PRISM Novel Care Delivery Options

PRISM is presently focused on the pharmacist’s role in two areas of novel healthcare delivery, Accountable Care Organizations and the Connecticut State Innovation Model (CT SIM).

Hartford Healthcare’s Integrated Care Partners (ICP) is a physician-led, clinically integrated health care network that includes employed physicians, and affiliated community physicians across Connecticut. ICP is committed to providing high-quality, cost-effective health services. As a strategic business unit of the Hartford Healthcare System, ICP helps to coordinate care between the six system hospitals, two behavioral health facilities, and three post-acute entities. ICP serves approximately 200,000 attributed-lives through various commercial value-based contracts and participates in a Medicare Shared Savings Accountable Care Organization program. In order to address the complex needs of patients, a care-management team was created which includes nurse care managers, licensed clinical social workers, health coaches, behavioral health clinicians, and pharmacists. ICP pharmacists serve a vital role in population health management by focusing on medication use data analytics to address quality and cost metrics related to prescribing practices. The pharmacists target patients with high-modifiable medication risks (e.g. polypharmacy, poor medication adherence) and work along with the care management team to coordinate medication reconciliations, targeted drug therapy reviews, and provide direct patient care.  Pharmacists employ multiple modalities in managing patient medication needs, including through home-visitations, telephonic and e-consults drug therapy management.  Additionally, the pharmacy team is responsible for network medication education which is delivered via CME-accredited asynchronous, educational videos.  Topics focus on improving quality and reducing costs and include discussions on generic prescribing, high risk medications, and deprescribing.  In addition, pharmacists are responsible for developing treatment pathways for ambulatory care sensitive conditions to help standardize prescribing and reduce variability in treatments. Finally, the pharmacy team works closely with ICP’s commercial partners to ensure value-based contract deliverables are met.

In 2014, the Center for Medicare & Medicaid Innovation (CMMI) awarded Connecticut a four-year, $45 million State Innovation Model (SIM) Test Grant to “test state-led, multi-payer health care payment and service delivery models that will improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries—and for all residents”. The SIM Community & Clinical Integration Program (CCIP) includes clinical systems and group practices working to coordinate with community partners and to develop new capabilities for improving care, especially for at-risk populations.  CCIP focuses on the development of critical capabilities in several areas including:  integrating behavioral health and oral health; comprehensive medication management services; incorporating community health workers; establishing community linkages with social supports; and expanding the use of e-consults.  For more information on joining or proposing a project idea, please Partner with Us.