Utilization of Lean Six Sigma and the DMAIC process on oral treatment regimen entry and consent to improve patient care and mitigate practice risk.
Authors: Mendenhall Molly , Drosick David Randolph , Ward Patrick J. , Burdette Caleb , Davies Dan , Mink Hailee , Sheldrick Amy , Neeb Jessica louise , Waterhouse David Michael 
Published: September 2024

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Background:
Oral medication (chemo/hormone) volumes in oncology treatment selection will continue to increase year over year. In 22’, oral meds accounted for the largest market share in dollars at 51% vs IV treatment at 49%. Oral medication volume is projected to increase by proliferation and utilization, though revenues may decrease due to decreasing drug margins. Medication regimen consent is a critical part of specialty pharmacy accreditation through one of the national accrediting organizations. This accreditation is vital to meeting the requirements and maintaining contracts with pharmacy benefit managers (PBMs) and specialty-focused pharmacy services administrative organizations (PSAO). Without improved and continued consent compliance, OHC was at a significant risk of losing the ability to provide care for this impacted patient population, thus resulting in increased risk of financial toxicity. PBMs and accreditations require quality components be completed to maintain the ability to run a specialty oncology pharmacy. When a new oral prescription is written, the oral must be 1.) entered as a regimen and not a single script-only in the EHR and 2.) must have a completed teaching visit and legal consent.
Methods:
Following the DMAIC
(define, measure, analyze, implement and control)
process, OHC’s Lean Team deployed Lean Six Sigma strategies and tools in PY23’ to bridge the gap to goal for both oral medication risk areas. OHC followed the lean methodology A3 process using DMAIC, deployed implementation strategies and curated data analytic reports to ensure oral medications were entered as regimens vs script-only, that teaching/consents were completed, and that the control phase maintained a steady state.
Results:
In 23’, OHC providers accurately prescribed in the EHR a new oral chemo/hormone at 98% (1037/1055) accuracy vs 22’ at 69% (586/845). Additionally, OHC achieved a 93% (986/1055) teach/consent compliance rate vs 22’ at 59% (499/845). With mitigation of compliance risk (est. at 12,114,000), OHC ensured no loss of pharmacy accreditation and contracts. Increased oral medication teaching visits capture rate increased (n=399) resulting in $114,000 additional return on investment in calendar year 23’.
Conclusions:
Utilizing Lean Six Sigma tools and the DMAIC process, OHC was able to implement strategies to meet both measure goals in one performance year, resulting in improved patient care, organizational risk mitigation, and sustainable profitability. The results have been maintained in the control phase of PY24’. Lean Six Sigma and the DMAIC process are vital to organization success. Tactics deployed have proven to be reproducible and scalable to other projects.

Measure
PY2022
PY2023
Goal

Oral Medication Regimen NCCN Entry vs Script-only

69%
(586/845)

98%
(1037/1055)

90%

Oral Medication Regimen Teach/Consent

59%
(499/845)

93%
(986/1055)

93%