1. PONCE HEALTH SCIENCES UNIVERSITY PONCE RESEARCH INSTITUTE Puerto Rico Improve Medication Adherence & Effective Use Of E-prescribing

2. A Community-Based Approach To address these issues, TMF Health Quality Institute has partnered with the Arkansas Foundation for Medical Care, Primaris in Missouri and the Ponce Medical School Foundation in Puerto Rico to form the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO), under contract with the Centers for Medicare & Medicaid Services. As a collaborative effort, the TMF QIN-QIO is organizing a community coalition of primary care physicians, inpatient psychiatric facilities (IPFs), hospitals, additional medical providers, partners and other stakeholders throughout Arkansas, Missouri, Oklahoma, Puerto Rico and Texas to increase the screening for depression and AUDs in primary care settings, reduce the 30-day readmission rate and increase follow-up care for patients discharged from IPFs.

3. QIN: Quality Innovation Network QIO: Quality Improvement Organization The Centers for Medicare & Medicaid Services’ (CMS) Quality Improvement Organization (QIO) Program is one of the largest federal programs dedicated to improving health quality at the community level. It serves as the engine that drives greater connectivity and coordination across all care settings to transform health care delivery for Medicare beneficiaries.

4. The QIO Program operates through a national network of QIOs, which are independent, mostly non-profit, private organizations staffed by health care professionals and quality improvement experts working to improve the quality and efficiency of health care across all care settings. There are two kinds of QIOs: Quality Innovation Network-QIOs (QIN-QIOs) and Beneficiary and Family Centered Care-QIOs (BFCC-QIOs). Fourteen QIN-QIOs and two BFCC-QIOs serve the entire United States and its territories.

5. A.Improve medication adherence rates for three chronic conditions: - Diabetes -Hypertension -Cholesterol B. Effective use of e-prescribing by physicians Although medications are effective in preventing or delaying complications and disease, only an estimated 50% percent of patients take their medications as prescribed. Lack of medication adherence causes approximately 125,000 deaths, 10% percent of hospitalizations, a substantial increase in mortality and morbidity rates and $100 – $289 billion in costs to the U.S. health care system per year.

6. As shown in Figure 3, the prevalence rates for diabetes, hypertension and high cholesterol for FFS beneficiaries in Puerto Rico are higher when compared to the national rates. Figure 4, many conditions known to result from poor medication adherence in patients with diabetes, hypertension and high cholesterol also show higher prevalence in Puerto Rico than seen nationally.

9. By concentrating on areas such as how medications affect chronic disease states, the importance of medication adherence in preventing complications and open communication between physicians and patients regarding barriers to adherence, TMF and PRI strive to achieve the following goals by September 2017: Recruit 50 pharmacies in the six municipalities to implement medication adherence programs. Recruit and maintain 250 non e-prescribing physicians in the six municipalities and have 90% percent e-prescribing. Achieve 10% percent relative improvement rate for medication adherence for hypertensive, diabetes and cholesterol medications for recruited physicians. Achieve 5% percent relative improvement rate for communitywide medication adherence in the six municipalities for hypertensive, diabetes and cholesterol medications.

10. Puerto Rico Target Municipalities 1 2 3 4 5 6 1.Bayamón 2.Cataño 3.San Juan 4.Carolina 5.Trujillo Alto 6.Guaynabo

11. Medicare Claim Reference Baseline 50% Increase eRX Achievement 250 Recruited Physicians 90% Increase eRX Achievement Maintain 250 Recruited Physicians Program Enrollment January 31, 2016 Enroll Deadline

12. Avoidable readmissions and patient satisfaction with discharge care are growing problems nationwide. National research shows that 17.5 percent of Medicare beneficiaries are re-hospitalized within 30 days of a hospital discharge. Of those patients who are re-admitted, the Medicare Payment Advisory Committee estimates that 64 percent received no post-acute care between discharge and readmission and project that 76 percent of readmissions may be preventable. The problems associated with poor transitions of care and 30-day hospital readmissions are not solely the responsibility of the community hospitals; they often result from a breakdown in communication

13. Recruit high prescribing volume physicians in the targeted municipalities who are either not e-prescribing or not effectively using e-prescribing and support the establishment of e-prescribing as the preferred standard of care.