Pharmacy Management Initiative in 19 States Strives for Best Possible Care for Medicaid Patients
May 21 2007 - 9:00AM
PR Newswire (US)
Program has resulted in 1.3 million patient care improvement
interventions INDIANAPOLIS, May 21 /PRNewswire-FirstCall/ -- An
award-winning program seeks to improve the quality of care Medicaid
patients receive by aligning physicians' prescribing of mental
health medications with national, evidence- based best prescribing
practices. The Behavioral Health Pharmacy Management Program
evaluates Medicaid pharmacy claims for all mental health
medications to identify prescribing patterns that are inconsistent
with national, evidence-based best prescribing practices. The
program then educates doctors who deviate from these best
practices. Since implementation, the program has resulted in
190,000 prescriber and 1.3 million patient care improvement
interventions nationwide. Some of the inconsistent prescribing
patterns seen in reports about the program include: -- Duplicative
prescribing of medication by different doctors for the same patient
-- Premature, rapid switching from one medication to another --
Failure of patients to fill their prescriptions in a timely fashion
-- Prescribing multiple medications from the same therapeutic class
-- Prescribing above or below recommended dosing levels In addition
to the specific patient physician communications, these doctors
receive regular information bulletins about special topics related
to mental health medications, such as behavioral health medication
for children. Physicians who continue to experience the same issues
over time are offered a peer consultation to discuss prescribing
practices. "We know that educating physicians on prescribing
patterns for drugs that treat mental illness is an excellent way to
improve the overall quality of mental health treatment within our
Medicaid program," said Janet Olszewski, Michigan Department of
Community Health director. "Through this project, many
opportunities for coordination of care have been identified,
resulting in improved quality of care and enhanced quality of life
for persons with mental illness." Michigan is one of 19 states that
is using the program in partnership with Comprehensive NeuroScience
Inc. (CNS), a national clinical research company. The state and CNS
work together to identify prescription patterns. Eli Lilly and
Company provides financial support for the initiative, with the
operation and implementation of the program being done solely by
the states and CNS. If the state decides to share data with Lilly,
the data is blinded and aggregated and does not contain information
about individual patients or providers. In addition, Lilly has
sought approval and received support from the Centers for Medicare
& Medicaid Services for these initiatives. "The states should
be proud of their achievements nationwide with this program," said
Dr. Richard Surles, CNS executive vice president. "The data is
showing how focusing on the quality of prescribing practice to
assume good patient care also results in the most effective use of
limited Medicaid resources." "CNS provides quality improvement
programs for people with serious mental illness. By combining state
of the art data analytics and best practice standards we are able
to provide doctors with tools that enable them to better serve
their patients," said Keith Dayton, CNS executive vice president.
"We believe that by providing physicians with targeted information
related to their patients we can support them in their treatment of
these patients, improve the care patients are receiving and
ultimately significantly reduce health care costs." EXAMPLES OF
SUCCESS Each program is customized to meet the needs of the
participating state; therefore data points vary accordingly.
Studies of the programs have found the following results: MICHIGAN
- The Michigan Department of Community Health's Pharmacy Quality
Improvement Project (PQIP) demonstrated improvement in the quality
of care provided to Medicaid patients with mental illness. The
PQIP, launched in May 2005, is a three-year educational program
that analyzes the prescribing of mental health medications for
Medicaid adult and child members and identifies prescribing
patterns inconsistent with evidence-based guidelines. An Impact
Analysis was performed comparing claims cost before and after the
PQIP. A 22% reduction in claims and 21% reduction in cost were
realized for the time period May 2005 through January 2006. (i)
MISSOURI - During the American Psychiatric Association Institute on
Psychiatric Services meeting and the Disease Management Association
of America meeting in 2005, presentations were given on the
analysis of the Missouri Mental Health Medicaid Pharmacy
Partnership Program (MHMPP). The analysis included 1,911 Medicaid
recipients whose physicians received notification for at least one
of the program's quality indicators during two consecutive written
communications. Individuals similar to those patients were selected
for the comparison group. The study compared the two groups six
months pre- intervention and six months post-intervention. The
researchers found: (ii) -- Hospital admissions for those in the
intervention group decreased by 43% compared to a .1% decrease in
the comparison group. -- A 1,813 day decrease in total hospital
days for those in the intervention group compared to a 688 decrease
in the comparison group. -- A $1,238 decrease in cost per person
for the intervention group compared to a $312 decrease in the
comparison group. "We had two landmark findings. First that
focusing on improving quality really is an effective way to control
costs; second, even though we were only focusing on improving
prescription practices for psychiatric medications, we found
greater savings in reductions of costs of hospitalization,
outpatient treatment, and other medications. You really have to
look at the total health-care impact to understand what a
difference improving quality can make," said Joseph Parks, M.D.,
director of the Division of Comprehensive Psychiatric Services and
chief clinical officer, Missouri Department of Mental Health. The
Missouri program was featured at the 2006 APA Institute on
Psychiatric Services and the Disease Management Association of
America meeting, where it received the Bronze Achievement Award for
its success. "The partnership is a model for reducing
hospitalizations, containing pharmacy costs, improving prescribing
practices, and maintaining open access to psychiatric medications
through collaboration and education," Parks said. NEW JERSEY - The
New Jersey HealthyLiving Behavioral Pharmacy Management (BPM)
program is a collaborative project within the Department of Human
Services' Division of Medical Assistance and Health Services and
Division of Mental Health Services that has been using the BPM
product for providing information to prescribers about the
psychiatric medication utilization of their patients. The BPM hopes
the information provided by this project will help improve the
psychopharmacological care for New Jersey FamilyCare/Medicaid
clients. Although the program has just recently started, positive
trends have already been seen in the area of children's mental
health. (iii) OKLAHOMA - In August 2004, Oklahoma's SoonerPsych
Program began to send educational material to prescribers. From
September through December 2004, the average monthly spending for
Medicaid behavioral health drugs remained constant at roughly $12
million. From January through December 2005, the average monthly
spending rate for behavioral health drugs was $12.2 million. This
rise in spending represents less than a 2% increase in the cost of
behavioral health medications in Oklahoma during 2005. In
comparison, most states experienced a 14-18% annual growth rate in
the cost of behavioral health medications in 2005. (iv) "Physicians
want the best for their patients, and this program has given them
another tool to get the right drug to the right person at the right
time. It is this practice that saves everyone time and health care
dollars," said Nancy Nesser, PharmD., J.D., pharmacy services
director, Oklahoma Health Care Authority. UTAH - Utah's Behavioral
Pharmacy Management Program began in March 2004. A study of
prescribers who received educational material from the program
found that between Jan. 1, 2004, and Aug. 31, 2005: -- The number
of their child and adolescent patients receiving three or more
psychotropics decreased by 76%. -- The number prescribing two or
more atypicals decreased by 74%. -- The number of their adult
patients receiving five or more psychotropics decreased by 68%. --
In addition, for those prescribers who received notification that
their patients were being prescribed behavioral drugs by multiple
prescribers, the number who continued this prescribing pattern
decreased by 74%. -- Also, between June 2004 and September 2005,
there was no substantial increase in monthly behavioral pharmacy
claims despite an increase in Medicaid enrollment. (v) Getting
reports from the state and CNS on the success of the program has
been rewarding for Lilly. "We're particularly pleased to see how
this program is helping improve care for Medicaid patients with
mental illness, who represent some of our most vulnerable citizens.
The program operates on the principle that high quality care is
offered when the management of mental health drugs is based on
nationally recognized standards and guidelines, as well as
individual patient needs,' said Jack Bailey, Lilly vice president.
"We believe Medicaid dollars for mental health mediations can be
wisely managed by providing educational initiatives rather than
limiting access to these vital medications." "Mental illness is a
serious issue for the nation," Bailey said. The National Institute
of Mental Health estimates that more than a quarter of adult-age
Americans suffer from a diagnosable mental disorder. SUPPORT FROM
ADVOCACY COMMUNITY The mental health advocacy community views the
program as a quality alternative to more restrictive measures for
Medicaid cost-savings, such as prior authorization, that could
compromise access to needed medications. "The Behavioral Pharmacy
Management process is an excellent approach to improving
healthcare. It's a process that promotes evidence-based care while
helping to save valuable healthcare dollars. The National Council
supports this and other initiatives that focus on improving the
quality of care for persons with serious mental illness," said
Linda Rosenberg, MSW, president and CEO, National Council for
Community Behavioral Healthcare. James E. House II, executive
director, Mental Health Association of Greater St. Louis, said, "We
were excited to see the positive results Missouri's program has
produced thus far and that it provides the state with another
option to saving costs without having to restrict access to
medications. It can be challenging for doctors to find the best
medication for patients with mental illness that afford the most
effective control of symptoms with limited side effects. Further,
many medications are not easily interchangeable as no medication is
exactly the same as another. That's why open access, especially for
those with mental illness, is so key." SUPPORT FROM MEDICAL
COMMUNITY The initiative also has received positive comments from
doctors. Jonathan Henry, M.D., medical director, CMH Authority of
Clinton-Eaton- Ingham Counties, and Michigan PQIP Psychiatric
Consultant, states, "The PQIP provides a valuable tool on both a
large scale, statewide view of medication prescription patterns,
and also a small, provider-specific level to improve the rational
use of psychotropic and narcotic medications. The Michigan
Department of Community Health has long demonstrated a positive,
educational, and collegial approach to promoting a 'best practice'
model when prescribing these medications, with PQIP representing
its latest effort. Michigan medical providers and citizen patients
can all benefit from the ongoing work of this project, with even
more planned improvements in the future." The program is entirely
voluntary for doctors. All decisions regarding treatment and
medications are made privately between the physician and the
patient and are completely individualized. About Eli Lilly and
Company Lilly, a leading innovation-driven corporation, is
developing a growing portfolio of first-in-class and best-in-class
pharmaceutical products by applying the latest research from its
own worldwide laboratories and from collaborations with eminent
scientific organizations. Headquartered in Indianapolis, Ind.,
Lilly provides answers-through medicines and information- for some
of the world's most urgent medical needs. Additional information
about Lilly is available at http://www.lilly.com/. About CNS
Comprehensive NeuroScience, Inc. is a privately-held company,
specializing in research, care management, and education related to
central nervous system disorders. CNS actively invites
collaboration and contact across multiple spheres, including
academia, government agencies, and with members of the
biopharmaceutical and commercial healthcare industries, as well as
financial and investment communities. (i) Innovative Program
Improves Medicaid Quality Of Care For Individuals With Mental
Illness news release, issued by State of Michigan Department of
Community Health; January 24, 2007 (ii) Study Shows How Improving
Quality of Psychotropic Prescribing Practices Reduces Hospital
Utilization news release, issued by Missouri Department of Mental
Health; November 16, 2005 (iii) According to the New Jersey
Department of Human Services' Division of Medical Assistance and
Health Services (iv) SoonerPsych Program Helps Contain Medicaid
Costs and Improves Prescribing Practice news release, issued by
Oklahoma Health Care Authority; October 12, 2006 (v) Working
Hand-in-Hand to Manage Pharmacy Costs. Behavioral Healthcare. May
2006;40 - 42. *All data on file with Comprehensive NeuroScience
Inc. and respective state Medicaid departments. (Logo:
http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGO)
http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGO
http://photoarchive.ap.org/ DATASOURCE: Eli Lilly and Company
CONTACT: Janice Chavers, (US) +1-317-651-6253, of Eli Lilly and
Company
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