The implementation of a Home Delivery Mail Pharmacy (HDMP) program at William Beaumont Army Medical Center (WBAMC) led to several changes: 1) There was a significant decrease in the number of prescriptions and patients at the retail pharmacy, but no significant change in the number of retail prescriptions. 2) There was a significant increase in the number of prescriptions filled through the HDMP program and patient satisfaction scores. 3) Wait times and the number of total prescriptions and patients decreased at the main outpatient pharmacies after implementing the HDMP program.

1. THE IMPLEMENTATION OF THE TRICARE PHARMACY HOME DELIVERY MAIL
PROGRAM (HDMP) AT A MILITARY TREATMENT FACILITY
CPT Obinna O. Alu, PharmD, MBA, OIC, WBAMC Supply & Support Pharmacy; Ricardo Cisneros, CPhT, Pharmacy Informatics Technician
INTRODUCTION METHODS RESULTS
CONCLUSIONS
RESULTS
BACKGROUND
In June of 2015, the WBAMC Department of Pharmacy
implemented a new Home Delivery Mail Pharmacy (HDMP)
service to enhance patient choice and convenience, fiscal
responsibility, and workload distribution that allows for the
most efficient use of Medical Treatment Facilities (MTF)
resources across a continuum of patient care. This presentation
will highlight general aspects of the mail order program, as well
as some descriptive analysis, statistics, and objective results that
had an impact on the overall pharmacy operation.
RESULTS
t-test Results for Difference Before vs After HDMP Implementation
Retail Rxs
b/
* There is a significant difference in the Mean Monthly AudioCare for
Before versus After Implementation of HDMP with Lower Mean After
compared to Before.
Mail Order Rxs
c/
* There is a significant difference in the Mean Monthly Rx Mail Order
for Before versus After Implementation of HDMP with Higher Mean
After compared to Before.
DISCLAIMER: The views expressed in this poster are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the United States Government.
TRICARE beneficiaries have had access to a mail order
pharmacy benefit for well over 12 years. While available to all,
many beneficiaries were still unaware of this component of
their pharmacy benefit because up until 2014, the education
and marketing for the program within MTFs was almost
nonexistent. In April 2014, the Defense Health Agency (DHA)
awarded a comprehensive contract to a Pharmacy Benefit
Management (PBM) company to provide claims adjudication
services, as well as to expand the home delivery capabilities.
This was done through the creation of an electronic connection
between CHCS and the PBM to facilitate electronic transfers of
MTF prescriptions to the mail order pharmacy.
A multi-faceted marketing campaign throughout the installation
along with embedding HDMP advertising into each window
transaction was used to provide patients with information
about the program. Average window transaction time was
assessed to determine if the additional time required to embed
HDMP advertising is off-set by other metrics. Patient HDMP
enrollment was completed during the provider visit or at the
pharmacy (majority). The primary objectives were assessed
through monthly metrics, which include: workload (defined as
prescription and patient volume), total HDMP prescriptions
transferred, pharmacy wait-times, patient satisfaction scores,
and the impact on retail pharmacy expenditure in the local
catchment area. Monthly workload, patient wait times and
satisfaction were analyzed using a two-sample t-test for two
means and the Binomial test for one proportion before and
after Implementation of the program. Descriptive statistics
were conducted to assess unsuccessful HDMP transfers.
Based on the data, we see a decrease in MTF workload (rxs
& patient volume) and wait times along with an increase in
satisfaction scores and transaction times. Challenges
experienced include patient concerns regarding co-pays, the
number of local medications (80.8% of formulary, 41.2% of
non-formulary) available for TMOP and limited HDMP options
for controlled substances. Opportunities for expansion include
an auto-transfer feature through the patient refill phone line
and TriCare Online website.
a/
No significant difference in the Mean Monthly Retail Rx for Before
versus After implementation of HDMP.
WBAMC Pharmacy Patient Satisfaction Scores (APLSS)
* There is a significant difference in the Mean Satisfaction Score Before versus
After Implementation of HDMP with Higher Mean Score After (77.3% ± 3.3%)
compared to Before (73.9% ± 1.6%), p-value = 0.0076.
* There is a significant difference in the proportion of CHCS Total RXs, Before
versus After Implementation of HDMP with Lower Proportion After (49.5%)
compared to Before (50.5%), p-value < 0.0001.
* There is a significant difference in the Proportions of Patients Before versus
After Implementation of HDMP with Lower Proportion After (49.6%) compared
to Before (50.4%), p-value < 0.0001
FEB – JUL 2016
Total: 24 Rejections
AudioCare Rx Refill
Monthly Rx
Mean ± SD
t-test
p-value
Before HDMP After HDMP
Retail 14430 ± 811 14132 ± 627 0.3710*a
AudioCare 15924 ± 1106 15009 ± 555 0.0207*b
Mail Order 4807 ± 154 5617.± 491 0.0009 *c
Q-Flow
Jul14 -
May15
Jul15 -
May16
Jul14 -
May15
Jul15 -
May16
Jul14 -
May15
Jul15 -
May16
All Patients
Avg
Service
Time
Avg
Service
Time
Avg
Waiting
Time
Avg
Waiting
Time Patients Patients
Main
Outpatient 0:06:47 0:12:49 0:17:49 0:12:53 114,158 113,488
Freedom
Crossing 0:04:43 0:07:20 0:14:31 0:09:43 129,593 123,605
Mendoza 0:04:37 0:07:16 0:13:09 0:10:36 99,650 96,893
SFMC 0:05:10 0:05:07 0:09:25 0:07:08 47,460 46,098
East Bliss 0:04:11 0:04:55 0:02:44 0:04:46 17,484 17,927
Rio Bravo 0:03:57 0:04:09 0:02:24 0:04:23 16,065 21,327
McAfee 0:02:48 0:26:20 0:10:24 0:05:32 13,204 11,339
Average 0:04:36 0:09:42 0:10:04 0:07:52 62,516 61,525
Main 3
average 0:05:22 0:09:08 0:15:10 0:11:04 114,467 111,329
weighted
average 3 0:05:22 0:09:11 0:15:13 0:11:03 343,401 333,986
Main
3
Total
weighted
average 0:05:10 0:08:46 0:13:28 0:09:54 437,614 430,677 Total