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Utah's Medicaid program is implementing an Electronic Pharmacotherapy Risk Management system to enhance medication therapy and reduce adverse events. The program involves computerized surveillance tools, clinical interventions, and pharmacist-led services to target high-risk medications and chronic diseases. Through provider feedback, academic detailing, and patient education, the initiative aims to optimize drug use, increase compliance, and enhance health outcomes for Medicaid members.
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Strategies to Modernize State Medicaid Programs,Utah’s Medicaid TransformationByLisa V. Hulbert R.Ph.Transformation Program ManagerUtah Medicaid Program
Electronic Pharmacotherapy Risk Management (ePRM) Adopt innovative methods to improve effectiveness and efficiency in providing medical assistance under title 1903 of the Social Security Act. Objectives • Refine and Implement a computerized surveillance tool to support risk management. • Conduct innovative multi-pronged interventions with providers of health care.
Statement of Need • Spending Increases • 16% Increase 2004-2005 • Patient Noncompliance up to • 3.8 times the risk for death • 1.5 times the risk for hospital admission • Adverse drug events associated with: • 13.3% of all hospitalizations
Who is involved? • Utah Division of Health Care Finance • Utah College of Pharmacy, Drug Regimen Review Center (DRRC) • Utah Office of Health Care Statistics • Salt Lake VA Medical Center, Informatics Decision Enhancement And Surveillance (IDEAS) Center • Utah School of Medicine, Division of Clinical Epidemiology • Utah School of Medicine, Department of Pediatrics
The Tool: A computerized surveillance and trigger tool which supports medication therapy and risk management services. • Will be used to identify potential drug-therapy problems. • Quality (under-utilization by patient, sub-therapeutic dosing, etc…) • Safety (duplications within same class, multiple prescribers, etc…) • Cost-related problems (Brand Issues, NDC billing issues) • Will be used to identify providers for in-depth clinical reviews and direct interventions. • Letters • Phone calls • Medication Therapy Management Services (MTMS) – targeted disease management education provided in an easy access environment. • Academic Detailing (MD/Pharm. D.)
The Tool: • Will be used to identify potential fraud and diversion • Will be used to track... • pattern of medication use/diagnosis • evaluate performance • to direct policy change
Medication Therapy • Clinical areas chosen for review include: • Diabetes therapy – high incidence of preventable adverse events • Hypertension therapy – high occurrence of under use of diuretics • Asthma therapy – high incidence of preventable adverse events • Antipsychotic therapy – high use • Pain Management – high over use, ineffective use • Anticonvulsant therapy – high unlabeled use • Anticoagulation/antiplatelet therapy – high incidence of preventable adverse events
Risk Management Services • Pharmacist provided Medication Therapy Management Services Found to reduce: • Unscheduled physician visits • Emergency department visits • Over all costs • Direct Feedback to providers • Letters, Telephone Calls, Academic Detailing.
Patient Education Visits to Clinical Pharmacists • Goals • Enhance the patient’s understanding of appropriate drug use • Increase compliance with medication therapy • Improve in the detection of adverse drug events • Core Components • Medication Therapy Review • Medical Record for patient • Medication Action Plan • Intervention and Referral to Prescriber (when needed) • Documentation and Follow-up • Focus • 4 or more chronic diseases • Multiple drug therapy potential problems • At high risk for drugadverse events
Over-All Project Time-line Quarter 1 Finalize work plan & architecture for trigger system-VA/UCP Quarter 2 - Quarter 7 Quarterly deploy newly-developed triggers-VA/UCP Implement direct patient & prescriber intervention-UCP Quarter 2 – Quarter 4 Develop support tools for MTMS-VA Certify Pharmacist Develop Documentation Requirements Implement Payment System Using Pharmacy Provider #/ $30 - $90/per visit
Project Time-line Continued Quarter 3 – Quarter 7 Phone intervention & academic detailing-VA/UCP/USM Quarter 5 - Quarter 8 Certified pharmacists provide MTMS Quarter 1 – Quarter 8 Evaluation-OHCS Quarter 8 Sustainable proposal to Medicaid-VA/UCP
Impact 175,000non-institutionalized Medicaid members 4,800will receive targeted interventions due to high risk medications 3,000prescribers will receive intervention material 600will receive MTMS 120prescribers will receive academic detailing
Outcomes 1)increased diuretic prescriptions among hypertensive patients 2)increased appropriate use of diabetic and asthma medication 3)improved compliance of antipsychotics 4)reduced adverse events among patients using narcotics, anticonvulsants, anticoagulation and antiplatelet drugs 5)improved quality of health care and health outcomes in patients referred to the MTMS
