Maximizing Pharmacist Role in Chronic Disease Management: The Maryland P3 Program

1. The Maryland P3 Program: A Collaborative Solution to Medication Therapy Management Magaly Rodriguez de Bittner, PharmD, BCPS, FAPhA, CDE Professor and P3 Director

2. Outline • Pharmacy Education • Program Overview • Preliminary Program Results • Impact on Public Health Needs

3. Patients Pharmacists Partnerships (P3) Program An effective solution to patient-centered health education, medication adherence, and chronic disease management

4. Chronic Care Model Health System: Community: Health Care Organization Resources and Policies ClinicalInformationSystems Self-Management Support DeliverySystem Design Decision Support Informed, Activated Patients Prepared, Proactive Practice Team Productive Interactions

5. Maryland P3(Patients, Pharmacists, Partnerships) • Maximizes the role of the pharmacist (medication expertise) • Pharmacists serving as “coaches” to stress self-management education • Delivery system design (aligned incentives, convenient location) • Decision support working collaborative with the patient’s physician and other health care providers • Data Collection System-MedPath

6. The History • This pharmacist-delivered diabetes management initiative arose out of an effort to improve patient health and reduce employer health costs • Began in 2006 with one employer in Western Maryland • Now involves 6 employers and ~500 employees • Support from DHMH and the Maryland Legislature • Patients engaged in self-management • Employers provide benefits and waive co-pays • Pharmacists deliver care and coordinate care with • primary care providers and specialists The Partnership

7. The Pharmacists medication experts on the health care team • Meet face-to-face with patient 5-7 times depending on patient needs • Counsel patients on medication adhering and self-management • Educate patients on medication, and possible drug interactions, as well as adverse effects • Coach patient in self-management skill development • Help with personal goal setting (therapeutic indicators) • Coordinate referrals for necessary • laboratory tests and specialist visits • (annual eye and foot exams, and • dental check ups) • Immunizations for pneumococcal • and influenza • American Diabetes Association Clinical Care Guidelines (2011)

8. Patients Self-management of chronic disease Pharmacists Partnerships UMB School of Pharmacy Network Coordination Training PSM System/Reporting • Maryland Pharmacists Association • P3 Pharmacy Network • Department of Health and Mental Hygiene • Maryland General Assembly • Employers/Payers

9. Results From Early Program Implementations

10. Total Healthcare Costs (Rx and Medical)Mission Hospitals & City of Asheville Combined

11. Baseline, Year 1, 2 and 3 compared toProjected Costs* Year 3 Projected $13,740 Yr 3 savings Per Patient from projected Costs $6,250 from Baseline Costs $1,545 Year 2 Projected $11,948 Yr 1 Projected $10,390 Baseline $9,035 Total costs $9,035 $8,913 $8,802 $7,490 *for 63 patients with baseline,1st, 2nd and 3rd year results

12. Patient Self-Management ProgramSM for Diabetes: First Year Cost SavingsJ Am Pharm Assoc. 2005; 45: 130-137 Average Cost Savings Per Patient $918 Align the Incentives, Empower the Patient, Control the CostsSM Combined data from Mohawk, VF, Manitowoc, OSU, Kroger (n=165)

13. The Diabetes Ten City ChallengeInterim Results: n=914, 10.2 months • Through 30-Sep-07, 29 employers, 10 cities: • Charleston, South Carolina • Chicago, Illinois • Colorado Springs, Colorado • Cumberland, Maryland • Honolulu, Hawaii • Milwaukee, Wisconsin • Northwest Georgia • Pittsburgh, Pennsylvania • Los Angeles, California • Tampa Bay, Florida J Am Pharm Assoc 2008;48:181-190.

14. Can the p3 program model improve clinical outcomes AND DECREASE HEALTH CARE COSTS FOR people with diabetes?

17. Figure 4. Blood Pressure at Therapeutic Levels (mmHg)

18. Results 2009 (N= 159 patients )

19. Results 2009 (N=159)

20. Results 2009 (N=159)

21. Cost Savings for the Maryland P3 Program • On average our employers are saving approximately $900 per employee per year ($495-$3,281).

22. Track Record of Success: • Clinical outcomes: • improvement in clinical indicators such as A1C and LDL measures • Economic outcomes: • reduced overall costs of care • Satisfaction results: • high employee satisfaction with the program and pharmacist care

23. Implications:Public Health Issues • Underserved Populations • Health care Reform- Patient Centered Medical Home and Transitioned of Care • Team-based Care • Access to Health Care and Prevention Services

24. 2010 Recipient of the APhA Foundation Pinnacle Award

25. Conclusions/Lessons Learned • Pharmacists are an innovative and effective solution to control chronic disease by improving clinical, humanistic and economic outcomes • Pharmacists accessibility and geographic location-in every patient’s neighborhood- has a significant strategic potential • Collaboration between the Departments of Health/Office of Chronic Diseases, academic institutions, professional organizations and private employers have proven to be effective maximizing resources and increasing efficiency of chronic disease initiatives