Marshfield Clinic Health System (MCHS) oversees Marshfield Clinic and other subsidiaries, including Security Health Plan of Wisconsin, Inc., Marshfield Clinic Information Services, Flambeau Hospital in Park Falls and Lakeview Medical Center in Rice Lake. Marshfield Clinic, with more than 50 locations statewide, more than 700 physician specialists in 86 specialties and subspecialties and 6,800 employees, provides patient care through accessible, high quality health care, research and education.
Mission and Vision
The mission of Marshfield Clinic’s Clinical Pharmacy Services is to provide accessible, comprehensive, professional pharmacy services for all high-risk patients. Pharmacy Services has a commitment to promote safe, high-quality and cost-effective medication therapy and patient care in support of the Institute of Quality, Innovation and Patient Safety. This is done by excelling in professional leadership, educational excellence, customer service, medication safety coordination and optimization of patient outcomes throughout Marshfield’s health system.
- Total number of patients: 375,000
- Number of high–risk patients: 15,000
- Number of high-risk patients not at goal (the gap): 4,000
- Current number of high-risk patients receiving CMM services: 2,800
- Number of high-risk patients being tracked in the Population of Focus: 2,800 (70%)
AIMM Inclusion Criteria (n=2800)
Patients had to be taking four or more chronic/maintenance medications; have incurred or were likely to incur Medicare Part D costs of at least $784 quarterly or $3,138 annually and have at least three of the following health conditions: arthritis/osteoporosis; chronic heart failure (CHF); diabetes; dyslipidemia (high cholesterol); hypertension (high blood pressure); depression; asthma; chronic lung disorders; and/or chronic obstructive pulmonary disease (COPD), as well as patients newly enrolled in the Clinic’s Heart Failure Center.
Provide sustainable integrated medication management services for 2,800 high-risk patients within 12 months:
- Decrease Medication Related Problems (MRPs) by 50%
- Decrease A1c to less than or equal to 8 in 50% of patients with A1c greater than 8 at start of intervention period
- Meet system blood pressure goals in 82% of patients
- Decrease use of high-risk medications by 50%
- Composite measure: population health management dashboard
- Of all patients at goal at the end of the 2015 measurement period, maintain 80% at blood pressure goals and 75% at A1c goals
- Scale up and provide clinical pharmacy services to all high-risk patients
Prior to joining AIMM in 2012, Marshfield had outpatient pharmacies; sterile products services, CPS primarily focused on population health initiatives; one PGY1 resident, accredited by ASHP; and a drug information service. Since that time, Marshfield has accomplished the following:
- A full-time CPS integrated in the care team
- BPS board-certified clinical pharmacists
- APPE student involvement
- Drug Safety Alert Program
- Level 1 Medication Related Problem (MRP) Severity Process
- 2 PGY1 ASHP-accredited residents
- Specialty pharmacy
- Collaboration with affiliated health plan to provide integrated medication management services to Medicare patients
- Demonstrated improvement in patient A1c goals, blood pressure goals, and reduction in adverse drug events and potential adverse drug events.