Successful Disease Management Programs Can Play Role in Health Care Reform
08 June 2009 - 11:00PM
PR Newswire (US)
Medicaid Pharmacy Management Program Improves Patient Care While
Saving Eight States Almost $95 Million INDIANAPOLIS, June 8
/PRNewswire-FirstCall/ -- An eight-state study of the award-winning
Behavioral Pharmacy Management Program (BPM) shows the
private-public Medicaid partnership program has helped improve
patient care while saving eight states almost $95 million in
behavioral health pharmaceutical costs.(1) Lilly funds the program,
which is designed and run by research firm Comprehensive
NeuroScience, Inc. (CNS) at the sole direction and guidance of
state Medicaid departments. The BPM, which has been executed in
more than half of the states, has won a variety of national awards,
including the Substance Abuse and Mental Health Services
Administration Science and Service Award, URAC Silver Award for
Best Practices in Consumer Empowerment and Protection, American
Psychiatric Association Bronze Achievement Award and Disease
Management Association of America Gold Award. Missouri, one of the
states included in the study, has seen significant improvements in
patient care, as well as Medicaid cost savings.(2) "We need to make
sure we take the very best care of the Medicaid patients we serve
and help them understand how to take the very best care of
themselves. With the BPM, we have the opportunity to do that by
simply targeting best practices and making educational information
available to physicians, so they understand the best practice
alternatives. We believe that, if you do the right things, the cost
will follow and it has," said George Oestreich, deputy division
director, Clinical Services, MO HealthNet Division. "Controlling
health care costs and improving quality is a big, complicated
issue. These kinds of partnerships, which pursue quality as a way
to contain costs, are really going to be the solution to a lot of
the health care problems that America faces," said Dr. Joseph
Parks, chief clinical officer and division director, Comprehensive
Psychiatric Services, Missouri Department of Mental Health. How the
Program Works The BPM reviews Medicaid prescription patterns for
more than 400 mental health medications. Then, it compares them to
national best practice guidelines, which are compiled by each state
Medicaid department and CNS. These guidelines are based on the
latest medical research, including studies published in
peer-reviewed medical journals. When there is an inconsistency with
what is considered best prescribing practice, the BPM sends an
educational mailing to the physician, so they can consider the
information for the next visit with the patient. Some of the
inconsistent patterns the program has identified include:
duplicative prescribing of a medication by different doctors for
the same patient; prescribing above or below recommended dosing
levels; and prescribing multiple medications from the same
therapeutic class. "Physicians will change their prescribing
practice patterns to be in keeping with best practice, when they
know what the best practice is. They use the educational
information from the program's mailing, and, when they do, the
overall care of the patient is improved, and we see overall
reduction in health care costs," said Carol D. Clayton, Ph.D., vice
president, account management services, CNS. The BPM also informs
physicians when their patient has not refilled their prescription.
This is a health care concern because poor compliance or
non-compliance with medication treatment is strongly is linked to
relapse, rehospitalization, poor outcomes, and high economic
costs.(3) In addition, physicians receive regular information
bulletins about special topics related to mental health
medications, such as tips for addressing and discussing treatment
adherence with patients. Eight-State Study Cost Savings Results The
study, conducted by CNS, evaluated eight representative state BPMs
to determine behavioral pharmacy costs for Medicaid patients whose
physicians received an educational mailing compared to costs for a
similar group of patients who had not yet been a subject of a
mailing. On average, the program helped states avoid almost $800 in
behavioral health pharmaceutical costs each year, per patient, or a
total of $94.5 million since the programs began for the eight
states studied.(1) "These data document that it is possible to
improve the care of people with psychiatric illness in a
cost-efficient manner. The treatment of mental illness has advanced
remarkably in recent years, but those advances are generally only
slowly translated into better clinical practice. The BPM puts
evidence-based best practice guidelines into clinicians' hands on a
fast track," said Jack Gorman, MD, SVP and chief scientific
officer, CNS. "The Behavioral Pharmacy Management Program is an
excellent example of evidence-based interventions that increase
access to quality mental health care while reducing costs.
Community behavioral health providers across the nation are
committed to replicating such science to service initiatives to
provide outcomes that benefit individual patients," said Linda
Rosenberg, MSW, president and CEO, National Council for Community
Behavioral Healthcare. Patient Care Improvement Results In addition
to saving Medicaid costs, the BPM has resulted in more than 2
million patient care improvements nationwide.(4) For example, an
analysis of the first year of Missouri's BPM found a:(5) -- 98
percent decrease in the number of patients who are prescribed the
same mental health medications from multiple doctors; -- 64 percent
decrease in the number of patients who are on two or more mental
health medications of the same type; and -- 40 percent decrease in
the number of patients receiving an unusually high dosage of
medication. A separate study of Missouri Medicaid patients found a
43 percent decrease in hospital admissions for those whose
physicians received an educational mailing versus a 1 percent
decrease in those from a similar comparison group who did not yet
receive a mailing.(6) For other state examples of patient care
improvements and cost savings, visit
http://www.lillyforbetterhealth.com/. The program has run in 26
states, including Oklahoma, which began its BPM in 2004. "We call
our BPM 'SoonerPSYCH' which stands for Prescription Solutions for
Your Cognitive Health. Through the program, our partnership with
Lilly and CNS has allowed us to target physicians with
patient-specific information and education in the most efficient
and effective manner. Physicians are able to know whether their
patients are filling the prescriptions on time or not at all, and
to see if other physicians are prescribing similar medications for
the same patient. Having the information in hand provides an
opportunity for the physician to educate the patient about the
chronic nature of their condition and the importance of
persistence, compliance and adherence to their prescribed
medication regimen," said Nancy Nesser, J.D., Pharm. D. pharmacy
director for the Oklahoma Health Care Authority's state SoonerCare
program. Evidence suggests that 96 cents of every Medicare dollar
and 83 cents of every Medicaid dollar are used to treat chronic
diseases.(7) Disease management programs help patients with chronic
diseases manage their condition and get the care they need. For
more than seven years, Lilly has funded disease management programs
in partnership with state Medicaid departments. "Just like cancer
or diabetes, mental illness is a devastating disease that impacts
millions. We believe disease management and coordination of care
programs that leverage health care information, technology and
education are a viable option to manage rising health care costs
rather than limiting patients' access to vital medications and
treatments," said Alex M. Azar II, vice president of
business-to-business, LillyUSA. Lilly 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 BPM is entirely voluntary for
physicians. All decisions regarding treatment and medications are
made privately between the physician and the patient and are
completely individualized. About Eli Lilly and Company Eli Lilly
and Company, a leading innovation-driven corporation, is developing
a growing portfolio of 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. For more information about the BPM and other Lilly programs
that help improve patient care, visit
http://www.lillyforbetterhealth.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 health
care industries, as well as financial and investment communities.
O-LLY (1) Data provided by Comprehensive NeuroScience, Inc. (2)
Missouri pharmacy program decreases hospitalization for Medicaid
SMI patients. Mental Health Weekly. December 15, 2005; Vol. 15, No.
47. (3) Perkins DO. Predictors of noncompliance in patients with
schizophrenia. J Clin Psychiatry. December 2002; 63(12):1121-8. (4)
Data provided by Comprehensive NeuroScience, Inc. (5) Missouri
achieves success with Medicaid pharmacy initiative. Mental Health
Weekly. December 20, 2004; Vol. 14, No. 48. (6) MO's Pharmacy
Program Decreases Hospitalization for Medicaid SMI Patients. Mental
Health Weekly. Dec. 12, 2005; Vol 15:Number 47, 1-3. (7) Kenneth E.
Thorpe, "Prevention and Public Health: The Key to Transforming our
Sickcare System," (Written testimony to the U.S. Senate Committee
on Health, Education, Labor, and Pensions Hearing) December 10,
2008. (Logo: http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGO)
(Logo: http://www.newscom.com/cgi-bin/prnh/20080416/CLW066LOGO)
http://www.newscom.com/cgi-bin/prnh/20080416/CLW066LOGO
http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGODATASOURCE: Eli
Lilly and Company CONTACT: Janice Chavers, Eli Lilly and Company,
+1-317-651-6253, Cell: +1-317-612-4974, ; or Beth Minnigerode,
Standing Partnership, +1-314-469-3500,
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