This is a demo of the ActualMeds system for team-based medication reconciliation and management at point of care, as presented at Health Datapalooza 2014.
2. Getting to the crux of poor medication outcomes
in high risk patients ...
HIGH RISK PATIENTS
13 different physicians
50 different Rx’s
76% of all hospital
admissions
Preventable Hospitalizations,
Re-admissions, Long Term
Care and
Unnecessary Rx
> $290 Billion
Healthcare Costs
WHY?...
A patient’s medication information is
mostly incomplete, inaccurate and unavailable
WHEN and WHERE
it is needed
by healthcare teams to improve these outcomes
3. ActualMeds: Best Possible Medication Information at
the Right Time and Right Place
PAYER
(claims)
PROVIDER
(EHR)
PATIENT
(?)
Rx
Filled
Self
Medication
Behavior
Rx
Ordered
PAYER: risk
resolution and
management
PROVIDER:
Tailored
intervention at
Point of Care
PATIENT:
engagement
and
adherence
Reduced
Preventable Hospitalizations
Re-admissions
Lower Costs
ActualMeds
Aggregation &
Validation of
Data including
Patient Self-
Medication
Identification of
Risk
Medication
Action Plans for
Care Team &
Patient
BetterHealthCare
Deliivery
4. ActualMeds: Better Medication Management
All Around the Care Continuum
Payer Patient
Provider
Home Care
Admission
Acute Care
Discharge
Ambulatory
Care
Payers
• Cost-effective MTM
• Population risk management
• STARS medication metrics
Providers
• Medication management and
reconciliation at transitions of
care, complex care
• HEDIS measures; MU II & III
Patients
• Personal medication record
and virtual pillbox available
through Payer and Provider
portals
5. Accelerated Workflow: Validation of Real Regimen
Based on Best Available Data
Healthcare team has validated information ready for reconciliation
(C) 2014 ActualMeds Corp
7. Evidence-based automated risk assessment
guides tailored intervention
Risk rules incorporate CMS STAR rating metrics for medication and adherence,
other quality measures
8. Action Plans support care coordination workflows
Medication Action Plans can be shared among payer, health care team, and patient,
within the ActualMeds system or as an external message
(C) 2014 ActualMeds Corp
9. Medication Reconciliation On-DemandTM
(C) 2014 ActualMeds Corp
Completed reconciliation available as a CCD or C-CDA export or
transaction, bringing high quality structured data back to the EHR or HIE
10. Better Medication Reconciliation &
Management
1. Get the data: automate what you can
– All possible third party sources
• Accommodate a variety of standards
– Patient self reporting (as appropriate)
– Structured interview with the patient
2. Make the data meaningful for the long haul
– Mapped to coded values
– Harmonized for comparison
– “Scrub as you go” adds structure, interoperability, value
– Save and share in standards-based formats
3. Merge into a variety of care workflows: evolution OR revolution
4. Flexible analytics – requirements will change
(C) 2014 ActualMeds Corp
11. Data Sources
– “Off the shelf “
• Demographics / patient load
– “834” CMS approved, HIPAA-compliant Benefit Enrollment and
Maintenance Transaction.csv batch
• Claims/Fills: ActualMeds - Certified Surescripts integration partner for
Acute Medication History since August 2012
• EHRs: per-patient upload of EHR exports of CCR/CCD/CDA/C-CDA
standards-based data files
– In development
– State Health Information Network of New York (SHIN-NY) – app on
the SHIN-NY data backbone.
– Allscripts – Development Partner
– Custom or workflow integrations available
• e.g. PBM feed, EHR, HIE, care coordination platforms, other
12. Medication Reconciliation Is Critical
for Successful Care Transitions
VALUE PROPOSITION PROVIDERS PAYERS
Improve Outcomes &
Reduce Cost of Care*
Reduces < 30 Day
Hospital Readmissions
Reduces preventable
hospitalizations & re-
admissions
Earn Govt. Incentives
HEDIS Quality Metrics;
ONC Meaningful Use 2
& 3 Incentives
Medicare Quality
rating & bonus
payments : STARS and
HEDIS metrics
Cost-effective
Workflows
Saves time
Reduces labor costs
Bridge to complex care
teams
*Improving Medicaton Adherence & Reducing Re-admissions; NEHI Brief; Literature Review; October 2012
13. Medication Reconciliation “On Demand” ™
at the Point of Care
Home Care
Admission
Acute Care
Discharge
Ambulatory
Care
Targeting High Risk Patients
ActualMeds- a cloud-based enterprise solution for medication management and reconciliation for high risk patients- meaning older adults and individuals with chronic conditions
They see multiple providers, fill dozens of prescriptions, and their complex medication regimens are directly related to the high costs of PREVENTABLE hospitalizations and re-admissions
There are a many solutions aimed at helping patients stick to their medication regimens- but this is the tip of the iceberg for these complex patients.
They would do little to prevent Grandma from arriving in the ER in hypoglycemic shock because no one realized she was taking 3 different insulin Prescriptions together.
Nor would they help the senior healthcare executive who had to have his daughter, a physician, help him sort out his regular meds from those he received at discharge from the hospital after his heart surgery. Most of our frail and elderly patient population would not have that luxury and depend on encounters with their healthcare providers to guide their medication therapy.
The root of the problem is that healthcare teams do not have the PATIENT’S MEDICATION INFORMATION when THEY have the best opportunity for patient engagement and can have the greatest impact on an outcome-
Those were true stories and we hear a new one every day. They happen because Payers use their own retrospective claims data reflecting the patient’s prescription refill history. Providers rely only on partial lists of medications in their EHR to make treatment choices. And no one is aligning this with how and what the patient is really taking.
ActualMeds aggregates,validates and aligns medication information from Payer, Provider and Patient to produce the most current and accurate medication history serving it up available at the right time and place. Risks are identified and made actionable by the care team.
None of us would be at a HIMSS meeting if we did not believe that integration of this kind of information will be critical to transforming healthcare to improvie outcomes and reduce costs.
ActualMeds controls a huge amount of squeaky clean, structured medication data and there are multiple uses for it around the care continuum- that’s a challenge for a small start-up – so we are focused FIRST on who is paying for this information now.
Medicare requires Medicare Advantage plans to do medication management (MTM) for their highest risk members as well as to achieve performance levels tied to incentives measured through STARs ratings. Plans segment member populations by risk to manage these processes. ActualMeds data can help them do all of these more cost-effectively.
Those lead us to the next product opportunities with Providers to automate medication reconciliation and support team based care; and to make tools and information available in formats appropriate for informal caregivers and the patients themselves.
Please see us in the start-up showcase where we can demo :
“the best damn med rec display” in the land
Our structured interview tool that can be used by all levels of the care team and in a variety of settings to capture patient self-medciation info as structured data
The heart of our IP- our evidence-based risk rules
And how risk is made actionable by the care team
Please see us in the start-up showcase where we can demo :
“the best damn med rec display” in the land
Our structured interview tool that can be used by all levels of the care team and in a variety of settings to capture patient self-medciation info as structured data
The heart of our IP- our evidence-based risk rules
And how risk is made actionable by the care team
But now we know what we are dealing with – so we can begin to tackle those risks head on – and possibly prevent a major problem.
Please see us in the start-up showcase where we can demo :
“the best damn med rec display” in the land
Our structured interview tool that can be used by all levels of the care team and in a variety of settings to capture patient self-medciation info as structured data
The heart of our IP- our evidence-based risk rules
And how risk is made actionable by the care team
Surescripts Integrations typically available within 2 weeks after authorizations completed
HER: user driven upload
SHINY ActualMeds will be one of the earliest commercial vendors to certify on this API
:
Allscripts Deep integration including single-sign-on
ActualMeds- a cloud-based enterprise solution for medication management and reconciliation for high risk patients- meaning older adults and individuals with chronic conditions