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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