Learn insider tips from industry experts on how to successfully complete your URAC Specialty Pharmacy v3.0 accreditation requirements.* You’ll walk away with insider knowledge about how to use tools, technology, and lessons learned that specialty pharmacies pay thousands of dollars to access.

1. URAC Specialty
Pharmacy v3.0
Accreditation:
Learn Insider Tips to Satisfy the Latest
Patient Management Requirements
July 11, 2017

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the webinar recording.
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4. SPEAKERS
CHASE DYE, CPHT
Specialty and Mail Order Pharmacy
Operations Manager
Cleveland Clinic
RUSSEL ALLINSON, RPH, MS
Co-founder, CEO, and CCO
Therigy
PAM DEVAUL
Vice President of Quality
Therigy
@therigy #Therigy4Specialty Although this webinar covers URAC Specialty Pharmacy v3.0 Accreditation requirements specific to patient management, it is not sponsored by URAC.
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5. GEND
Navigate the changes in URAC Specialty Pharmacy v3.0 for patient management
Apply the new URAC Specialty Pharmacy v3.0 standards for patient
management to specialty pharmacy accreditation
Plan and implement URAC Specialty Pharmacy v3.0 requirements
for patient management
Use technology to meet the new patient- and specialty-drug management standards
What You’ll Learn
How to:
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6. Preparation
Standards changes
Competitive advantage
Value-based environment
Insider knowledge
Why this Webinar?
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7. Types of Accredited Specialty Pharmacies:
Independent
Payer
Owned
Retail
Owned
Health
System
Infusion
Pharmacy
Physician
Practice
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8. Mandatory document control
New policies and processes
New decisions
More resources needed
Leadership support and
coordination across teams
Time commitment
What Makes the
Accreditation Process
Challenging?
!
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9. URAC Specialty Pharmacy v3.0
for Patient Management
Navigating Changes in
$$
Specialty Drug Management
(SDrM)
0
10
20
30
40
50
$$
Patient Management
(PM)
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10. Specialty Drug Management (SDrM)
SAFETY APPROPRIATENESS EFFECTIVENESS
Patient and
prescriber education
Access to specialty
drugs
Cost-effective drug
management
Evidence-based
medicine
Patient adherence
management
Drug Utilization Review
(DUR)
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11. Patient Management (PM)
PM 1: PATIENT
CENTERED STRATEGY
Written overview of services based
on individual needs
All patients receiving specialty
medications
What types of services does
your program provide?
Prior
authorization
TYPES
OF SERVICES
PROVIDED
Copay
assistance
Patient
assistance
programs
Adherence
monitoring
Educational
materials
Patient
education
and clinical
counseling
Availability
to clinical
staff
Qualified
staff
$$$
24 7

12. Policies and
Procedures
Clinical practice
guidelines and services
Documentation in
central location
Process to communicate
with prescribers
Evaluation of
therapeutic outcomes
Initial Assessment
Reassessment
Patient Education, Counseling, and Resources
Diagnosis Appropriateness Comorbidities Medication list Allergies
Appropriateness Effectiveness Adverse events Adherence
PM 2-3: PATIENT MANAGEMENT PROGRAM
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13. PATIENT RECORDS30
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14. PM 8: COORDINATION OF CARE
Who
What
When
Policies and Procedures Care Plan
Statement
Strategies
Goals
Timeframe
Resources
Patient desires/motivation
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15. PATIENT RECORDS3
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16. PM 14: DEMONSTRATING PROGRAM VALUE
Clinical Benefits
Financial
Benefits
Quality of
Life
Patient Satisfaction
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17. PM 15: PROGRAM EVALUATION OUTCOMES REPORTING
Patient Satisfaction Quality of Life
PROJECTED OUTCOMESPAST OUTCOMES
Clinical Benefits Financial Benefits
Template letter
Mock reports
Technology for reporting
metrics and data
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18. HOW
TECHNOLOGY
Can Help Meet
Accreditation
Requirements
Organize workflow
Automate evidence-based
care plans
Document and report
clinical interventions
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19. OUTCOMES REPORTING
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20. CLEVELAND CLINIC
Case Study
CHASE DYE, CPHT
Specialty and Mail Order Pharmacy
Operations Manager
Cleveland Clinic

21. Timeline
• Funds Approved
• Director Hired
• Construction
Plan
• Construction
• Initial Caregiver
Recruitment
• Opened
Specialty
Pharmacy
• URAC In-process
• URAC Desktop
Review
• On-site Visit
Accreditation
Determination
2013
Q2/Q3
2014
Q4
2014
2015
2016
Q1
2014
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22. Business Overview
Oral and self-injectable products
Disease states
Driving unique value propositions
Resetting service expectations
Service-line integrations
Integrated data warehouse
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23. The Obstacles of Delivering Specialty
Pharmacy Care
Providers
PATIENT
Specialty
Pharmacy
Pharma-provided
Patient Services
Program
Employer / Payer
• Get the patient on drug fast and keep
them on drug above all costs
• Product of service limitations
• Achieve best possible outcomes
• Minimize paperwork and delays
• Overburdened focal point
• Achieve best possible outcomes
• Minimize out-of-pocket costs
• Reduce hassle/delays
Needs help! • Provide high quality of service to members
• Reduce waste
• Optimize outcomes
• Define value
• Provide service, cost savings, and
value to the payer
• Incented on dispensing volume
Faxes and phone calls

24. Cleveland Clinic’s Solution
Physician CCF Specialty Pharmacy
Pharma-provided
Patient Services
Program
Employer
PATIENT
Concierge Data Flow
Utilize, but Limit
Electronic links, single point-of-contact, and new opportunities for value
EHR Link
Follow-up via CarePath

25. Seeking Accreditation
External, independent evaluation
Quality and structure
Patient safety
Metrics
Limited distribution drugs and access to payer networks
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26. Accreditation
Process
Sales discussion and review of standards
Gap assessment
Quality and clinical oversight committees
Contract negotiation
Policy and procedure development
Execute agreement
Staff training and mock survey
Desktop submission of materials
Requests for information in response to desktop submission
On-site review
Accreditation committee review and decision
Consider URAC a part of your team
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27. On-site Survey
Agenda and
checklist
Mock
surveys
Prepare and
audit materials in
advance
Offline staff
member
Define
expectations
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28. INSIDER TIPS
Data reporting
and metrics
Continue to work
with URAC
Initial accreditation
is a great achievement;
maintaining ongoing
accreditation is demanding
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29. ADDITIONAL TIPS
Create a project plan
Identify gaps, set deadlines
Review, modify, and approve all existing policies and procedures
Update quality improvement programs and annual reports
Organize the evidence in one location or file
Ask URAC questions about interpretations
Create interview questions
Organize all onsite materials
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30. QUESTIONS & ANSWERS
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31. RUSS ALLINSON
russel.allinson@therigy.com
PAM DEVAUL
pam.devaul@therigy.com
Contact us today.
Patient-Centered Therapy Management Software for Specialty Pharmacies
@therigy #Therigy4Specialty
www.therigy.com