Transcript Document

COST CONTAINMENT
STRATEGIES
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FOCUS ON PRODUCT
FOCUS ON PATIENT BENEFITINCREASING THE VALUE OF WHAT YOU
HAVE PURCHASED
EFFECTS OF PATIENT BEHAVIOR AND
ADVERSE DRUG EVENTS
PRACTICAL SOLUTIONS
7/20/2015
Jim Miller RPH.MBA
Strategic Options
Focus On Drug Product
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Maximize Generics
Tablet Splitting
PBM Formularies and Rebates
PBM and Mail Order
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Brand Use vs. Generic
Waste from 90 day supply
Transparency
Importation
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Jim Miller RPH.MBA
Strategic Options
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Focus on Patient Benefit- Increasing the
Value
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Patient Safety
Patient Compliance
Patient Education
Patient Meeting Therapeutic Goals
Identification,Resolution and Prevention of Drug
Related Problems
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Jim Miller RPH.MBA
Headline- Sept. 26,2006
Patients Suffer Rx Malaise
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1 in 8 Heart Attack Patients Stop
Medications in 1 month
30% Were Discharged Without The 3
Recommended Medications
50% of Patients Were No Longer Taking
Medications After 1 Year
Ho, P.M. et al. Arch Intern Med 2006; 166:1842-1847
Headline-Telegraph Herald-Dubuque: page 1
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Jim Miller RPH.MBA
Rates of medication use for the entire cohort
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Ho, P. M. et al. Arch Intern Med 2006;166:
1842-1847.
Copyright restrictions may apply.
7/20/2015
Jim Miller RPH.MBA
35% OF PATIENTS DO NOT FILL
ALL OF THEIR PRESCRIPTIONS
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Patient Perceived Lack of Need-42%
Patient Thought Rx was too Costly-27%
Patient was Concerned About Side Effects17%
Patient Insurance Didn’t Cover-16%
Patient Forgot-4%
J Scott Group. AmPharmacist, Oct 2006:9
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Jim Miller RPH.MBA
When Prescription Was Filled, The
Directions Were Not Followed
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Patient Forgot to Take-79%
Patient Ran Out of Rx-19%
Patient Thought Rx was too Costly-9%
Patient Perceived Lack of Need-9%
Patient Experienced Side Effects-3%
Patient Noted No Improvement-3%
J. Scott Group, AmPharmacist, Oct 2006:9
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Jim Miller RPH.MBA
Headline-Drug Reactions Send
700,000 to Hospital Yearly
Study Reviewed ER Visits:
 16% of drug related visits resulted in hospitalization
 2.5% of all ER visits were from adverse drug events
 Cause of event: 53.4% unintentional overdose, 31%
adverse effects, 11.3% allergic reaction
 Most Common Drugs: Insulin, Warfarin, Amoxicillin,
Aspirin
Budnitz,D.S. et al. JAMA 2006;296:1858-1866
Headline-Telegraph Herald-Dubuque, page 1
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Jim Miller RPH.MBA
Medication Waste
Medication Waste Occurs Whenever:
 A high cost medication is used when an equally
effective, lower cost alternative was available.
 A patient is non-compliant with their prescribed
regimen.
 A patient requires additional medical treatment due
to an adverse drug event.
 A medication fails to achieve the intended results.
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Patient Focused Solutions
Ia. Pharmacy Case Management
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Patient Eligibility: 4 or more chronic meds,at least
one of 12 select diseases, eg. Diabetes, CHF,
Asthma, Hypertension
Requires collaboration between patient,doctor and
pharmacist
Structured procedure: assessment,follow-up, new
problem identification, preventative follow-up
Provides both pharmacist and doctor reimbursement
IPA and IMS initiative, legislative approval
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Jim Miller RPH.MBA
Outcomes Pharmaceutical Health
Care
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LLC ,Founded in 1999 by Ia. Pharmacists
National leader in medication therapy management
(MTM) services
Provides marketing, delivery, documentation and
administration of MTM services
Clients include, unions, self insured employers, state
Medicaid plans and Medicare D plans.
Average is $600 saved in estimated avoidable
healthcare costs for a member receiving a
Medication Check-up
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Jim Miller RPH.MBA
Initiation Of Clinical Services In
Mercy Family Pharmacy
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Create a business model for both distribution and
clinical pharmacy practice
Focus on patient safety, customer service
Use a documentation system that creates efficient
workflow, includes quality indicators, documents
results and provides management tools for practice
oversight
Create high expectations for our pharmacists and
raise the standard of practice at our sites
Share lessons learned with our professional peers
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Jim Miller RPH.MBA
MPI Consulting Practice Results
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Approximately 350 patients working with 8
pharmacists
Average of 33 minutes per patient interaction
Physician acceptance rate of 96.2%
Quality Assessment of Interventions: 10% resulted in
lower drug cost, 32% were a result of drug related
problems
Financial: $8360 in revenue for pharmacy resulted in
$44,124 ECA for Medicaid
Clinical: Patients attaining therapy goals:
hypertension-80%, diabetes-82%, hyperlipidemia7/20/2015
Jim Miller RPH.MBA
86%
How To Get Started
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Think big, start small
There may be a motivated pharmacist in your
backyard
Contact Outcomes, 7 years of creating the wheel
Contact Iowa Pharmacist Association, numerous
collaborative efforts, Medicaid,BCBS, Farm Bureau
Start with the focus on patient safety and results, but
START
7/20/2015
Jim Miller RPH.MBA