Saint Joseph Candler

Practice Setting

St. Joseph’s/Candler (SJ/C) offers 16 primary care medical groups in the greater Savannah, Georgia area and provides pharmacists at 4 of the higher volume medical group practices that average 2400 patient visits per month. Pharmacists primarily provide Annual Wellness Visits and Comprehensive Medication Management while supporting patients and providers as defined by the Board of Pharmacy Specialties.

Why was the pharmacy service developed? (Describe any compelling data collected prior to implementation)

Efforts are focused on continuing to build value for Ambulatory Care Pharmacy within the primary care medical groups. Optimizing patient adherence to guideline directed medical therapy has been previously identified as a successful way to reduce cost and provide more comprehensive patient care.This project sought to demonstrate a primary care setting model that provided quality improvement of adherence measures and cost justification of the time spent by the pharmacy team. Medicare Advantage plans were attractive because heavily weighted outcomes were available three months later, instead of two years like traditional Medicare. Real-time data makes implementation of process improvement plans more effective.

Adherence calls were made from September 1, 2019 through January 15, 2020 based on protocol rules developed by the primary care pharmacy team and care gaps identified by third parties pharmacy benefit claims.

What training, certification, credentialing, and practice agreement is utilized by the practice setting pharmacist(s)?

SJ/C Ambulatory Care Clinical Pharmacy Specialists are residency trained and are required to be Board Certified per the Board of Pharmacy Specialties within 2 years of hire. SJ/C Ambulatory Care Clinical Pharmacy Specialists enter into a collaborative agreement with one or multiple supervising physicians, a component of Certificate of Drug Therapy Modification per the Georgia State Board of Pharmacy. This Certificate must be renewed annually with the Board of Pharmacy.

What outcomes are being measured to evaluate the model's success? (Clinical metrics, revenue, cost-savings, patient satisfaction, etc.)

Medication adherence for diabetes medications (D11) improved from 78% in 2018 to 83% (p=0.18) at the close of 2019. Medication adherence for hypertension (RAS antagonist) medications (D12) maintained at 84% in 2018 and the close of 2019 (p=0.88), and medication adherence for cholesterol (statin) medications (D13) increased from 81% in 2018 to 82% in 2019 (p=0.37). Average star rating increased from 3.25 in 2018 to 4.05 in 2019 for all Quality measures and Advantage plan providers received a bonus of $50 per member per year (PMPY) = $91,750. The improvement in the percentage of patient adherence for diabetes medications and statin medications in 2019 likely contributed to a 4 star rating ($50 bonus dollars PMPY) over a three star rating ($25 bonus dollars PMPY) and a net bonus attributable to adherence scores of $45,875.

How have you made this service sustainable? (Include billing, reimbursement, etc.) 

A care gap analysis was incorporated into the pharmacy care delivery model with students and pharmacy residents. The pharmacy manager follows monthly with the quality department to identify care gaps with third parties and leverage patient care outreach within medical groups.

How did you gain support of administrators, providers, and other key stakeholders to implement your practice model?

Communication, elevator pitches, and patience! SJ/C Pharmacy is focused on quality patient care and promoting the safe and effective use of medications. The team has been patient while tracking patient care metrics and engaging relevant stakeholders during opporutnities to align with a system initiatives (e.g. changing MIPS measures or insurance contracts, EMR upgrades that provide for increased collaboration) The Ambulatory Care Pharmacy team has relationships and regular follow up with physicians and providers, administration, and revenue integrity. It takes a village.

What are some lessons learned while implementing your practice model that you would like to share

Take advantage of opportunities and try to be consistent and patient, not pushy. Ambulatory Care Pharmacy is not always immediately received by all stakeholders as a significant return on investment. You need to provide quality services above advanced practices and always have physician, and most of all, patient satisfaction.