Final Flashcards
Cummins Occupational Health serves how many people in the US
54K (22k in southeastern Indiana
Cummins’ onsite pharmacist’s impact on drug adherence
Increased adherence through therapy classes (Diabetes, HTN, Cholesterol)
% of adult diabetics in US that had A1c > 8% in 2020
27.8%. (not at Cummins though they have 96% of patients with A1c <8%
Cummins’ pharmacist performs high-cost claim intervention
$422,127 in client savings just switching metformin prescriptions to less expensive formulation
Benefit design impacts
Modulating patients’ benefits plans to save them money and keep them in better health
Brian Musial
VP of Pharmacy at McLaren group
Population Health Services Organization (PHSO)
an optimized, physician partnered operations entity that powers a system to improve health outcomes, promote economics of scale and coordination and reduce variation across the continuum.
allows healthcare organizations to purchase shared services under value-based payment arrangement (supports population risk management)
Population health; analyzed factors
star ratings measures, HEDIS measures, national guidelines, standards of care, other evidence-based interventions
Pharmacy team at McLaren (PHSO)
VP of Pharmacy Data analysis= Brian Musial
5 pharmacists
1 RN, 8 Pharm Techs, 3 Data Analysts
46brooklyn
drug analytics, historical data, Medicaid data, NADAC, WAC. Tells us the Medicaid spend etc.
Supply chain
Manufacturer–> wholesaler –> Pharmacies–> patients
ASP
average sales price
Specialty use in the past 3 years (according to Brian Musial)
51% of spending (highest growth in immunology, endocrinology and oncology)
Effect of COVID on diagnosis visits in 2020
almost 1 billion (967 M) diagnosis visits that did not happen. leads to less prescription utilization
Common health insurance misconceptions
health insurance doesn’t cover all medical expenses, employers typically pay 25-30% of total annual salary for benefits, people need health insurance because health care is expensive
Define a self insured health care plan
Employer assumes risk of providing health coverage for insured events. Employer acts as own insurer, claims processed by insurance company
Benefits of self insured plans
Control and flexibility (avoid state-mandated benefits and control over providers), potential for decrease cost (avoid state health insurance premium taxes and other fees)
List strategies to decrease short term health care costs
change insurance plans (tier and deductibles etc.), encouraged consumerism, wellness campaign (incentivize improving wellness outcomes)
List strategies to decrease long term health care costs
develop metrics/brand/identity (awareness)
share stories, education, partner with local providers, create penalties and rewards (engagement/ accountability)
evaluate outcomes, add new incentives (Improvement and maintenance)
Identify and stratify perspective populations used providing healthcare via the VA
Veterans, and those with service connected disabilities
Nikola Markoski
Pharmacy manager analytics and clinical insights
Supply Chain Definition
Network between a company and its suppliers to produce and distribute a specific product to the final buyer, interconnect journey that materials take before they are sold to customers, a system of organizations, people, activities, information and resources that provide products or services to consumers.
4 primary pharmaceutical spend categories
Generic injectables, generic non-injectables, branded non contract, branded contract
Group purchasing organizations (GPO)
aggregate and leverage purchase volume to negotiate discounts with manufacturers (never take possession of the product). leverages data
Types of supply chain analytics
descriptive, diagnostic, predictive, prescriptive
Causes of drug shortages
unknown would not provide (60%), supply demand (14%), manufacturing (12%), business decision (12%), raw material issue (2%)
how climate change may impact healthcare and population health
increased heat related illnesses, worsening of air quality, spread of vector borne disease, waterborne disease, food insecurity and malnutrition, mental health impacts, increased allergies and infectious disease, healthcare system strain, displacement and migration, social inequities
describe which populations and sectors of healthcare might be impacted the greatest by changes in the climate
those with high exposure (low income population, occupational groups, people in certain locations), people who are more sensitive (pregnant women, pre existing medical conditions, children), those without the ability to adapt (older adults, people with disabilities, indigenous people)
describe the role of the pharmacist and other healthcare professionals in preventing and combating the impact of climate change on the patients we serve
encourage healthy lifestyles and prescribing, avoiding unneeded meds, encouraging green manufacturing, minimize waste, critically evaluate disposal of unused product, consider changes to expiration dates and recycling of medication, advocate for leaders to develop an environmentally sustainable HC system, review personal practices)
describe the role of individual citizens in helping minimize the impact of climate change
MAKE THE RIGHT THING TO DO THE EASY THING TO DO, just like healthcare there will be winners and losers, long term solutions in a short term world, advocate for national standards, and incentives
Overview of rare diseases
rare disease is <200,000
ways to incentivize research and development in areas with high unmet needs
The Orphan Drug Act (1983), tax incentive, Public private partnership, advanced market commitments, regulatory incentives, prize fund
review unique challenges providing high quality care for people living with rare diseases
many rare diseases result in premature death of infants and young children, disjointed/ uncoordinated healthcare system, specialty care, limited resources, expensive therapies, not a priority for healthcare entities, limited quality data
describe the role of specialty pharmacy in healthcare
32K+ specialty Rx in US, market value is $68.3 billion, forecasted $1.5 trillion in 2033
Specialty Medication
meds for small populations, medications for rare diseases, high cost medications, special handling requirements, not just injectables, reimbursement challenges
describe where specialty pharmacies fit into the drug supply chain and how patients receive medications from these pharmacies
specialty pharmacies receive specialty drugs from specialty distributors. Patients receive drugs by shipment
describe the different specialty pharmacy models
Open distribution (manufacturer wants everyone to have access): many people have choices
Controlled distribution: (manufacturer wants to control access) lower cost less product access choice
describe the services typically provided by specialty pharmacies vs HUBs
dispensing, quality of life screening, medication adherence, adverse drug reaction screening, clinical interventions, follow up, education, REMs
explain the importance of accreditation of specialty pharmacies
drug manufacturers and payors want to work with the best specialty pharmacies, provides competitive advantage, fosters continual improvement, compliance with the law.
has become integral and MANDATORY part of the operational excellence.
URAC, Joint Commission, National Committee for Quality Assurance (NCQA)
number of deaths in US associated with the 1918 H1N1 pandemic
675,000 (fewer died in US than worldwide)
number of deaths in US to date (2023) associated with the COVID 19 pandemic)
1.1 million
january 2022 covid was what leading cause of death in US
2nd
which is associated with greatest risk of poor outcomes and death associated with COVID 19
advanced age, underlying respiratory disease, immunosuppression, obesity, underlying cardiovascular disease
which of the following is associated most closely with willingness to get vaccine
political party
