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Medication Therapy Management Sample Presentation: Given to Local Employer

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

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Medication Therapy Management Sample Presentation: Given to Local Employer

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  1. Medication Therapy ManagementSample Presentation: Given to Local Employer

  2. 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

  3. Background • 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 organizations 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

  4. COSTS OF DRUG THERAPY PROBLEMS Total U.S. Costs = $177 billion / year • Physician/Urgent Care Visits $ 14 billion • +Added Medications $ 3 billion • +Emergency Room Visits $ 6 billion • +Hospital Visits $ 121 billion • +Long-term Care Stays $ 33 billion Ernest FR and Grizzle AJ. Drug-Related Morbidity and Mortality: Updating the Cost-of-Illness Model J. APhA 41: March 2001.

  5. Business Case WHO Definition of a Healthy Workforce Four Key Attributes • Healthy • Productive • Ready • Resilient

  6. Business Case Focus of Pharmaceutical Costs

  7. Now Which Way? Value Management Cost Management

  8. Cost Management • Carve out silo management • Focus on unit price • Ties copayment to acquisition price • Limit access

  9. Value Management • Focus on cost/benefit • Access based on evidence of value • Financing based on ROI to payer

  10. Impact of Health on Productivity Average Number of Unproductive Hours by Condition in a Typical 8 Hour Work Day* Condition Heart Disease 4.3 Respiratory Infection 4.1 Diabetes 4.0 Migraine 3.4 High Blood Pressure 3.4 Arthritis 3.2 Allergies 2.8 High Stress 2.3 Anxiety 2.2 Depression 2.2 On days when affected by the condition/Sample size = 563 Source: Medstat

  11. Value Proposition for a Medication Therapy Management as a Benefit • 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

  12. 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

  13. 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

  14. 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 Several recommendations of the Institute of Medicine

  15. Standardized Assessment Assessment parameters • 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

  16. 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

  17. 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?

  18. Drug Therapy Problems Identified(n=5,136 patients) Data from Medication Management Services, Inc.

  19. Experience

  20. The Service Value Proposition • 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

  21. Example Practice Profile for a Medication Therapy Management Service

  22. Demographic Summary • 700 Active Patients • 1500 Documented Visits • 60% female and 40% male • Average age = 62 years old • Average number of medical conditions = 6 • Average number of medications = 10

  23. 1. Hypertension 2. Hyperlipidemia 3. Peptic Ulcer Disease 4. Allergic Rhinitis 5. Diabetes 6. Osteoporosis 7. Pain-general 8. Arthritis Pain 9. Prevention MI/Stroke 10. Hypothyroidism 11. Depression 12. Insomnia The Most Frequent Indications for Drug Therapy in Practice These 12 conditions represent 52% of all indications for drug therapy

  24. Sources of Medications In addition to their prescription medications: • 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 medicalconditions

  25. 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

  26. Drug Therapy Problems Identified

  27. Ten Most Common Drug Therapy Problems and Associated Medical Conditions • Dosage too low Hypertension • Needs additional drug therapy Allergic rhinitis • Adverse drug reaction Hypertension • Dosage too low Arthritis Pain • Adverse drug reaction Arthritis Pain • Adverse drug reaction Hyperlipidemia • Needs additional drug therapy Depression • Dosage too low Allergic rhinitis • Needs additional drug therapy Angina pectoris • Needs additional drug therapy Esophagitis

  28. 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

  29. Program Outline • 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

  30. Program Outline • 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

  31. Additional Support Service • Integration with wellness screening • Cholesterol testing • Diabetes mellitus testing • Spirometry • Special group classes • Diabetes education • Proper inhaler device technique • Smoking cessation

  32. MTM Program Metrics • 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

  33. Financial Support • Plan would cover MTM service for active employees and retirees • Promotional program

  34. Retiree Cost – Benefit Analysis • 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 average copay of $10 would be $176,100 • Total cost $366,000

  35. Retiree Cost – Benefit Analysis • 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

  36. Organizations Who Have Embarked on Similar Programs • Iowa Medicaid • Minnesota Medicaid • 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

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