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McCormick adds Lilly exec to board

BY DSN STAFF

SPARKS, Md. — Global flavorings leader McCormick named Eli Lilly executive Jacques Tapiero to its board.

Tapiero has served as SVP and president of emerging markets for Lilly since 2009 and brings more than 25 years of international business experience to the $3.5 billion spice company. Tapiero currently leads Lilly’s business strategy in many of the world’s fastest-growing markets, such as China, Russia, Brazil, Mexico, South Korea and Turkey. He is a member of Lilly’s executive committee.

Previously, Tapiero served as president of the intercontinental region for Lilly, which comprised offices in Asia, Australia, African and Middle East countries, Canada, Latin America and Russia. Prior to this role, Mr. Tapiero has served as president and general manager for both Lilly France and Lilly Brazil, as well as managing director of Lilly Sweden. He has held several sales and finance positions in Indianapolis, France, Sweden and Switzerland since joining Lilly in 1983.

"We are extremely pleased to have Mr. Tapiero join our board. His broad business experience and extensive global background will bring our board meaningful insight and expertise as we continue the global growth of our business," McCormick chairman, president and CEO Alan Wilson said.

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New solutions for health system in crisis

BY Jim Frederick

The nation’s health system is critically short of front-line doctors and in dire need of new solutions. Walgreens is ready to step into that breach.

“The public is demanding that someone fill that role,” said Jeff Kang, M.D., SVP health and wellness services and solutions.

“With more than 27,000 pharmacists, we want to move away from just filling prescriptions  Our community pharmacists are a precious resource and can be part of the solution,” he said.

Kang joined Walgreens last fall after serving as chief medical officer at Cigna. He is board-certified 
in internal medicine and geriatrics, and also was chief clinical officer at the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) from 1998 to 2002.

As Walgreens expands the repertoire of disease management, chronic care and preventive health services its pharmacists and Take Care Clinic nurse practitioners can provide — and transforms its stores into “destinations for health and daily living” — the chain already is well along in its evolution from traditional drug store to something very different, Kang said. The company has become a source of health services and solutions for payers, providers and patients in desperate need of more convenient and cost-effective access to care.

“Five or 10 years ago, our purpose was to fill prescriptions as fast and conveniently as possible,” Kang pointed out. “From an organization standpoint, we’re now very clear about our purpose, and it’s fundamentally to help our customers get, stay and live well." Walgreens, he added, is working “to position our clinicians and pharmacists as an extension of the physician’s office. “We’re not seeking to substitute for the physician. The reality, though, is that in this current market, … they’re overwhelmed. Our nurse practitioners and pharmacists can complement that physician care.”

How? By “investing in consumers’ health and wellness” by “helping them live and stay well with prevention, screenings and behavioral risk-factor modification,” he said.

“About two-thirds of the diseases in the United States are driven by four behaviors: lack of exercise, diet, smoking and stress. So if you deal with those four risk factors, you could create a lot of health savings.”

Walgreens, Kang said, can play a role in helping Americans reduce those risk factors.

The accelerating adoption of health information technology and electronic patient health records, he noted, also is putting that collaborative care model within reach.

Call it the commercial version of health reform. Walgreens is doing its part to force the healthcare system to break with the past and abandon a century-old model. “Everyone is guilty of designing processes in a provider-centric fashion. So we’ve developed a clinician-centric system at the convenience of the clinician,” Kang said. For instance, he said, “you go to a doctor’s office, and it’s all built around the doctor’s schedule and the workflow.”

Walgreens, he said, is pushing to replace that model with one that puts the patient at the center of the picture. The future network of care providers — including physician practices, clinics, health plans, and pharmacy and wellness retailers like Walgreens — should be built around the patient and should adapt to his or her needs with services that are more convenient and accessible. And if it follows the concept of medical homes advanced by the health-reform law passed in 2010, Kang added, “the home should be where the patient is.”

“The technology is there now, and what it’s going to take to change that is for consumers to demand a system that’s patient-centric,” he asserted. “What the consumer wants is an integrated system that’s coordinated on his or her behalf, and convenient to him or her.”

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Where oh where did my reimbursements go? Today’s pharmacy audit landscape

BY Paul Hooper

There is no doubt about it. Pharmacy audits can be time consuming and laborious for all parties involved. And as both government and commercial money gets tighter and tighter, all of health care is searching for the most effective means to manage the financial challenges associated with doing business. In addition to the clinical aspects, audits are used to identify genuinely fraudulent or erroneously paid healthcare claims. Nevertheless, a survey released in September 2012 by the National Community Pharmacists Association found that nearly 87% of those surveyed stated that reimbursement and auditing practices are “significantly” or “very significantly” affecting their ability to provide patient care and remain in business.

As audits continue to rise, more and more pharmacies are finding it increasingly important to identify possible situations and trends that might help them legitimately reduce their exposure to auditable situations. One method is to properly determine a prescriber’s eligibility before the claim is submitted to payers for processing and the prescription is dispensed. According to Emdeon data, a sanctioned prescriber could write more than 400 prescriptions per month, totaling more than $30,000 in at-risk drug costs. That could mean almost $400,000 of financial exposure to a pharmacy in a year from just one ineligible physician.  Some doctors write a lot more prescriptions than these numbers.

Pharmacies can help mitigate audit risk by incorporating improved prescriber management into their workflow. Utilizing real-time methodology, such as prescriber eligibility alerts, can not only help pharmacies lessen the audit risks and financial penalties associated with submitting prescriptions written by prescribers who do not have prescribing authority, but it can also reduce administrative costs by decreasing the time personnel may otherwise spend researching prescribers and plans. Real-time screening can be greatly improved by accessing the most current federal and state prescriber data available. Prescriber eligibility alerts can provide an advanced validation component that is able to check each submitted pharmacy claim in real time for licensure, status, sanction, DEA prescriptive authority and other issues. Rejected claims return compliance notifications with clear messaging that identifies the reason for rejection.

In addition to prescriber eligibility, pharmacies also can help protect against audits by determining appropriate patient eligibility. Pharmacy claims can be billed as primary to state Medicaid plans if, and only if, patients have no other active coverage. Consequently, pharmacies that submit claims to Medicaid for patients who are covered by other plans can be billed or penalized by the state for paid Medicaid claims.

Here are five things a pharmacy should be aware of when they are examining means to manage audits:

  1. During an audit, the scope of the claim review can cover up to three years retrospectively. Pharmacies should implement controls today to reduce the risk of potential audits tomorrow.
  2. An audit performed by the Centers for Medicare and Medicaid is contracted to a recovery audit contractor. The purpose of a RAC audit is to identify improper Medicare payments and fight fraud, waste and abuse in the Medicare program.                     
  3. RAC audits review claims prescribed by an excluded or ineligible provider. Several third-party and private payers are adopting the same excluded provider provisions and audit criteria.
  4. According to the NCPA survey, 3-in-4 pharmacists (76%) responded that audit requirements across Medicare Part D plans are not consistent, increasing their compliance burden.
  5. Pharmacies can participate in forums to discuss and collaborate with their peers who have completed an audit.

At the end of the day, healthcare stakeholders on all sides want to see an efficient healthcare system. Healthcare payers want to ensure they are paying valid claims, and pharmacies want to dispense accurate, legitimate medications from eligible prescribers to qualified patients.


Paul Hooper
Emdeon VP of pharmacy network services
As VP of pharmacy network services at Emdeon, Paul Hooper directs the company’s pharmacy network services initiatives with a focus on developing programs, standards and partnerships that increase pharmacy efficiency and reduce healthcare costs. Paul has spent more than 25 years in the healthcare industry with a predominant focus in pharmacy. During this time, he has held roles in product development, systems, finance and operations at various recognized industry leaders: BASF, Abbott Laboratories, Cardinal Health, ArcLight and Emdeon. He holds a master's degree in business administration from Ohio University and a bachelor of science in food science from The Pennsylvania State University.

 

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