Transcript Document

Community-Based Case Study: MEDNET
©
A Collaborative Approach to Prescription Drug Access
Presented to National Congress on the Uninsured by
Elizabeth Rugg, Executive Director, The Health Councils, Inc.
Karen van Caulil, Executive Director, Health Council of East Central Florida, Inc.
Steve Lesky, Regional Vice President, Allegany Franciscan Ministries
Chronically Ill
Adults
Prescription Drug
Access
MEDNET©
Bridges Gap Between Prescription Drug Needs
and Prescription Drug Access
Origin: 2003 Health Systems Plan
Collaborative community health planning process
Engaged multi-tiered approach to identify health needs
Step 1: Data Analysis
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Step
Step
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Step
Population Demographics
Mortality/Morbidity Indicators
Health Care Access (Resource Analysis)
Health Care Coverage Options
2: Community Survey (web-based & in-person)
3: Focus Group Discussions
4: Issue Summary & Priorities
5: Action Planning
Finding: Aging population will increase need for care
Adult Population, 2000
Age
Composition of Seniors, 2000
Number Percent
Number Percent
0 - 14
147,814
16.0%
65 - 74
96,537
10.5%
15 - 24
88,816
9.6%
> 75
111,026
12.0%
25 - 44
251,954
27.3%
45 - 64
225,335
24.5%
> 65
207,563
22.5%
Source: 2003 Health Systems Plan
Growth in Seniors & Near-Seniors,
2000-2020
45 – 64
> 65
2000
225,335 207,563
2020
294,697 281,390
%
Growth
31.0%
36.3%
Finding: Income will limit access to care
Uninsured Non-Elderly, 2000
Household Income, 2000
< 65
675,452
Pinellas
Florida
# Uninsured
91,999
$33,765
$37,307
% Uninsured
13.6%
Commercial Premium Costs,
1996-2001
Premium Cost Per Enrollee
2500
2000
1932
1553
1500
1202
1297
1680
1379
1000
61% Increase 1996-2001
500
0
Source: 2003 Health Systems Plan
1996
1997
1998
1999
2000
2001
Finding: Lack of care will increase cost of care
Health Care Expenditures - 1992 – 2001 (Florida)
90000
80000
77341
71010
In $ Millions
70000
60000
50000
40000
30000
45055
72% increase 1992-2001
Personal Health
Care
20000
14000
10000
12000
0
2000
2001
Medicinal Drugs
In $ Millions
1992
11459
10156
10000
8000
6000
4000
4683
145% increase 1992-2001
2000
0
Source: 2003 Health Systems Plan
1992
2000
2001
Greatest Health System Impact:
Medication Access
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#1 Health Issue in Pinellas County
Circle of Influence
• 45% - Issue to Self or Family
• 85% - Issue to Entire Community
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Barriers to Prescription Drug Access include:
• Lack of Health Coverage for Prescription Drugs
• Cost of Prescription Drugs
• Lack of Awareness about Alternate Resources for
Prescription Drug Access
Source: 2003 Health Systems Plan (Pinellas County)
Community Solution: MEDNET©
Four Essential Program Components:
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Patient Advocates – deployed strategically
throughout community to work one-on-one with
chronically ill adults, either in a clinic setting or
at a one-stop service center
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Program Software – web-based data system
to coordinate client intake, forms processing,
and service delivery
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Pharmacy Vouchers – short-term support to
at-risk clients accessing free long-term use
through MedNet
•
Health Literacy – to teach frontline care
givers and able-bodied adults to access free
medications on their own
Patient Advocates (MedNet Navigators)
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Receive referrals from local
physicians and clinics
Record prescription drug needs
Determine eligibility for free
use of prescription drugs from
pharmaceutical manufacturers
Download and complete
application forms – request
vouchers, if appropriate
Coordinate provider relations
Initiate refill requests
Advocate for patient needs to
expedite medication receipt
Confirm receipt of free
medications
Program Locations
Free Clinic
FQHC
Sliding Fee Residency Clinic
Public Health Department
Local Hospital
Community Organization
8 FTE Total
Site Options, Program Needs & Cost Factors
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Site Options & Program Needs
Staffed Site
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advocate OR volunteer
coordinator)
• 1 FTE Patient Advocate
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Volunteer Site
• 3-5 reliable volunteers
• 1 FTE Volunteer Coordinator
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Both Site Types Need:
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Office Space
Computer w/Internet Access
Printer, Copier & Fax Machine
Postage
Office Supplies
Locally-developed or
commercially-produced client
enrollment & services tracking
database
Cost & Other Factors
Salary & Fringe (1FTE
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Need to:
• develop & maintain
client enrollment &
services tracking
database OR
• subscribe to
commercial product
Community Consensus: A Critical Success Factor
Prioritize chronic disease concerns
• Reason: Establish eligibility criteria for pharmacy voucher
component (30 day supply of medications)
Establish program policies
• Reason: Establish consistent program practices across
multiple partner sites; e.g., policy requiring validation of
secured medication against patient chart, etc.
Create targeted referral system
• Reason: Respond to specific health care needs; e.g., access to
mental health medications
Develop patient advocate training program
• Reason: Create well-educated network of community-based
patient advocates
Review client enrollment & service utilization
• Reason: Recognize emerging trends, assess community return
on investment, and establish best practices
What to Expect: Return on Investment
MEDICATIONS BY DRUG CLASS
1 Site
1st 9 Months of
Operation
% OF ALL
Arthritis
$2,732.12
0.7%
Asthma/Allergy/Lung
$46,498.46
13.0%
Diabetes/Endocrine
$46,414.21
10.7%
Gastro-Intestinal
$22,670.45
9.4%
Heart, Cholesterol & Stroke
$124,621.58
25.1%
Mental Health
$121,742.26
19.0%
Migraine/Other Pain
$11,122.92
6.1%
Other, Including Seizure
$19,226.09
16.0%
$395,028.10
$10 : $1
TOTAL MEDICATIONS
(9-Month Return)
Program Evaluation
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Reviewed MedNet database to identify
potential data points for study
Qualitative analysis – observation,
interviews
Convened evaluation team meetings to
discuss implementation, outreach and
processing efforts and challenges, lessons
learned and “best practice” differences
between clinic and community based
sites
Developing client satisfaction survey
instrument and process
Continuing to review/analyze outcome
data differences between program sites
Outcomes
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High level of satisfaction by
program staff with MedNet
software and technical support
General Finding: Clinic sites
have an easier time securing
needed paperwork from MDs;
however, community sites
achieve a strong return to the
community
Major Strength: Ability to share
“hot tips” and network best
practices across program sites
Next Steps…
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Measure impact of MedNet on clinical
health outcomes to determine:
• Does MedNet reduce the incidence and impact
of “avoidable admissions” to local hospitals?
• Has MedNet reduced the cost of managing
chronic disease for low-income residents?
Program Design
Elizabeth Rugg, Executive Director
727-217-7070 [email protected]
Program Evaluation
Karen van Caulil, Executive Director
Health Council of East Central Florida, Inc.
407-493-6808 [email protected]
Program Funding
Steve Lesky, Regional Vice President
Allegany Franciscan Ministries
727-741-2744 [email protected]