UNIVERSITY OF UTAH HEALTH 14-AUG-2019 Facing the threat of domestic violence, being a survivor of sexual assault, struggling with depression or thoughts of suicide are four topics that are difficult to broach with anyone. Including those who can help you. A new study reveals up to 47.5 percent of patients who feel they face one or more of these four threats do not disclose this critical information to care providers out of embarrassment, fear of judgement or the possible long-term implications of sharing such information. Scientists at University of Utah Health, Middlesex Community College, University of Michigan and University of Iowa collaborated on the study, which was published online in JAMA Network Open on August 14. Understanding how to make patients feel more comfortable with clinicians is key to helping patients address such life-threatening risks, says the study's senior author Angela Fagerlin, Ph.D. "For primary care providers to help patients to achieve their best health, they need to know what the patient is struggling with," says Fagerlin. Patients who withhold they have been sexually assaulted are potentially at risk for post-traumatic stress disorder and sexually-transmitted diseases, she explains. "These are numerous ways providers can help patients with such as getting resources, therapy and treatment." She is chair of the department of Population Health Sciences at U of U Health and an investigator with the VA Salt Lake City Health System's Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for innovation. The study reflects responses from over 4,500 people in two national online surveys from 2015. Participants in one survey averaged 36 years old, while participants from the second had a median age of 61. They reviewed a list of types of medically relevant information and asked to indicate whether they had ever withheld this information from a clinician. They were also asked to recall why. The surveys show that 40 to 47.5 percent of participants chose not to tell their provider that they had experienced at least one of the four threats. Over 70 percent said the reason why was embarrassment or fear of being judged or lectured. If the patient was female or younger then the odds were higher they would keep this information to themselves. What compounds this issue is that multiple studies in recent years have highlighted how health care providers downplay or fail to take seriously women's medical complaints. One limitation noted by the study's first author Andrea Gurmankin Levy, Ph.D., MBe, a professor in social sciences at Middlesex Community College in Middletown, Connecticut, is that study participants may have not shared in their survey responses all the information they withheld, meaning that this phenomenon may be even more prevalent than the study reveals. Levy says the survey reinforces the point that there is discomfort and a lack of trust between patients and providers. If patients filled out a questionnaire about sensitive information when they arrive at the provider's office, might that improve the information flow? She wonders, "Is it easier to tell a piece of paper something sensitive than to look into your clinician's eyes and say it?" The next step in Fagerlin and Levy's research may be contacting patients as they leave an appointment with their provider. Person-to-person interviews would permit the research team to get patients to respond while their memories are still clear. "If we are there, we can ask them right in the moment so they can more easily put their finger on exactly what was at issue - why they didn't share such crucial information," Levy says. This is the second article by this team to draw upon the 2015 surveys. The first, published in November 2018 revealed that 60 to 80 percent of those surveyed did not share pertinent information with their provider regarding daily issues like diet and exercise. One third did not speak up when they disagreed with their provider's recommendations. Both surveys raise concerns about communication and trust between patients and their care givers. Improving rapport falls both on providers' and patients' shoulders, the authors say. Providers need to establish an atmosphere where the patient feels neither judged nor rushed but rather are able to share concerns fundamental to their well-being. In addition, patients will benefit by sharing sensitive information with their providers. Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system. https://www.eurekalert.org/pub_releases/2019-08/uouh-uth081219.php?utm_source=linkedin&utm_term=baylor+scott+%26+white+health&utm_content=5c6092e0-dbb8-4398-abfe-2ff02ca5eec4&utm_campaign=Hootsuite&utm_medium=social

Troy Medicare's model is based on paying pharmacists directly for enhanced care management services at a rate of between $30 to $50 per-member-per-month.

By KEVIN TRUONG / May 12, 2019 at 10:29 AM

The independent community pharmacy is under siege from emerging mail-order drug services, pharmacy chains like CVS and Walgreens and declining reimbursement rates, but as Flaviu Simihaian likes to point out the segment is holding steady at around 35 percent of the country’s retail pharmacy space.

Simihaian is the CEO of Troy Medicare, a Charlotte, North Carolina-based Medicare Advantage startup looking to leverage these independent pharmacists to help deliver care and manage the chronic conditions of seniors.

Simihaian previously helped start a company called Amplicare, which provided workflow automation software for pharmacies. It was in this role that he started to see the potential of pharmacists as a key cog in care delivery.

Instead of just filling prescriptions, he witnessed pharmacists providing health assessments, helping overcome patients’ social barriers to care and helping patients understand how to keep healthy and stay adherent to their medications.

“There’s this idea that pharmacists are just pill dispensing machines, but there’s a reason they continue to stay around even with everyone healthcare is effectively trying to put them out of business,” Simihaian said. “They stay because they have developed a trusted relationship and provide a much higher level of care for their patients.”

Medicare Advantage is a rapidly growing segment within the insurance industry, driven by favorable federal policies which allow more flexibility in how plans operate. Because of Medicare Advantage’s capitated payment model, health plans are incentivized to figure out new ways to coordinate care and keep patients healthier and out of the hospital.

According to research sponsored by AmeriSourceBergen, patients interact with their pharmacist 35 times a year versus only four visits with their provider. Troy is betting that these touch points can be more effectively used to manage chronic diseases, ensure medication adherence and deliver preventive health measures like flu shots.

Amina Abubakar, the owner of Rx Clinic Pharmacy in Charlotte, North Carolina and Troy’s clinical director, said in her normal practice she delivers medications to homebound patients, put together medication adherence packages and works with patient’s clinicians on their care.

She said that the problem is that these actions don’t receive any commensurate reimbursement from health plans. 

“We still get paid only for the pills we dispense,” Abubakar said. “These things we do are so important to drive better outcomes, but no payer seems to actually value them.”

Troy Medicare’s model is based on paying pharmacists directly for those care management services at a rate of between $30 to $50 per-member-per-month.

Where Troy’s technology comes in is in developing a data infrastructure that will allow the cross sharing of pharmacy and medical claims data to help improve care coordination between a patient’s provider and their pharmacist.

“A lot of times we just don’t know if a patient was discharged from the hospital,” Abubakar said. “If we can improve that turnaround time and reach them earlier, then we have a high chance of preventing readmission.”

Doctors, in turn, can benefit from the insight that pharmacists provide to help build better care plans that patients will be more likely to stick to.

In order to ensure a standardized level of clinical services across its pharmacy partners, Troy is working with Community Pharmacy Enhanced Services Network (CPESN). The organization is a network of clinically integrated pharmacies which provide enhanced clinical services meant to reinforce and support patient care plans.

Troy is using the National Average Drug Acquisition Cost (NADAC) figures to help price its prescription drugs. The NADAC reference data is a weekly estimate published by Medicaid of the average drug invoice paid by independent and retail chain pharmacies collected through surveys.

In Troy’s model the NADAC numbers will be used to determine drug reimbursement and pricing levels for pharmacists by adding a dispensing fee of $10 for generic medications and $4 for branded drugs.

The tabulation flips the way pharmacy contracts normally work, which are based off of negotiated discounts from drug maker listing or wholesale prices.

“The way it is today, you don’t know what the prescription is going to cost if you’re senior, or if you’re a pharmacist you have no idea what you’re going to get paid,” Simihaian said.

Troy’s MA plan is being offered in 2019’s Open Enrollment period with a modest 1,500 member first-year enrollment goal. The company’s plan is launching in Iredell, Cabarrus, Rowan, Granville, and Robeson Counties in North Carolina, which are relatively rural areas in which independent pharmacy owners play a larger role in the community and have existing provider relationships.

Still, it will be an uphill journey. Traditional insurers like UnitedHealthcare and Humana dominate the Medicare Advantage space and upstarts like Devoted Health and Clover Health have raised hundreds of millions of dollars as they try to edge their way into the market.

Troy’s $5 million Series A round pales in comparison to those numbers and the insurer is still in the midst of building out its provider network in the communities it wants to operate in.

Where Simihaian sees his company’s advantage is through leveraging the existing trusted relationships between patients and their pharmacists as a distribution and promotional pathway for Troy’s plan.

While Troy is initially working only with independent and community-based pharmacies the hope is to eventually and drive better health by engaging more even larger retail pharmacies in more care delivery.

“Repeating the same old same old hasn’t given us better outcomes. We need to take pharmacists outside of their box and leverage the touches they already have with patients,” Abubakar said. “It’s a perfect storm, we’ve moved from fee-for-service, to value based care and we need everybody on the bench and all hands on deck.”

https://medcitynews.com/2019/05/troy-medicare-is-launching-a-north-carolina-ma-plan-with-pharmacists-at-its-center/