A clinical pharmacist counseling type 2 diabetes patients improved patients' HbA1c levels, lowered patients' blood pressure, and reduced hospitalizations and emergency room visits, according to a case study published in the February 15, 2010.
The Polk County Pharmacist Intervention Model, over one year, led to a 9% relative improvement in patients' HbA1c levels, a 30% reduction in all-cause hospitalizations, and a 24% reduction in all-cause emergency room visits, the study found. The model, implemented in February 2005, provided medication and disease counseling by a clinical pharmacist to diabetes patients in Polk County, Fla., who were employees, dependents, and retirees of the county government.
Program participants had six, 30-minute visits with the clinical pharmacist. Patients also received copayment waivers for disease-related medications, supplies, and nonprescription products. Patients were required to sign an agreement to comply with program rules and were terminated from the program if they did not. There were 564 patients enrolled in the program, with 477 patients who remained enrolled at the end of the program's first year.
The study is available at:
Iyer R, Coderre P, McKelvey T et al. An employer-based, pharmacist intervention model for patients with type 2 diabetes. Am J Health-Syst Pharm. 2010; 67:312-15.
Pharmacists Improve Clinical, Economic Outcomes, Review Shows
Twenty studies found pharmacists improved economic and clinical outcomes through direct patient care, according to a systemic review in the October 1, 2010, American Journal of Health-System Pharmacy.1 These studies showed that a pharmacist's care reduced and avoided costs by "reducing drug expenditures, hospital admissions, lengths of hospital stay, and emergency department visits."
Pharmacists improved outcomes for patients with a variety of health conditions, from patients with multiple diseases to those with asthma, infections, or patients in need of anticoagulation management. Patients with diseases such as dyslipidemia, diabetes, heart failure, hypertension, epilepsy, and HIV/AIDS experienced improvements in their conditions as well.
The study is available online Chisholm-Burns MA, Zivin JSG, Lee JK et al. Economic effects of pharmacists on health outcomes in the United States: a systematic review. AJHP. 2010; 67:1624-34.ext
Health Plans Demand More ROI Data as CMS Toughens its Regs on Medication Therapy Management
Featured Story, Oct. 19, 2010 Reprinted from DRUG BENEFIT NEWS, biweekly news, data and business strategies for health plans, PBMs and pharmaceutical companies.
By Renée Frojo, Editor (firstname.lastname@example.org)
Complying with the growing number of CMS requirements for medication therapy management (MTM) programs is becoming tougher as the number of Medicare Part D beneficiaries eligible to enroll in such pro-grams also expands. While the agency is convinced of MTM’s effectiveness, some payers — including an in-creasing number considering MTM programs for their commercial populations — are demanding more specif-ics on such programs’ return on investment (ROI), according to several pharmacy benefit experts who partici-pated in a Sept. 28 webinar sponsored by AIS.
At the beginning of this year, CMS estimated that 25% of Part D beneficiaries were eligible for MTM services, compared with 10% to 12% in previous years. At the same time, CMS began requiring Part D plans to expand their current MTM programs to include an annual comprehensive review of medications, a process to assess the medication use of individuals who are at risk, and automatic enrollment of targeted beneficiaries who qualify on a quarterly basis.
As a result of increased reporting requirements, many plans have had to invest more money and hire addi-tional staff to meet CMS standards, according to Marissa Schlaifer, the Academy of Managed Care Pharmacy’s (AMCP) director of pharmacy affairs.
“Previously, all Part D plans were required to report the number of bene-ficiaries eligible for their MTM program and the number who opted out,” she said during the webinar. “Begin-ning this year, plans had to report at the beneficiary level the receipt of a comprehensive medication review, the number of targeted medication reviews, the number of prescriber interventions and changes in therapy from MTM requirements.”
In interviews with several plans to see how they are complying with the 2010 requirements, Schlaifer found that one plan had to hire more staff and provide additional training for its internal call center staff. Other plans either contracted with an outside call center or an MTM pharmacy network to provide person-to-person com-prehensive medication reviews and other services.
What they all had in common was “the need for updated and improved information technology systems to provide integrated data and reporting capabilities,” Schlaifer said. “Some of that was to provide MTM services, but to a greater extent it was to comply with increased reporting requirements.”
Taking note of the increased work and investment necessary on behalf of plans, many payers often question how these MTM providers determine ROI. The problem is that “it’s very hard to isolate ROI with your MTM program,” Schlaifer maintained. “Pretty much any plan that is offering MTM services is also offering other ser-vices — whether it’s the standard PBM utilization management or disease management programs — and it’s very hard to isolate ROI and just quantify it as being due to MTM services.”
MTM Company Estimates $4.73 ROI
However, some providers say they can provide solid numbers. Over the past two years, “we’ve seen a lot of expansion of MTM programs to non-Medicare Part D populations,” Brand Newland, vice president of MTM services provider Outcomes Pharmaceutical Health Care, said during the webinar. “And many other plans are considering doing such.”
According to Newland, this is because plans are seeing an ROI of $4.73 for every $1 spent for overall esti-mated cost avoidance. “And when we just looked at drug product costs, we were seeing $1.87 to $1 for our en-tire book of business — a number that has increased over the past year,” he added.
ROI can be calculated by assessing improved quality of care, drug product costs, number of physician visits, hospital admissions and emergency room visits, among other things.
WellPoint, Inc. is one health plan that has been experimenting with MTM programs in the commercial space for the past couple of years. “There just hasn’t been a lot of education for patients about medication compliance,” Laurie Amirpoor, staff vice president of clinical program policy at WellPoint, Inc., said during the webinar.
As a result, WellPoint rolled out an “innovative” employer-based MTM program in Cincinnati aimed at improving diabetic and hypertensive members’ knowledge of their disease, medication adherence, self-management behavior and clinical outcomes. This “Pharmacy Coaching” program encouraged eligible patients to go to large pharmacy chains to get one-on-one consultations with a pharmacist.
While it’s too early to disclose the final results of the study, Amirpoor revealed that WellPoint did see im-proved outcomes for patients in the form of lower hemoglobin A1c, blood pressure and lipid levels, and a sig-nificant ROI for the plan. WellPoint is planning to launch a similar program in California later this year.
Trends in Pharmacist Reimbursement
SUMMARY: Many healthcare organizations reported a strong effort to improve medication adherence levels, with a serious focus on patient education and primary responsibility assigned to either the PCP or pharmacist. We wanted to see which medication adherence-related tasks were reimbursable for pharmacists.
The January 2010 Medication Adherence e-survey by the Healthcare Intelligence Network captured the industry's efforts to improve medication adherence. Sixty-nine percent of responding healthcare organizations include a pharmacist on their medication adherence team. According to responding organizations, pharmacists are reimbursed for the following medication adherence-related tasks:
- Medication reconciliation/review (26.5 percent);
- Patient education (17.6 percent);
- Resolving drug therapy problems (14.7 percent);
- Converting regimens to generic drugs or preferred formulary medications (8.8 percent); and
- Not currently reimbursing (70.6 percent).
For additional research data and insights on this topic:
Download the executive summary of 2010 Benchmarks in Medication Adherence and Management.