Transcript Brooke Bliss - Michigan Purchasers Health Alliance

Adding Value to Healthcare
Management:
Patient Self-Management: Diabetes
MICHPHA
September 20, 2007
Brooke Bliss, R.Ph.
Clinical Pharmacy Consultant
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HealthPlus of Michigan
An independent regional health plan providing services for over 200,000
Michigan Commercial HMO, PPO, and government program members.
Membership:
202,000
Employer-sponsored:102,000
Medicaid: 64,000
Other Government Programs: 36,000
Service Area:
Ten full counties in Mid-Michigan plus 8 partial counties
Pharmacy Network:
1,500 Pharmacies statewide
50,000 plus pharmacies nationwide
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HealthPlus of Michigan
An independent regional health plan providing services for over 200,000
Michigan Commercial HMO, PPO, and government program members.
Physician HMO-Network:
900 Primary Care Physicians
1800 Specialists
29 Contracted hospitals
Physician PPO-Network:
60,000 Providers regionally and nationally
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HealthPlus Vision
“A Healthier Community”
How does HealthPlus intend to achieve that
vision?
By being dedicated to improving the value of health
care services for our members and purchasers. By
working in partnership with providers to improve
the quality and cost effectiveness of health care
services.
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The Patient Self-Management:
Diabetes (PSM: Diabetes) Program
A one year pilot program based on the highly
successful “Asheville Project” with a twist:
For the first time, HealthPlus, as a HMO, will
reimburse certified pharmacists for counseling
services provided to patients about their
disease.
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PSM: Diabetes Goals
Improve clinical outcomes, productivity and
quality of life for participating individuals with
diabetes.
Reduction of overall health care costs associated
with diabetes.
Demonstrate value related to pharmacist-driven
medication therapy management services as part
of a disease management team.
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Key Players and Their Roles:
Patients:
Invited to participate in the pilot program based on
targeted clinical criteria. Choose to “opt-in” based
on program description
Agree to meet with chosen pharmacist educator
once per month for the first 3 months then at least
quarterly there after in order to continue having
copays waived (patient pays ZERO co-payment for
all diabetic medications, ACE inhibitor/ ARB class
of medication and diabetic testing supplies)
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Key Players and Their Roles:
HealthPlus:
Solicit and encourage community pharmacists to
participate in the Patient-Focused Diabetes
Education Program
Administer a scheduled fee to pharmacists who have
completed a diabetes certificate program and
provide clinical services to identified members
Provide incentive for member participation
Provide collaboration between patients, physicians,
educators, and pharmacists
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Key Players and Their Roles:
American Pharmacist Association (APhA) Foundation:
Provides a written outline of the process of care to
pharmacists for program implementation
Provides a curriculum with which to educate members and
prepare them to participate actively in their own diabetes
care and treatment
Provide access to a secure website for submission of
outcome data by pharmacy educators
Provide monthly reports based on outcomes data
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Key Players and Their Roles:
Michigan Pharmacist Association (MPA):
Provision of initial and continuous diabetic
certificate CE program for participating pharmacists
Physician:
Confer with pharmacist educator to establish
collaborative practice:
Individualized patient goals
Guidelines for treatment/ referral
Receive patient visit summary/ SOAP note
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Key Players and Their Roles:
Pharmacy Network Educator (Certified Pharmacist):
Comprised of 20 independent and chain pharmacists who
attended and passed a Diabetes Certificate Program
Located throughout Genesee, Bay, Saginaw, and
Shiawassee Counties
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Key Players and Their Roles:
Pharmacist Role:
Act as coach to encourage active patient involvement in
his or her care and discuss/educate regarding patient selfmanagement using motivational interviewing technique
Provide written and/or verbal progress reports to the patient’s
primary care physician or specialist to establish collaborative
practice using SOAP notes
Document all pharmacist/patient interactions and
interventions that take place throughout the project, and
forward this data as required
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Member Selection
Criteria:
Commercial line of business
Diabetic as defined by HEDIS
Meet 1of 2 targeted clinical criteria arms
 Disease Management Arm
• No connectivity with disease management program vendor AND
• Glycosylated hemoglobin A1c (HbA1c)  7.0 or no HbA1c on record
 Pharmacy Management Arm
• Non-adherent (medication possession ratio (MPR) of  80%) with
oral diabetic medications AND
• Total number of medications  5 (based on pharmacy claims) AND
• HbA1c  7.0 or no HbA1c on record
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Outcome Measures
The APhA Foundation will provide a data summary analysis to
HealthPlus based on de-identified information from the web-based
documentation system used by the pharmacist educators
HealthPlus will do additional analysis to compare the treatment group
vs. the control group*
 HEDIS Related Measures:
• HbA1c screening/ control (<7% & >9%)
• LDL screening/ control (<100 mg/dL)
• Urine albumin
• Eye exam (retinal) performed
• Blood pressure control (<130/80 mmHg & <140/90 mm/Hg)
*
The treatment group is defined as those members who are enrolled and managed in the program.
The control group is defined as members with the same criteria who did not participate in the
program.
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Outcome Measures Continued
 Non-HEDIS Related Measures:
• Prescription claims for Ace inhibitors/ ARB Medication class
• Prescription claims for “statin” medication class
• Routine foot exams
• Medication adherence
• Total medical costs (pharmacy and medical)
• Body Mass Index (BMI)
• Overall return on investment (ROI)
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Challenges
Members being proactive and enrolling in the program
Members keeping scheduled appointments
Community pharmacist comfort level in the role of clinical
educator
Pharmacist ability to meet time commitment
Pharmacist comfort level communicating with physicians
on a peer-to-peer level
Chain-store contract signatures/ legal consults
Pharmacist documentation in the web-based system
Physician’s willingness to communicate on a peer-to-peer
level and share lab data with pharmacist
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