Results-Based Accountability

Results-Based Accountability (RBA) is a model used to organize the metrics you collect and demonstrate their impact. RBA is used by state governments, grant funders, and others as an accountability tool for their programs. Measures can be used to improve programs and make them more effective. Another metric tool is Theory of Change), which helps demonstrate causal links between program activities (providing medication access, MTM services, etc.) and the organization vision (fewer ED visits and hospitalizations, increased primary care visits and improved community health.) “It’s about following the flow of activity to the ultimate impact. The activity itself is not enough to measure; it’s the impact of that activity which makes the metric so meaningful.” Natalie Bridgeman Fields, Accountability Counsel, Social Startup Success, pg. 63)

The three kinds of performance measures are “How much did we do?”, “How well did we do it?”, and “Is anyone better off?” Most of the measures you collect fall into one of these categories.

How Much Did We Do or How Many?

  • Patients – new, returning, demographics 
  • Prescriptions (Rxs)– new, refills, synchronized refills 
  • PAPs – total PAPs submitted, approved
  • Interactions/interventions
  • Glucometers/spacers dispensed
  • Dollar value dispensed as prescriptions, PAPs, Safety Net

Example:How Many:

Dashboard of metrics regarding patients, prescriptions and dollar value for prescriptions

Number of Patients ServedHow Many
Patients with prescription filled
Patients with PAPs dispensed
Total patients served
Number of New Patients
New Pts NOTeligible for Assistance
Prescriptions
Number of RX filled
Average # Prescriptions/day
Number of PAPs submitted
Value of Meds(Based on WAC)
HDGB Meds
Dispensed as PAP
Total Meds Value Dispensed

HOPE Dispensary of Greater Bridgeport (HDGB)

Dashboard from Wyoming Medication Donation Program measuring the number of units (tablets) dispensed and the medication dollar value for 2016. The pharmacy is operational 30 hours per week. Staffing includes 1 full time pharmacist, 1 fill-in pharmacist as needed, and 3 pharmacy technicians.

Natasha Gallizzi, Pharm.D, Program Manager, Wyoming Medication Donation Program, 3.29.2018

How Well

How Well Did We Do It? (% of common measures or activity-specific measures). A “How Well” measure evaluates the degree to which a goal/population has been met. When possible compare data from your charitable pharmacy to a reference – from literature, hospital or clinic data, patients with Medicaid or insurance other insurance.

Goals established for measurement need SMART indicators:

Specific: clearly defined

Measurable: objective measurement- “How Many”, “How Much”Specific: clearly defined

Attainable/Achievable: goal is realistic

Relevant: there is a connection between the activity and the intended outcome

Time-Bound: there is a realistic timeframe to achieve the goal

TIP: Measuring impact is a critical focus of an organization. The presentation of data helps to tell a great story well. 

Within the zip codes covered by our service area

  • Did we serve patients:
    • From all the area clinics
    • Within the income levels established
    • Not eligible for other types of assistance
    • Using multi-lingual services for patients needing them
  • Did we meet goals or best practices:
    • Average % of patient prescriptions filled on initial visit
    • Increase patient compliance as measured by refill rate
    • Counselling impact on compliance of a complicated regimen
  • Did we need: (workload measures)
    • overtime
    • extra staff
    • changes in software

Example:How Well:

Dashboard of metrics regarding referral sources served and patients meeting income (FPL) requirements

Referral Sources to HDGBHow Well
Bridgeport Hosp/Clinic
Optimus Care
Private Practice
SVMC Hosp/Clinic
Southwest Community Health
Other
Federal Poverty Level (FPL)
FPL < 100%
FPL 100-199%
FPL 200%+

HOPE Dispensary of Greater Bridgeport (HDGB)

Tracking referral sources helps measure the effectiveness of marketing and partnerships with other stakeholders or partner safety-net organizations in our community.  It also allows monitoring if re-education needs to occur to a particular referral site (internal or external).

Map of density of uninsured patients in area served with number of patients served and prescriptions filled by Zip Code. (See: Geo-mapping in Local Factors for Community Charitable Pharmacy Implementation and Appendices\Marketing\Building a Map of Impact.docx).

HOPE Dispensary of Greater Bridgeport 7.17

Is Anyone Better Off? or Benefit/Impact

Is Anyone Better Off? (skills, knowledge, attitude, behavior, circumstances) “Better Off” measures demonstrate the benefit or impactof services on the patient or the institution/community. Impact measurements may include intermediate outcomes or goals that lead to achieving the final vision of the charity pharmacy. An intermediate goal could be improved or stable number of patient primary care visits and the vision or success goal is to decrease ED visits and hospitalizations.

Patients

  • Measurable clinical outcomes if available (A1C, blood pressure, lipids, etc.) 
  • Regular use of maintenance meds in comparison to rescue meds (inhalers)
  • Proper use of devices
  • Interventions
  • Renewed applications (patient perceived benefit of program) 
  • Patient dollars saved by coupons, vouchers, therapeutic interchanges
  • A patient satisfaction survey can be a tool to measure patient’s perceived impact of pharmacy services on their health, economic, or other areas of their life 

Institutions or Community

  • Cost avoidance
  • Potential billable amounts
  • Referrals
    • ED visits, hospitalizations, primary care visits

Example:Better Off:

Dashboard of metrics regarding measures of benefit to patients and the community

Better OffPatient Impact
Interventions and referrals
Collaborative Practice
Therapeutic Interchanges
Community Impact
Cost Avoidance
Potential Billable Amount
Volunteer/Education Hours

HOPE Dispensary of Greater Bridgeport (HDGB)

Wyoming Medication Donation Program(WMDP) relies heavily on county donated medication as their source for dispensing. The formulary is supplemented by reclamation of meds from Long Term Care facilities and pharmacies (LTC), purchasing meds, and non-profit vendors. The following chart is used to encourage counties to donate medication samples and quantifies the value of medication dispensed to patients within the counties. 

In RAB terms:

  • How Manydollars of donated medications (value) by Wyoming counties versus amount spent to acquire meds from vendors and reclamation 
  • How Wellis the WMDP serving the state of Wyoming and its counties based on the value of medication dispensed and number of counties being served
  • How Wellis each county contributing donated medication samples to WMDP
  • Better Off:by county, dollar value of patients benefiting through medication access

Natasha Gallizzi, Pharm.D, Program Manager, Wyoming Medication Donation Program, 3.29.2018

WMDP reports a Return on Investment (ROI) to communities consistently above 5 (value of Rx’s dispensed (AWP)/program cost). In 2015 the value was $10.77. See Return on Community Investment (ROCI) Funding