Optimizing Medication Use and Patient Outcomes

Las Vegas—Although managing expensive new drugs and improving benefit designs are helpful in reducing healthcare costs, industry professionals must also pay attention to optimizing medication use and patient outcomes through better adherence and integrating the work of pharmacists, technologists, and care delivery and care management teams.

Approximately half of people do not take their medications correctly and 20% to 30% of prescriptions are never filled, according to Susan Cooper, MPH, RPh, senior director, pharmacy services, HealthPartners. Dr. Cooper, who spoke at the PBMI conference, said people not adherent to their medications costs $177 billion per year and leads to 125,000 deaths per year, 10% more hospital admissions per year, and 23% more nursing home admissions per year.

HealthPartners is a nonprofit healthcare company based in Minnesota that includes a health plan with 1.4 million members, 40 medical clinics with 1700 physicians and 1 million patients, 20 dental clinics with 60 total dentists, and 6 hospitals. Dr. Cooper said HealthPartners is focused on improving the health of the population, improving affordability, and improving the experience of the individual.

Responsible Medication Adherence

She noted several reasons for people not taking their medications, including they believe the medications are unnecessary, they cannot afford them, they are concerned about side effects, they forget to take them, they lack information about the medications, and they have a poor relationship with their physician.

In October 2012, the IMS Institute for Healthcare Informatics released a report that found the healthcare system could avoid $500 billion in annual costs through more responsible medication use. Of the cost savings, 57% were attributed to better adherence, according to Dr. Cooper.

Still, Dr. Cooper said simply adhering to medications is not enough. She cited internal HealthPartners data that evaluated patients with hypertension. Of the patients who were nonadherent to their medications, 39% did not have their blood pressure under control. However, even if patients were adherent, 30% still did not have their blood pressure under control.

Responsible Medication Optimization

Dr. Cooper defined medication optimization as focusing on people who are taking medications that they should not be using, such as patients receiving antibiotics or duplicate therapies or abusing prescription drugs, and people who are not taking medications when they are prescribed and people who are taking the wrong medications and are having an inadequate clinical response.

To optimize medication use, HealthPartners has instituted several initiatives, including a free service called Sync My Meds that notifies people when their prescriptions are running low, automatically refills the medications and tells people when they are ready, and bundles all prescriptions so people can pick them up on the same day. HealthPartners also has a program called OnTrackRx that allows people to have their medications delivered to their homes, work with pharmacists from the medication therapy management department to determine if the therapies are safe and effective and being used correctly, access pharmacy navigators who can answer any questions, and calculate and compare the costs of medications. In addition, HealthPartners has mobile applications for the iPhone that allows people to refill their medications on their mobile device.

The medication therapy management program has been successful, according to Dr. Cooper. After its first full year, 92% of participants said they always or usually followed the recommendations, 97% made a lifestyle change to reduce their need for medications, 85% said the program was worth their time, and 99% said they would recommend the program to their friends or family members.

Medication Therapy Management Program

Following Dr. Cooper’s presentation, 2 speakers discussed a partnership between CareSource and OutcomesMTM that began in 2012 for people in Ohio who were eligible for Medicaid.

CareSource is a managed care plan that that serves >1 million members in Ohio and Kentucky as well as 1500 Medicare special needs plan members. OutcomesMTM is a company that designs, delivers, and administers medication therapy management programs. OutcomesMTM has served >5 million patients and contracted with >40 health plans, commercial plans, employers, Medicaid, and state programs with regards to network requirements, covered services, policies and procedures, quality assurance, documentation standards, and reporting.

In the first 12 months of the CareSource/OutcomesMTM partnership, 15% of CareSource’s members (n=61,026) participated, according to James Gartner, RPh, MBA, vice president of pharmacy and medical management, CareSource. Covered services included comprehensive medication review, prescriber consultation, patient adherence consultation, and patient education and monitoring. During the first full year, there were 106,239 medication therapy services delivered and 2246 consultations provided that helped members avoid emergency room visits, hospitalizations, life-threatening complications, and other adverse events, according to Dr. Gartner.

CareSource collaborated with the Ohio Colleges of Pharmacy and the Ohio Pharmacy Association and received support from an OutcomesMTM network support team on an outreach program to promote the program. Pharmacists participating in the CareSource/OutcomesMTM partnership receive $10 for each patient education session and $75 for each medication review. The number of participating pharmacies increased from 959 in the third quarter of 2012 to 1076 in the fourth quarter of 2012, and 1287 in the first quarter of 2013 to 1492 in the second quarter of 2013.

The program also saved money, according to Jessica Frank, vice president of operations, OutcomesMTM. She said the return on investment (ROI) based on an actuarial investment model was $10.74 saved for every dollar spent, while the ROI based on drug product cost savings was $1.37 for every dollar spent. Ms. Frank added that the savings are similar for Medicare medication therapy management programs.

Dr. Gartner mentioned that CareSource also did its own ROI analysis to make sure OutcomesMTM’s conclusions were correct. The CareSource finance and analytics team altered the values for interventions, reducing an emergency room visit from $845 to $400, decreasing the cost of a hospital admission from $26,205 to $7500, and choosing not to annualize drug costs. Even with its conservative analysis, CareSource found its program with OutcomesMTM led to a ROI for $4.40 saved for every dollar spent.

For medication therapy management to work successfully, the speakers said the program must pay close attention to network management, leverage local pharmacy relationships, and focus on improving the quality of care delivered. They also mentioned that pharmacists now play a major role as health coaches and as part of a team of providers with more responsibility to improve outcomes and reduce costs.