Addressing Language Barriers, Medication Therapy Management at Medicare Part D Outreach Clinics

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Pharmacy Times interviewed Rajul A. Patel, PharmD, PhD, pharmacy professor on the University of the Pacific in Stockton, California, and director of the Medicare Part D Outreach Clinics, on his work providing medication therapy management and drug savings advice to Medicare beneficiaries in diverse communities throughout northern and central California.

Query: What are among the challenges that may arise for pharmacists and providers when treating culturally diverse populations, akin to those in central and northern California?

Rajul A. Patel: I believe one in every of the largest challenges is usually the language barrier. Especially if we’re attempting to go into a few of those underserved, underrepresented areas, English may not be a primary language for those individuals, and there is perhaps a dearth of health care providers who can actually help patients, empower patients, by speaking their language and ensuring that the knowledge that is communicated is accurate.

Query: What are the Medicare Part D Outreach Clinics you currently oversee, and why were they essential to determine?

Rajul A. Patel: We began this program shortly after the inception of the Part D profit in 2006. And quickly, we realized it was going to be an exquisite profit, because for the primary time, individuals who had Medicare would have access to a prescription drug profit under Medicare. Prior to that, most individuals who had Medicare would either pay out of pocket for his or her prescribed drugs or they might have private insurance, each of which were quite costly. So, that was wonderful.

Nonetheless, there was a challenge that we immediately saw in that, most of us, during our working years, if our employer is generous enough to supply medical insurance, have 4 or 5, possibly 6 different plans from which to decide on. Back then, and it hasn’t modified an excessive amount of since, but there have been 70, 80, 90, even 100 different Medicare drug plans from which to decide on, depending on where you resided. So, that was going to be overwhelming.

Certainly one of the primary things that we desired to do was really try to deal with the price barrier because you will have all of those different plans. Each has a unique formulary or set of medicines that they cover, and in addition a unique cost sharing structure. Although that they had prescription drug insurance, we desired to be certain that that they were making one of the best selection. So choosing the plan that best met their needs based on the medications they’re taking, based on the pharmacy they wish to go to, and other personal parameters. So we were trying to attenuate, if not altogether eliminate, cost-related medication non-adherence.

Then shortly thereafter a number of years into this system, we quickly realized, we’re sitting down with these individuals who’ve Medicare, and on average, the patients that we assist, take about 5 to six prescribed drugs, and about 3 over-the-counter drugs. And we deploy a military of trained student pharmacists, and so they’re all overseen by licensed pharmacists. So we thought, okay, we’re addressing the price issue, how about now if we do a comprehensive medication review and take a look at to eliminate, again, barriers to medication nonadherence. So I believe that is what’s really most important: Nearly all of patients that we assist are going to be over the age of 65, and plenty of of them have, as I said, several medications, each prescription and over-the-counter, and several other chronic diseases, and what we’re attempting to do with our Medicare program is absolutely attempting to help minimize those barriers to medication nonadherence.

Query: How can patient education language translation services help to not only reduce common barriers to medication adherence, but in addition help to enhance patient treatment outcomes?

Rajul A. Patel: So after we began providing the medication therapy management services, one in every of the core pieces of that was creating a personalised medication record. And that was form of done by hand, by scratch. We created an Excel template and commenced populating the meds, nevertheless it was only available in English. I mean, that is all we could do. So quickly, we realized that was not going to fulfill the needs for all of our patients, because about 1 in every 5 patients that we assist, English was not their preferred language, so something apart from English. We leverage the bi- and multilingual skills of our students, but then we now have to depart patients with information in order that they’re properly empowered after the intervention is finished. And so, a number of things almost about that.

The platform that we found that best met our needs and really was a game changer was the Meducation platform that is now under the First Databank umbrella. And there is a number of things in there that actually resonated with patients. So primary, the power to create that personalized medication record, which they are not going to actually find in another health care setting. But then, the power to—with a straightforward click of a button—convert every thing that was typed up in English into 1 of over 2-and-a-half dozen different languages. That is really helpful, because, if we’re helping patients which might be Vietnamese speakers or Spanish speakers or Russian speakers, there’s going to be a necessity for those sorts of translation services.

The opposite thing is oftentimes about 1 in 5 of the patients that we see haven’t got a high level of formalized education, so sometimes not even a highschool graduate. And so the pictogram really is useful. Based on the pictogram with the sunrise or the sunset or the moon, you may tell the timing of day to take your medication. That was really helpful as well.

And the good thing just isn’t only the personalized medication record, but in addition if we desired to print the person drug monographs, those are also available in all of those different languages, and for certain products, like injectable products or products utilized by inhalation, even the videos, the demonstration videos on easy methods to properly use those products are also available. So, we not only share that information with them on the intervention, but then after we print that personalized medication record, it has a novel code, and we show them how they’ll use that code to access the knowledge thereafter. And that actually helped us empower the patients after we were done with the intervention. We might print a duplicate in English in order that that they had one for his or her health care providers. But then we might also print one of their preferred language in order that that they had it for themselves.

Query: What’s the reach and impact of the Medicare Part D Outreach Clinics in central and northern California?

Rajul A. Patel: It’s a great query—2 years ago, I could have answered that query very easily, but now it’s form of expanded and I’ll explain why. For the reason that program began in 2007, we have assisted 10,446 Medicare beneficiaries, that is just with their Part D plan, and collectively saved just over $10 million. So, you are looking at slightly below $1000 per person each year on the Part D plan optimization. And that has, as you asked, been confined just about to northern [and] central California. We go a few 90-mile radius from the university, which is the University of the Pacific in Stockton, California, so so far as San Jose and San Francisco and another cities.

But the explanation I hesitate is since it’s modified, because 2 years ago, due to the pandemic, we quickly realized we weren’t going to give you the option to have in-person events that yr. And so the query then was, will we form of close-up shop and are available back? We were pondering it could be in 2021 when the pandemic was in a a lot better situation. Or will we see if there is a need for services such that we’ll apply, or we’ll provide them virtually? And we actually reached out to all of those patients that we previously assisted, each via email for individuals who had an email address or by physical mail. We sent them a survey and asked them a series of inquiries to see what they wanted us to do. The response was quite overwhelming. Even those that had limited access to technology or comfort with technology, if we could help bridge that technology gap, they were very excited by us continuing to supply the services virtually.

So, in 2020, that is exactly what we did. We had all of our events virtually. And last yr, we had a hybrid. We had the vast majority of events that were in person, but we had several virtually. What we didn’t expect is that we assisted people not only in northern Central California, however the for the primary time we helped them in Southern California, and we actually expanded the services to help beneficiaries in 10 different states and Washington DC over the past 2 years. And this was not through any commercial and was completely unexpected. But what we found happened is that patients who would come to our events that lived in northern central California, would now tell their relatives who lived in Washington, or Florida, or Recent York, because now it was a virtual intervention, right, and it simply requires either a phone or a pc and an online connection. And so we expanded our outreach significantly. Due to that, we will proceed to supply the vast majority of our events in person, but in addition provide some virtual events to accommodate those individuals who not only live out of state but possibly mobility issue or transportation is a problem to get to one in every of our events, but they really need that Medicare review and the medication review. Well, now they’ll accomplish that through the comforts of their very own home.

Query: What’s the reach and impact of the Medicare Part D Outreach Clinics in central and northern California?

Rajul A. Patel: What happens is every state, right, it is a federal profit. So, that is all overseen by the Centers for Medicare and Medicaid Services. But every state and each county throughout the state has different Medicare plans. But it surely’s the identical process, right? You are still going through the identical meds, the popular pharmacies, in the event that they have a Medicare Advantage plan, you are looking at their list of preferred providers, and so the method is equivalent. And truthfully, one in every of the opposite things that is pretty unique about our program is we now have a really close relationship with our regional office in of Medicare, it’s based out of San Francisco, and so we work with them closely. But when it comes to the intervention, even though it might differ depending on where they live in when it comes to, again, plan offerings, the intervention is strictly the identical. We are going to still assist them and in the event that they’d like, with their consent, we’ll enroll them in a recent Part D plan. Once we do the medication therapy review, we’ll again provide them every thing the differences quite than printed and supply them the knowledge in person. We collect their address, and every thing gets sent to them via snail mail.

Query: How can pharmacies use patient education language translation services to deal with language barriers within the pharmacy and would that require hiring someone who speaks the region’s dominant non-English languages as staff or hiring external translation services?

Rajul A. Patel: I do not think the latter might be going to make economic sense because although you may give you the option to rent a staff that speaks the predominant language of patients that the pharmacy serves, what about all of those other their languages and what if that staff member just isn’t present or not working on that day? I believe one thing that may be easily integrated is the Meducation platform that First Databank has because it might integrate with the pharmacy software. And due to this fact, when the everyday intervention is occurring and the patient is getting the medication together with that drug monograph, well now it might be printed again of their preferred language. I believe that is probably essentially the most useful gizmo because it might be readily accessed and available, whatever the language proficiency of the staff that is assisting the patient.

Query: What are another sites of care that will greatly profit from the power to access and tap patient education language translation services to help treatment adherence and outcomes?

Rajul A. Patel: I believe it’s truthfully any platform, I mean, any setting through which there’s a review of a person’s medication. A number of the first ones that come to mind, after all, are prescriber’s office. Oftentimes, everyone knows, there’s downtime within the prescriber’s office. You is perhaps sitting there within the waiting room for 20 minutes, half-hour, 40 minutes, you is perhaps waiting within the doctor’s exam room as well. There might be a chance there for workers to truly collect the knowledge, after which periodically, when the patient revisits, update it. But the opposite setting I believe would lend itself very nicely is safety net clinics. Every county within the country has safety net clinics, especially for those individuals who utilize those clinics are going to be uninsured or underinsured. And oftentimes, English, again, just isn’t their primary spoken language. I believe those are among the settings that I believe that the platform would lend itself most nicely and profit the providers that interact with the patient.

Query: Any closing thoughts?

Rajul A. Patel: We just attempt to proceed to be certain that that we meet the needs of the patients as best as possible. Over time, this system has definitely matured. Way back after we began in 2007, in total, we only had 72 patients that we were assisting. I shouldn’t say only because that was from 0, so it was very comforting to see that some trusted us with this, with their information, and their medications. And through the years, it’s grown. The last yr that we had solely in-person events, we had about 1600 those who attended our events.

I believe over time you form of construct trust and proceed to look for tactics to best serve the patients, whether it’s, again, by minimizing economic barriers to medication adherence, like through Part D plans ation or helping them find pharmaceutical assistance programs or coupon cards, or it’s through the great medication review and identifying ways in which we will minimize those barriers and in addition provide communication of our findings to their providers with their consent. Again, we’re just going to proceed to form of evolve and it is a continuous quality improvement process. We just try to take a look at what the patients need and the way best we will meet those needs.

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