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Practice Transformation

Hospital EHR systems’ ability to detect harmful medication-ordering errors improved from 54% in 2009 to 66% in 2018, according to research published in the Journal of the American Medical Association. But that’s not the real takeaway. What is? The lack of consistency was the real lesson. The findings “suggest that although hospitals across the US have nearly universally adopted EHRs during the past two decades, the associations of these systems with safety are still mixed. These EHR systems are large, complex, and constantly evolving, yet they are largely unregulated with respect to safety.” (JAMA)
Last week, CMS announced it is decreasing the risk requirements and moving some deadlines for value-based payment models in the wake of the COVID-19 pandemic. The changes are aimed at minimizing reporting burden and increasing flexibility for providers–something provider organizations have been lobbying for. The agency has developed a table outlining the changes for various programs. (Healthcare Dive; CMS)
Current approaches to cost-effectiveness analysis of medication often fails to capture unique attributes and circumstances, which is a particular problem for precision medicine. There are, writes Jaime Rubin Cahill, MA, MPH, VP at Vertex Pharmaceuticals, “unique attributes of many serious diseases and novel innovative medicines, that, when combined, lead to inherent biases when traditional modeling methodologies are used to calculate their cost-effectiveness.” The most important of these attributes: “The profound projected improvements in survival and the time course over which potential benefits of innovative medicines materialize if they’re started at an early age.” (Health Affairs)

Evidence & Innovation

Genomic data is being incorporated in multiple parts of the EHR; to provide guidance, the American College of Medical Genetics and Genomics published a point-to-consider statement: “The interface of genomic information with the electronic health record,” in Genetics in Medicine. Critical issues to consider include patient access, privacy and protection. Among the recommendations: Genetic data in the EHR should be readily and continuously accessible to the patient, including test results, secondary findings and the clinician’s interpretation. (Genetics in Medicine; announcement)
In a pre-peer-review paper released last month, a group of pharmacists and researchers are calling for a quality scoring system for prescription drugs. Such a system, they argue, would encourage drug makers to manufacture medicines with better quality, incorporate transparency into the U.S. drug supply chain and limit shortages. In the proposed plan, private entities would develop scores by gathering and analyzing data on the drug in question and referencing criteria from health care systems. Metrics influencing the score would include regulatory information and drug-specific, third-party chemical analysis information. (Becker’s Hospital Review; pre-review paper)

Policy Solutions

In the last month, CMS has announced several policy changes related to medication and medication costs, Becker’s Hospital Review reports. Among the changes: CMS is limiting out-of-pocket insulin costs for Medicare beneficiaries to $35 per month and has proposed a payment increase for hospitals administering CAR-T therapy. (Becker’s Hospital Review)

In Case You Missed It!

Workgroup updates

GTMRx Distinguished Fellow Steve Chen, Pharm.D., FASHP FCSHP, FNAP, founder and executive director of the California Right Meds Collaborative (CRMC) presented on “Building a Value Framework for CMM: Insights from a California Consortium (health plans, pharmacies, and academic organizations)” to the GTMRx Payment and Policy Solutions Workgroup on Tuesday, June 2, 2020. Steve covered topics such as barriers, successes and approaches to CRMC’s comprehensive medication management (CMM) engagement work with health plans, providers, and patients and the resources that providers commonly request.

The newly structured Evidence-Based Resources Subgroup of the Practice and Care Delivery Transformation Workgroup had their first kick-off call Thursday, June 4 and recruited the following great minds to their group: Craig Beavers (University of Kentucky Healthcare), Lisa Smith (Veteran Health Administration, Eastern Colorado Healthcare Service), Jimmi Hatton Kolpek (University of Kentucky), Krystal Edwards (Texas Tech Jerry H Hodge School of Pharmacy), Brian Cross (East Tennessee State University), Judith Jacobi (Visante Inc.), Paul Bush (ASHP), Ashley Yost (Veterans Affairs Tennessee Valley Healthcare System), Erica Crannage (Mercy Clinic-Family Medicine- Olive-Mason and St. Louis College of Pharmacy), Mike Case Haub (CHC Health), Shannon Finks (Züp Medical Services, LLC and University of Tennessee) and David Angaran (Communication Prescription, LLC)
TODAY, June 9, 2020 | 1- 2 p.m. EDT
It makes sense that evaluation of a patient’s genotype can support the clinical decision-making process and target correct therapies, improving patient outcomes. This webinar will address barriers, incorporation of PGx into team-based care and how PGx aid in treatment decisions for COVID-19 patients.

Hear from a clinical pharmacist and a research consultant as they discuss findings from two separate research studies on pharmacogenomics. Colleen Keenan, a consultant with The Advisory Board’s Clinical Innovators Council, will share findings from her recent paper, “Considering pharmacogenomics during COVID-19? Here’s what you need to know.” And Emily J. Cicali, Pharm.D., BCPS, shares highlights from her recent publication, “Challenges and lessons learned from clinical pharmacogenetic implementation of multiple gene-drug pairs across ambulatory care settings.”
Remarks from the GTMRx / Bipartisan Policy Center Feb 6 keynote address by Gregory Downing, D.O.,(page 10-13) “Get the Medications Right: Innovations in Team-Based Care,” in the latest edition of the Personalized Medicine Coalition’s Personalized Medicine in BriefRead it here.
Hosted by the GTMRx Institute’s executive director and co-founder, Katherine H. Capps, Voices of Change features leaders who have knowledge, experience and ideas to solve this urgent need to get the medications right. The most recent episode features Orsula V. Knowlton, PharmD, MBA, president and chief marketing & new business development officer of Tabula Rasa HealthCare, Inc. Past guests include Anand Parekh, MD, chief medical advisor, Bipartisan Policy Center and GTMRx President Paul Grundy, MD, chief transformation officer, Innovaccer. Listen here.

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