Transcript Medication Therapy Management

Medication Therapy
Management
Sample Presentation: Given to Local Employer
Background
The Need for Medication Therapy
Management
Prescription drug spending in the United
States was $252 billion in 2005
 Medicare Part D will add $700 billion
over the next 10 years
 Prescription drug spending has grown
by an average annual rate of 11-15%
over the past 5 years
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Background
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The cost of drug therapy related morbidity and
mortality is the 5th most costly health condition
The cost related ratio is for every $1.00 spent
on medication an additional $1.30 is spent
managing drug therapy problems
The estimated 2000 cost was $177 billion
Institute of Medicine July 2006 report
Several organization including CMS, NCQA, and
others have called for action
Johnson JA, Bootman JL: Arch Intern Med 1995;155:1949 and
Ernst FR et al. J Am Pharm Assoc 2001;41:192
COSTS OF DRUG THERAPY
PROBLEMS
Total U.S. Costs = $177 billion / year
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Physician/Urgent Care Visits
+Added Medications
+Emergency Room Visits
+Hospital Visits
+Long-term Care Stays
$ 14 billion
$
3 billion
$
6 billion
$ 121 billion
$ 33 billion
Ernest FR and Grizzle AJ. Drug-Related Morbidity and Mortality:
Updating the Cost-of-Illness Model J. APhA 41: March 2001.
Business Case
WHO Definition of a Healthy
Workforce
Four Key Attributes
• Healthy
• Productive
• Ready
• Resilient
Business Case
Focus of Pharmaceutical Costs
Focus
Unit Pricing
Utilization
Therapuetic
Mix
Strategy
Volume
Purchasing
Financial
Substitution
Tactics
Pharmacy
Management
Consolidation
Benefit
Restrict
Prior
Generic
substitution
“step care”
formularies/
contracting
incentives for
based on cost
key stakeholders
Access control
design
authorization
Now Which Way?
Value
Management
Cost
Management
Cost Management
Carve out silo management
Focus on unit price
– Ties copayment to acquisition price
Limit access
Value Management
 Focus
on cost/benefit
 Access
based on evidence of value
 Financing
based on ROI to payer
Impact of Health on Productivity
Average Number of Unproductive Hours by Condition in a
Typical 8 Hour Work Day*
Condition
Heart Disease
Respiratory Infection
Diabetes
Migraine
High Blood Pressure
Arthritis
Allergies
High Stress
Anxiety
Depression
4.3
4.1
4.0
3.4
3.4
3.2
2.8
2.3
2.2
2.2
On days when affected by the condition/Sample
size = 563 Source: Medstat
Value Proposition for a Medication
Therapy Management as a Benefit
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Proper use of medications can lead to improved
health, enhanced quality of life, and increased
productivity
Overuse, under-use, and misuse of drugs is
linked to reduced health, poor quality of life,
and decreased productivity
Clinical pharmacists with advanced training can
reduce drug therapy problems and improve
health and economic outcomes
Patient-centered MTM services have
consistently provided a $4:$1 ROI*
* Sources
Wilcox S, Himmelstein D, Wolhander S: JAMA 1994;272:292-296
Col N, Finale J, Kronhom P: Arch Intern Med 1990;150:841-845
Isetts B, Brown L, Schondelmeyer S, Lenarz L: Arch Intern Med 2003;163:1813-1820
Zarowitz B, Stebelsky L, Muma B, Romain T: Pharmacotherapy 2005;25(11):1636-1645
Garrett D, Bluml B: J Am Pharm Assoc 2005;45:130-137
Cranor C, Christensen D: J Am Pharm Assoc 2003;43:160-172
Malone DC et al. Pharmacotherapy 2000;20:1149
Objectives
Transition the perspective of pharmacy benefit to:
 Enhance employee satisfaction
 Improve employee performance
 Improve economic outcomes
 Change the pharmacy care model to one of
action and prevention not reaction
 Improve targeting of drug therapy problems
 Improve health status
 Establish multi-risk focused interventions for
drug therapy management
 Develop a framework that is employee-centric
 Integrate MTM into the mainstream of corporate
health care
MTM Process of Care
Overview
Patient-centered
 Consistent and systematic processes that:
– Assess all of the patient’s drug-related needs
– Identifies drug therapy problems
– Establishes therapeutic goals
– Designs a medication therapy care plan
– Conducts follow-up visits to evaluate progress
– Communicates information to the patient’s
physician or nurse provider in a collaborative
practice
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Goals
Individualized
Establish desired goals of therapy for each
drug and measurement parameters
 Mutual negotiation with the patient and
health care providers when appropriate
 Goals are realistic based on patient’s ability
 Establish timelines
 Optimize the patients medication therapy
experience
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Several recommendations of the Institute of Medicine
Standardized Assessment
Assessment parameters
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Information about particular drug therapies
Information about non-drug therapies
Changes in drug regimens
Instructions for drug administration
Medications and products the patient requires
Assistance with drug administration devices
Information from other healthcare agencies
Referrals to other practitioners
Categories of Drug Therapy
Problems
Every drug the patient receives
undergoes the following evaluation:
Assessment of proper indication
– Is the drug being used unnecessary
– Is additional drug therapy needed
 Effectiveness of treatment
– The current drug therapy is
ineffective
– The dose is too low to produce the
desired response
Categories of Drug Therapy
Problems
Safety
– Is there an adverse drug reaction
present
– Is the current drug dosage too high
 Convenience
– Is the patient adherent to the
therapy
– Are there barriers to the patient’s
ability to comply with therapy e.g.
physical, financial
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Drug Therapy Problems Identified
(n=5,136 patients)
Number of
Drug
Therapy
Problems
% of Drug
Therapy
Problems
Indication
Unnecessary Drug
Therapy
Needs Additional Drug
Therapy
688
3,246
6%
28%
Effectiveness
Ineffectve Drug
Dosage too Low
882
2,328
8%
20%
Safety
Adverse Drug Reaction
Dosage too High
1,704
602
14%
5%
Compliance
Noncompliance
2,276
19%
11,726
100%
TOTAL:
Data from Medication Management Services, Inc.
Experience
The Service Value
Proposition
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High satisfaction with this care model
95% physician acceptance of care
recommendations by pharmacists
Data documented a 50% improvement in
patients meeting their therapeutic goals
Positive impact on health system utilization and
employee productivity including:
– Reduction in hospitalization / clinic / ER
visits
– Identification and resolution of drug therapy
problems
– Employee days saved
Example Practice Profile
for a Medication Therapy
Management Service
Demographic Summary
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700 Active Patients
1500 Documented Visits
60% female and 40% males
Average age = 62 years old
Average number of medical conditions = 6
Average number of medications = 10
The Most Frequent Indications
for Drug Therapy in Practice
1.
2.
3.
4.
5.
6.
Hypertension
Hyperlipidemia
Peptic Ulcer Disease
Allergic Rhinitis
Diabetes
Osteoporosis
7. Pain-general
8. Arthritis Pain
9. Prevention MI/Stroke
10. Hypothyroidism
11. Depression
12. Insomnia
These 12 conditions represent
52% of all indications for drug therapy
Sources of Medications
In addition to their prescription
medications:
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502 patients (72%) were taking 2010
different OTC medications
19 patients were taking 36 different
medications they received from friends or
family members
21 patients were also using 43 different
sample products to manage their medical
conditions
Practice Analysis
(n = 700 patients)
 724
drug therapy problems were
identified and resolved
 385
patients (55%) had > 1 drug
therapy problem
 98
patients (14%) had > 3 drug
therapy problems
Drug Therapy Problems
Identified
% of Drug
Therapy
Problems
Indication
Unnecessary Drug Therapy
Need Additional Drug Therapy
12%
26%
Effectiveness Ineffective Drug
Dosage too Low
9%
17%
Safety
Adverse Drug Reaction
Dosage too High
19%
10%
Compliance
Noncompliance
Total Number of Drug Therapy
Problems: 724
7%
Ten Most Common Drug Therapy
Problems and Associated Medical
Conditions
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Dosage too low
Needs additional drug therapy
Adverse drug reaction
Dosage too low
Adverse drug reaction
Adverse drug reaction
Needed additional drug therapy
Dosage too low
Needed additional drug therapy
Needed additional drug therapy
Hypertension
Allergic rhinitis
Hypertension
Arthritis Pain
Arthritis Pain
Hyperlipidemia
Depression
Allergic rhinitis
Angina pectoris
Esophagitis
Program Outline
Eligibility of 4 or more drugs or 2 or more
chronic illness
 6 – 8 service sites
 Active employees and retirees
 Program would be voluntary and
participants would consent to the program
 Participants would not be assessed a
copayment for pharmacist visits
 Incentives to participate
– Reduction in medication copayments
– other
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Program Outline
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Employees and retirees could self-refer
to the program or be referred by their
physician or other provider
Concerted internal effort to educate and
recruit active employees and retirees
into the program
Program Outline
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Targeting effort to the following groups as
much as possible
– Retirees and active employees with
complex drug therapies
– 4 or more concurrent drugs
– Multiple physicians and pharmacies
– Recent hospitalization
– More than two chronic illnesses e.g.
diabetes mellitus, COPD
– High risk drug therapies such as
cardiovascular drugs, diuretics, non-opioid
analgesics, anticoagulants, and
antidiabetic agents
Additional Support
Service
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Integration with wellness screening
– Cholesterol testing
– Diabetes mellitus testing
– Spirometry
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Special group classes
– Diabetes education
– Proper inhaler devise use techniques
– Smoking cessation
MTM Program Metrics
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Employee satisfaction
Clinical outcomes
– Reduction in drug therapy problems
– Improvement in clinical measures
Return on investment and value analysis
– Direct health care costs
– Absenteeism
– Presenteeism*
*The World Health Organization Health and Work Performance Questionnaire (HPQ) will be
used to assess employee at work performance
Financial Support
Plan
would cover MTM
service for active
employees and retirees
for.
Promotional program
Retiree Cost – Benefit
Analysis
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Estimated utilizers based on Rx utilization would
be 64.1% of 1309 members or 839 and 70%
enrollment (587 members)
Average visits of 4 - 6 per year at a cost of $65
per visit or $325 per year per enrollee
Estimated clinical visit costs $190,000
Copayment reductions based on 60% generic
use and copayments of $5 and $20 and average
of 2.5 Rxs/month/retiree
– 17,610 Rxs at ave copay of $10 would be
$176,100
Total cost $366,000
Retiree Cost – Benefit
Analysis
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Blue Cross Blue Shield Cohort Study-ROI 5 to 1.(Compared total health care
costs of APCS managed population
versus unmanaged.)
Caremark results of 4:1 ROI
Asheville North Carolina ROI of 4:1
Minnesota Medicaid results to date =
$155 per visit and cost of $72.50
Estimated ROI for City program would
be estimated at $755 per enrollee or an
ROI of about 2.38:1
Organizations Who Have
Embarked on Similar Programs
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Minnesota Medicaid program
City of Asheville NC
VF Corporation - Greensboro, NC
Mohawk Industries – Dublin, GA
Manitowoc Health Care Cooperative – WI
The Ohio State University
The Kroger Company – Columbus, OH
The University of Kentucky
West Virginia State Employees
Blue Ridge Paper
City of Chicago