Physician Dispensing Using ez Dispense powered by AHCS

Physician Dispensing Using ez. Dispense powered by AHCS An overview of the software Ainsley B. Little, Director of Software Development

Benefits of using ez. Dispense Compliance – All dispensing data is automatically reported as required by the relevant local and or state agencies. Our proprietary rules engines allow for easy configuration as new dispensing rules are enacted in various states. ◦ ◦ Limits to day supply for meds of concern such as C-II pain meds Pre-authorization formularies such as referencing ODG guidelines Patient convenience – Each dispense encounter can be processed in as little a few minutes. Patients are not subject to long waits at pharmacies or possibly having to cover some of the cost of their prescribed workers compensation medications

Benefits of using ez. Dispense Better outcomes - Patients get all their medications each time they see their physician thereby ensuring they follow the treatment plan as specified by their physician resulting in returning to work sooner Only registered and verifiable medications are available for dispensing in ez. Dispense. All meds must be listed in either Redbook, Medispan or First Databank. All medication suppliers must be licensed in the relevant state and meet our due diligence criteria. Recommended use of generic medications unless brand medications are specifically prescribed Electronic Billing interfaces – AHCS can submit bills using EDI X 12 5010 transaction code sets 835, 837, 999, 997 etc.

Benefits of using ez. Dispense e-Prescribing via Surescripts is available in ez. Dispense. Users can send and receive e-prescriptions and process/dispense the medications easily. The feature also allows for quick, easy searches of patient benefits and medication history available through the Surescripts network AHCS negotiates contracts with several PBMs with rates of reimbursement discounted from the state fee schedule. This makes ez. Dispense an in network pharmacy provider for many networks which benefits the patient, insurers and employers Electronic Billing interfaces – AHCS can submit bills using EDI X 12 5010 transaction code sets 835, 837, 999, 997 etc.

Compliance The ez. Dispense system is set up to report dispense data to all relevant local and/or state authorities as required by law AHCS currently reports to 28 state Prescription Drug Monitoring Programs. More added each year as legislation is passed. Our configurable software allows us to reconfigure these reports as or when the vendor, frequency, format, version or protocol might change We have implemented formularies for medication pre-authorization such as using a real time web service to refer to the ODG guidelines and return pre-auth requirements in a matter of seconds

Compliance Days supply limitations can be configured to allow limiting of controlled medications or meds of concern to the amount allowed by law ◦ In Florida C-II meds can only be dispensed to patients for a 14 day supply if in connection with a surgery. Our system captures the surgery date, supporting notes and applies the limit These rules can be applied to patients in or out of state. If there is a conflict of state rules due to a patient being seen in another state for a Florida jurisdiction workers compensation case then we apply the most restrictive of the conflicting rules Dedicated account managers do routine audits of our clinic partners to ensure they are maintaining DOH compliant dispensing protocols

Patient Convenience ez. Dispense offers a quick and easy way for patients to receive their meds in their physicians practice thereby alleviating the need for an injured patient to make additional stops at a local pharmacy which may not have the med in stock or may require the patient to return to collect the medication at a later time In some cases patients may be required to pay a portion toward the cost of the medication and then follow up with their workers compensation insurer for re-imbursement of their out of pocket costs

Improved Outcomes Patients receive all their prescribed medications each time they see their workers compensation physician thereby ensuring that they follow the treatment plan as specified by their physician This level of adherence to their treatment plan results in faster recovery time to reach Maximum Medical Improvement allowing the injured worker to return to work sooner

Medications All medications available for dispensing in ez. Dispense must be verifiable in either Medispan, Red Book or First Databank depending on what the requirements for re-imbursement are for the state of jurisdiction ◦ Florida uses Medispan as the basis for re-imbursement so we will only allow dispensing of meds to Florida patients that are verifiable in Medispan Our partner physicians are able to prescribe any medications they prefer but we advised them to stock and prescribe generic medications in their regular course of treatment. Brand medications are available but due to their high cost and AWPs they are only included if the physicians require them ◦ In Florida we see 83% generic medications and 17% brand medications dispensed

Questions

Physician Dispensing An Overview of the Practice Brian S. Bizub, CEO

Credentials 30 Years in Health Care Industry 12 Years in Executive Hospital Positions 18 Years in Physician Practice Operations, Management, Recruitment, Contract Management, Reimbursement, Coding, and Billing ◦ Tenet Healthcare Systems ◦ Temple University Hospital ◦ ◦ Thomas Jefferson Medical College Temple University Hospital Palm Beach Orthopaedic Institute Flathead Valley Orthopedic Center/Orthopedic Surgical Center Strategic Advisory - Mt. Tam Orthopaedics, Larkspur, CA Board Member – American Association of Orthopaedic Executives

Physician Dispensing Help Patients Receive Medication Convenience Patient Communication Adherence to Treatment Safety Clinical Outcomes Accuracy

Help Patients Receive Medication Ensures that patients receive their medication at time of treatment versus an extra trip to the pharmacy ◦ Injured Patients can have difficulty with Transportation ◦ Confusion about Benefits and Copays – May result in Rx not being filled ◦ Injury affects the ability to wait 20 -30 minutes for Rx to be Filled at Pharmacy Retail Spend Each Visit is Appx $12 Ensures Compliance ◦ Monitoring Medication Dispensing helps to reduce risk, fraud and abuse ◦ Diversion of Medications ◦ Refills help to determine compliance to Treatment Plan

Convenience Provides the Opportunities ◦ ◦ Patients to Obtain Medication at Time of Visit Begin Treatment before Leaving the Physician’s office Improve Compliance and Outcomes According to the Journal of General Internal Medicine, between 28 percent and 31 percent of new prescriptions are never filled, leading to serious health conditions ◦ In-practice pharmacies can also ease problems with over-prescribing. A recent study found that more than 1 in 100 discontinued prescriptions were filled by a pharmacy nonetheless.

Patient Communication Patient/Physician Proactive Approach ◦ Engage and Educate ◦ Customer Service ◦ Value-Added Services and Resources Patients have the opportunity to communicate with the physician on the following: ◦ Side Effects ◦ Proper Dosage ◦ Interactions of Medications - Medication Reconciliation is mandate by Federal Regulations ◦ Expectations ◦ Personal Contact with Medication-Related Questions

Adherence to Treatment Provides a vehicle to ensure the patient in taking the medication Progressing through their treatment plan Opportunity to Communicate on a Monthly basis regarding treatment plan and medications. Compliance with Medication ◦ 10% Never Fill Rx ◦ 30% Never Refill Rx Opportunity to modify treatment plan Opportunity to review work status and progress Nonadherence carries a huge economic burden. Yearly expenditures for the consequences of nonadherence have been estimated to be in the hundreds of billions of US dollars

Adherence to Treatment Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors. ◦ These include realistic assessment of patients' knowledge and understanding of the regimen, clear and effective communication between health professionals and their patients nurturance of trust in therapeutic relationship. ◦ Knowing the patient as a person allows the health professional to understand elements that are crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social supports, and emotional health challenges, particularly depression. Physician–patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence. ◦ Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and improves patients' healthcare outcomes.

Safety Ensure Medication are Dispensed Appropriately and Timely Education associated with Risk and Complications (Allergies, Reactions, Etc) Triple Check Safety System ◦ Ensure patients are receiving the correct medications Adherence to Federal Regulations ◦ Bi-Monthly Reviews of Medications Dispensed ◦ Appropriate Paperwork Completed ◦ Removal of Expired Medications PBOI is audited on a monthly basis by the Department of Health and has never received a citation or recommendation for improvement.

Clinical Outcomes Physician oversight promotes better clinical outcomes Discussion regarding medications, compliance of treatment plans, interaction with other medications and side effects Diet Exercise/Physical Therapy Goal is to return to work faster ◦ Monthly Visits with Refill Program ◦ Ability to Lower Dosages and Adjust Medication Depending on Physician Visit and Progress ◦ Decrease Loss-Work Claims for Employer ◦ Decrease Loss-Time Claims for Pharmacy Costs ◦ Improve Outcomes and Limitations and Restrictions

Accuracy Predefined medical protocols for disease, acute and chronic injuries and post surgical care for all patients regardless of financial class Prepackaged medication reduced the opportunity for errors and adverse events Dispensing software has triple check safety scans to eliminate errors Physicians have past, social and surgical history to ensure medication are prescribed appropriately from a whole body approach Reviewing medication reconciliation at time of service reducing potentially dangerous contraindications and interactions resulting in an adverse event

Conclusion Despite the misconceptions of physician dispensing being tagged as an enhanced revenue initiative the program has developed and created: ◦ ◦ ◦ ◦ Standardized Care Protocols Improved Communication Convenience – One Stop Shop Collaboration of Care Adherence Standards Safety Better Clinical Outcomes with Faster Recovery, which result in a decrease in Loss-Work Claims ◦ Returns the Patient to Normalcy

Questions

Physician Dispensing An Employers perspective Scott Clark, Title Risk and Benefits Officer, Miami-Dade County Public Schools (Retired)