Strategies to Modernize State Medicaid Programs, Utah

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Strategies to Modernize State Medicaid Programs,
Utahs Medicaid Transformation ByLisa V.
Hulbert R.Ph.Transformation Program ManagerUtah
Medicaid Program
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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.

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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

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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

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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.)

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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

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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

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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.

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Patient Education Visits to Clinical Pharmacists

• Goals
• Enhance the patients 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 drug adverse events

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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

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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

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Impact

• 175,000 non-institutionalized Medicaid members
• 4,800 will receive targeted interventions due to
  high risk medications
• 3,000 prescribers will receive intervention
  material
• 600 will receive MTMS
• 120 prescribers will receive academic detailing

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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