deliver the medications to the bedside as close to the time of discharge as possible, to ensure we are delivering the most up to date and accurate discharge medications to the patient.

Additional Tools

The Medication Access Team uses an online, automated prior authorization vendor to submit prior authorizations electronically. Electronic health record functionality is used extensively to optimize documentation and communication.

Patient Population Target

The scope of these services include patients discharging to home from the University of Michigan Health- Academic Medical Center Adult Hospitals and Children and Women’s Hospitals. With limited resources and high demand for our services, it is sometimes necessary to prioritize services to patients receiving complex medication therapy and with limited mobility.

Financial Considerations

The Transitions of Care Medication Access and Meds-to-Beds Program Pharmacy Technician positions are funded by the Pharmacy Department. Both services contribute to improved workflow efficiency, patient experience, and quality of care for discharging patients, and the Meds-to-Beds program contributes to increased revenue generated for the health system.

Patient Assistance

The Transitions of Care Medication Access and Meds-to-Beds Team provide the following services to assist patients:

• Obtain prescription insurance information
• Perform copay checks to assess for prescription insurance coverage
• Submit prior authorizations and write appeal letters
• Submit Patient Assistance Forms and assist with other financial needs for medications
• Work with interdisciplinary team members to overcome other medication access barriers
• Process, fill, and provide bedside delivery of discharge medications
• Transfer subsequent refills to the patient’s home pharmacy (if desired by patient)

Key Stakeholders and Operational Considerations

Our key stakeholders include interdisciplinary team members, as well as our own community and transitions of care pharmacists and pharmacy technicians. Interdisciplinary team members that we collaborate with most extensively include providers, pharmacists, nurses, case managers, social workers, and resident/clinical assistants.

The Transitions of Care Medication Access and Meds-to-Beds services help to significantly improve communication and coordination around discharge medications for the inpatient adult and pediatric medical and surgical teams. For this reason, our services help to reduce the workload burden on inpatient providers, pharmacists, nurses, social workers, case managers and resident/clinical assistants. This leads to a significant time savings for these team members. This empowers these team members to focus on patient care activities that they are uniquely qualified to perform.

Outcomes & Measures

Thousands of patients have been able to obtain timely access to their medications and improved affordability through our Transitions of Care Medication Access and Meds-to-Beds Services.

In FY23:

• 1,804 prior authorizations were submitted
• 644 insurance or pharmacy issues were resolved 
• 18,039 copay checks were performed 
• 3,115 Bedside deliveries were performed

Our medication access services have demonstrated the following positive patient outcomes:

• Reduced delays in medication access due to proactively determining insurance coverage and resolving medication access barriers, such as prior authorizations.
• Improved patient and staff satisfaction.
• Reduced the workload burden on providers, nursing, and pharmacists.
• Improved patient care experience and coordination of care.

Our meds to beds program has demonstrated the following positive patient outcomes:

• Improved patient and staff satisfaction with discharge pharmacy services.
• Reduced discharge prescription turnaround time.
• Reduced delays in discharge medication readiness.
• Improved patient care experience and coordination of care.

Key Elements of Success

• Pilot, pilot, pilot! We have found that this is the best way to demonstrate positive outcomes associated with a new or expanded patient care service. Utilize pharmacy students, pharmacy interns, or other temporary staff to implement a pilot, if existing staff cannot be utilized.
• Engage interdisciplinary stakeholders and champions. Much of our expansion was driven by our interdisciplinary champions who were, and continue to be, outspoken about the tremendous value our patient care services bring to their patient populations. Our interdisciplinary champions include providers, nursing, social work, and case managers. Our acute care pharmacists have also provided advocacy and support that has been instrumental in our expansion efforts.
• Prioritize and focus on just one to two major initiatives at a time. We have found if we are focused on more than that, we are spread too thin and will be much less likely to demonstrate successful outcomes. Each expansion effort has been labor intensive.
• Optimize use of electronic medical record functionality for streamlined and transparent communication and documentation with interdisciplinary team members.
• Demonstrate that there is a margin gain or operational efficiency opportunity (e.g., reduced length of stay) for the health system associated with the new or expanded service, or that the service is at least cost neutral.

Lessons Learned

See above.

Future Goals

We are currently focused on the following expansion efforts to continue to improve patient medication access and affordability:

• Continued expansion of the meds to beds program into the Children and Women’s Hospital. There is a significant need for our services in the pediatric population.
• Addition of transitions of care discharge medication access technicians for highly specialized pediatric patient populations to assist with medication access and the coordination of care. For example, pharmacy technicians were recently added to focus on the adult BMT and pediatric BMT and hematology/oncology patient populations. The focus will now turn to implementing a pharmacy technician for the pediatric cardiology and nephrology patient populations.