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VA Pharmacy Conference 2008 Consolidated Mail Outpatient Pharmacy Operations Kenneth Siehr Deputy Chief ConsultantPharmacy Benefits Management Service Consolidated Mail Outpatient Pharmacy Operations Department of Veterans Affairs Overview • • • • • A little about me Life of a VA mail out prescription Outpatient prescription fulfillment system CMOP today CMOP history – How we got to where we are • CMOP of Tomorrow • How does this affect you? Who Is This Guy? • 30+ years in Federal Pharmacy – Pharmacy Intern VA Madison 1977 • • • • • • Army Pharmacist 1978-81 VA Staff Pharmacist 81-82 VA Pharmacy Supervisor since 1982 Chief of Pharmacy 1988 Managed Multiple Services at Medical Center VISN Formulary Leader (VISN 12) when positions were established • PBM Manager 2004 • Present Position 10/07 The Life of a VA Mail Out Prescription Life of a VA Mail Out Prescription Provider Orders Medication 1 Hour to ?? Awaiting Verification Patient Receives 10 Hr 12 – 48 Hrs 48 Hrs to ?? CMOP Filling Awaiting Transmission to CMOP Delivery to Patient Goal: Delivery to Patient with 10 days of Patient/Provider request VHA Outpatient Medication Fulfillment System Contracting and Procurement Medical Centers CMOP Delivery to Patient Goal: Delivery to Patient with 10 days of Patient/Provider request Medical Center • Interface between – Patient and fulfillment system – Provider and fulfillment system • Ensures right – Medication for patient clinically – Dose, frequency – Cost efficiency • Dispenses Prescriptions (20%) – Window – Mail • Responsible for Performance – Chief of Pharmacy, Facility TMT, VFL CMOP • Dispenses Prescriptions (80%) – Mail • Primary Interface – Patient delivery services • USPS, FedEx • Mail consolidators • Direct to patient vendors – NAC for outpatient medication contracts – Contractors for direct to patient delivery • Responsible for Performance – CMOP Director, National CMOP and PBM Contracting and Procurement • National Pharmacy Benefits Management Services – – – – Formulary Management Identifies contacting opportunities Monitors utilization Contract compliance • National Acquisition Center (NAC) – National contracts, BPAs, FSS • Procurement and Contracting staff at each site and CMOP • Responsible for Performance – Chief of Pharmacy, CMOP Director – National PBM, NAC Delivery to Patient • Window at Medical Centers • To Patient’s Home – Contracted or third party vendors • US Postal Service • Federal Express or similar vendor – Mail consolidators • Facilitate and speed process – Direct to patient contractors • Responsible for Performance – Contracting Officer for contracted services – USPS VHA Outpatient Medication Fulfillment System Contracting and Procurement Medical Centers CMOP Delivery to Patient Goal: Delivery to Patient with 10 days of Patient/Provider request VA CMOP National System Leavenworth Hines Chelmsford Charleston Tucson Tucson Murfreesboro Dallas CMOP Today • 7 separate locations • Each highly automated and highly efficient and successful but with different equipment and software • Different practices, processes and products – Murfreesboro – Media Mail – Hines – mail manifesting – Various prescription and mailing labels • Limited national CMOP information system • Beginnings of organizational support structure • Collection of 7 individuals, not an integrated system CMOP: Grass Roots Effort • Grass roots effort – Concept proven at West LA and Leavenworth • RFP Process – Equipment centrally funded – Medical Centers selected were to provide support • Facilities Management, Contracting, Human Resources etc. – Medical Centers serviced provided inventory funding • CMOP Director reported to local Board • CMOP needed and fostered entrepreneurial culture – Highly successful results Each CMOP a Contract • Each CMOP the result of a turn key contract with a vendor – Vendor provided all equipment and software • Different vendors = different equipment and software not designed to integrate with other CMOPs Early CMOP Organization • Each CMOP essentially owned by the Medical Centers it serviced • Reporting to a Board made up of customers • Unique equipment and software • Organizational support provided by host site CMOP Tomorrow • 7 integrated locations • Each highly automated and highly efficient with different equipment but the same software • Standardized practices, processes and products – Same product list – Centralized customer interface, QA etc. – Patient medications from any CMOP • Robust national CMOP information system accessible by users – Standardized reports – ProClarity cubes • Mature and effective organizational support structure How Does This Affect You? • Ability to seamlessly shift workload between CMOPs – Equipment breakdown, disaster recovery – Specialty CMOPs – Patient centric, ship from closest CMOP • More tools – Track Rx and package – Report and trend problems – Track and validate costs Murfreesboro Zip Code Distribution How Does This Affect You? • Standardized product lists – Medical/Surgical supplies – Medications and pack sizes • Medication event prevention – Screen and identify inappropriate Rx directions – Rx quantity checks Get Involved and Work With Your VISN Formulary Leader as We Transition
