UB/BMG/IH PHARMACOTHERAPY

Question 1

What is the purpose of the UB/BMG Pharmacotherapy Research Initiative?

Answer 1

To improve the pharmaceutical care management (clinically and economically) of BMG patients

Question 2

What is a PCMH?

Answer 2

Patient centered medical home
NOT A PLACE but an IDEA
Interprofessional medical teams work “under one roof”/in one institution so they don’t need to find outside entities

Question 3

Certain value-based arrangements have lower or higher risk for the institutions involved. Categorize the following as low, moderate or high risk:
- Shared Savings + Losses (make money if good performance, lose money if bad)
- Full Capitation
- Shared Savings [Upside only] (ie. If group of MDs get ≥80% pts A1c to goal they get paid)

Answer 3

Shared Savings upside only = low risk
Shared savings and losses = moderate risk
Full capitation = High risk

Question 4

Give an example of “full capitation”

Answer 4

Ie. Medicare provides $X for EACH patient (determined by pt factors/comorbidities, etc). Instead of this $ going to an HMO, goes directly to BMG which ACTS AS IT’S OWN HMO. If BMG can keep pt costs low/out of the hospital, they get to keep any leftover money from Medicare.
All $ is managed by BMG

Question 5

What are 4 elements of the Value-Based Care Model?

Answer 5

Adjusted risk score (performance measures, codes)
Coordinated care/system interoperability
Quality of service/patient satisfaction
Value-driven payment

Question 6

What is the name of the old Medicare payment method?

Answer 6

Medicare Access and Children’s Health Insurance Program (MACRA)

Now Merit-Based Incentive Payment System (MIPS) and ALternative-Based Payment models (ABPs)

Question 7

What is Medicare Advantage?

Answer 7

Medicare pays a sponsor (ie. An HMO) a fixed payment. The sponsor then pays for the health care expenses of enrollees.

AKA Medicare Part C (includes inpatient [Part A] outpatient [Part B] and prescriptions [Part D])

Question 8

What was the conclusion of the “Comparison of Care Quality Metrics in 2-Sided Medicare Advantage vs FFS Medicare Programs” Study?

Answer 8

Overwhelmingly favored Medicare Advantage for all outcomes (inpatient admissions, outpatient visits, ED admission, Stroke/MI, COPD exacerbation)

Since Medicare Advantage allocates fixed $ per patient with BETTER outcomes, allows for more revenue to be used to develop infrastructure or PHARMACEUTICAL services!

Question 9

Patients are referred to BMG for:

Answer 9

Disease-state management
Cost consultations
Med rec
HF clinics
And more!

Question 10

What is the equation for ROI?

Answer 10

[cost avoidance - investment]/investment