Who is American Health Care?
American Health Care is a Rocklin, California based health care company that has been providing award-winning Population Health Management and Pharmacy Benefit Management services for over 30 years. American Health Care is a premier provider of 340B drug programs to qualified health centers and hospitals across the country. American Health Care currently services over 3 million lives throughout the United States and presently operates care management programs in 46 states. As a national award-winning developer of leading patient care delivery, technology and disease management tools, American Health Care is recognized as a leader in clinical pharmacy management and chronic conditions and wellness management innovation. As a provider of pharmacotherapy information, American Health Care is valued for its uncompromised integrity, ethics and dedication to science. In their passionate pursuit of excellence, American Health Care is a recognized innovator of products, processes, and tools that result in better care for patients through advanced data integration technologies, clinical pharmacy and disease/health management.
What is American Health Care's improved Asheville population health management (PHM) model and why does it work?
Modeled after the nationally recognized Asheville project, American Health Care's PHM program helps improve the health of an employer's population and offers specialized programs that treat chronically ill patients through face-to-face, telephonic and digital patient visitation with trained care managers (pharmacists, nurse educators or nurses). Each care manager is assigned to work with each participant in a one-on-one relationship. The care manager meets with the patient monthly and provides comprehensive care management services designed to stabilize the patient's condition and helps the patient work toward established health goals. These consultations proactively manage the patient's chronic condition by keeping the patient adherent with prescribed medications, lab testing and through collaboration with the primary physician. Individual consultations also identify targeted lifestyle changes with a focus on self-management in order to reduce the risk of serious health complications.
What type of training is offered?
Training is offered on the following topics: the role of the care manager, care management visits, Digital Outcomes Communication System (DOCS™), identifying gaps in care, checking patient medication, adherence, reviewing medial and prescription history, key disease-specific patient questions to be completed during patient visits and recorded in DOCS, goal setting, communication with providers, and the Simplify My Meds™ refill coordination program.
Training may occur in the form of online education, live programming, and/or webinars. American Health Care also has clinical support staff available for questions.
What disease states will be addressed in this program?
Typically employers will be asked to offer this program to individuals on their health plan who have been diagnosed with diabetes, hypertension, and dyslipidemia. Some employers also include asthma and COPD. For the pilot program these are the disease states that pharmacists will need to be comfortable focusing on.
How quickly can I get up to speed?
It depends on your training and background, but historically pharmacists that take the training become accustomed to the patient visits and documentation system in a short amount of time. The DOCS program serves as a helpful guide through the patient visit. Reference information and assistance is available to help you along.
On average, how many patients will I see each month?
The number of patient visits each month is a function of how many employers participate in the program. The pilot study will start slowly and increase over time. You will be able to indicate how many patient visits you want to conduct in your pharmacy. In other programs run by American Health Care, some care managers see over 100 patients per year.
What type of documentation is required?
Documentation is completed in American Health Care's web-based electronic health record, Digital Outcomes Communication System (DOCS). The system will walk you through the information that needs to be documented with each visit.
What is American Health Care's DOCS™ clinical technology and why is it critical to results?
AHC's proprietary care delivery model employs the use of their powerful DOCS clinical technology which creates an individualized road map for delivering care to a chronically ill patient. Using DOCS, care managers are able to quickly identify gaps in care against published, evidence-based national standards and employ best practice care delivery protocols to proactively manage the condition and keep chronically ill patients out of the hospital. DOCS quickly identifies medications that have not been refilled, lab tests that have not been taken and other lab measures that are out of compliance with national standards. DOCS incorporates the essential components of accountability, management and oversight in the care delivery process—which has proven to be the key element in driving unprecedented health improvement and cost savings evidenced by published outcomes.
Is there a required investment in hardware or software?
No. American Health Care's technology is a web-based, secure, HIPAA compliant technology maintained entirely by American Health Care. A computer connected to the internet will be necessary to access DOCS. The program is web based and no additional software installation is required to access DOCS and record the appropriate documentation for each patient visit.
What type of resources will be needed in my pharmacy?
Many pharmacies find it helpful to have a separate room or space set aside to conduct patient visits in a quiet and private area. Many pharmacists find it helpful to enlist the help of a technician as a program manager to help with organization and scheduling patient visits. To assist with work flow, pharmacists will need coverage for filling prescriptions during patient visits. Pharmacy students on rotation or pharmacy residents can assist with patient visits under the supervision of the licensed pharmacist.
How will I be paid?
The Digital Outcomes Communication System (DOCS) logs each patient visit. Upon completion of a patient visit, payment to the pharmacy will be issued by American Health Care. Payment typically occurs in 60 days. The reimbursement amount for each patient visit is outlined in the pharmacy's participation contract.
How does an employer identify and recruit patients into the program?
American Health Care will use its technology to analyze, medical claims, pharmacy claims, laboratory and health risk assessment data of an employer. An initial step in the program provides employers with a comprehensive report detailing the cost of chronic disease in their population. American Health Care's experienced plan design experts provide guidance in developing meaningful plan incentives (e.g., reduced health insurance premiums, waived medication co-pays and waived laboratory co-pays) together with strict measures of patient accountability required for continued participation in the program.
I know employers in my area. How can I help introduce them to the types of services offered by American Health Care?
We would love to hear from you. Contact Bill Popomaronis at 1-800-544-7447 ext 2644 or
Have any studies been done to evaluate the outcomes for a program like this?
Yes. The original Asheville Project study outcomes have been confirmed with a study by American Health Care called Hickory Project. These studies have been published in peer-review journals and have demonstrated significant financial savings and health improvements. One of the primary authors of the Asheville Project publications, Dr. Barry Bunting, was the Asheville Project director for the first 10 years of its existence. Dr. Bunting currently works for American Health Care as Vice president of Clinical Services and oversees the Population Health Management programs. Dr. Bunting was also the primary author of the Hickory Project publication.
The Hickory Project began in 2006 and continues today. It consists of 4,500 plan members located in 60 sites throughout the United States. Members diagnosed with diabetes, high blood pressure or high cholesterol voluntarily participate in the program. Under the program, participants visit monthly with an American Health Care trained care manager (e.g., a pharmacist, nurse or certified diabetes educator). These consultations proactively manage the employee's diabetes, high blood pressure or high cholesterol by assuring that lab tests, foot examinations, eye examinations, blood pressure measurement and other self-monitoring protocols are proactively accomplished in accordance with nationally published, evidence-based standards. Assuring patient adherence with prescribed medications together with on-going evaluation of appropriate drug therapy and collaboration with primary care physicians is critical to the process. In addition to the private consultations, the program provides certain financial incentives including waived co-payments for lab tests and certain medications.
What are the Hickory Project Clinical and Financial Outcomes?
The percentage of patients achieving HbA1c goals increased from 38% to 53%; the percentage of patients achieving LDL-C goal increased from 46% to 67%; the percentage of patients achieving BP goals increased from 55% to 72% (systolic BP) and 60% to 71% (diastolic BP); the percentage of patients having an annual eye examination increased from 37% to 61%; daily self-testing of blood glucose increased from 79% to 97%; and regular foot self-examination increased from 79% to 97%.
The number of patients regularly self-testing blood glucose levels increased from 79% at baseline to 97% at the end of the study. The ROI average during the 3 years of this study was $8.48 for every $1 spent on the program using a trended/projected cost comparison. Applying the same approach using nontrended data resulted in an ROI of $4.89 for every $1 spent on the program. Both ROI calculations include all program costs.
Why Should You Participate in the Population Health Management Missouri Pilot Project Administered by American Health Care and Supported by NCPA?
Community pharmacists are today recognized as a key resource that can bridge the gap between doctors and patients in an often disconnected and dysfunctional health care network of providers.
To that end, the 2010 enactment of the Patient Protection and Affordable Care Act (PPACA) set into motion changes in the delivery of care, for a healthcare system on the verge of financial collapse.
But with these changes, also comes the opportunity for community pharmacists to clarify their role and demonstrate their value by operating patient oriented and clinical pharmacy practice settings in communities with a goal of optimizing therapeutic outcomes and containing costs.
The evidence strongly suggests that the management of chronic diseases such as diabetes, hypertension, dyslipidemia, asthma, COPD, and cardiovascular disease is a role well suited for today's community pharmacist. Based on AHC historical clinical and financial outcomes, a growing number of health plans appear to be willing to pay for such services. The passage of the PPACA should alert pharmacists that the government believes they have the clinical skills to positively affect outcomes.
Many owners have become comfortable in measuring success based on the number of prescriptions they have filled in a day. But the delivery of health care HAS changed and the goal of improving margins will begin to be a challenge for those unwilling to recognize the new landscape.
Change makes us uncomfortable. Become uncomfortable and embrace the changing healthcare landscape. Participate in the Population Health Management Missouri Pilot and make a difference in your State.