SCIENCE UPDATES
How can ‘we’ make health care better? Patrick G. Clay
Who are the “we” who can make health care better? Simply put, “we” are those practicing in team-based, patient-centered care models designed to maximize outcomes while ideally improving efficiency of delivering care. This is not a goal. A goal implies a fixed destination. Instead, “we” must continually seek mechanisms to achieve improvement on the status quo. While some of us may have a personal bias that every positive outcome be the result of a pharmacist directly engaging with patients, in some environments that may not be the best or currently accepted mechanism. A recent publication by Lauren Brody, PharmD, and colleagues1 provides a perspective in which the pharmacist intervenes directly with the provider and case managers to improve outcomes of hospitalized patients with diabetes. Brody and her colleagues at PerformRx published results of a retrospective program investigating the effects of a collaborative drug therapy management (DTM) on hospitalization rates and overall costs of patients with diabetes treated with polypharmacy at high risk for medication-related problems. The program design, quasi-experimental with comparison group, evaluated the effects of a pharmacy benefits manager/health plan collaborative DTM program with both a pharmacist and a care manager assigned to these high-risk patients. The analysis also considered whether the DTM program reduced medical utilization and total pharmacy and medical costs. Through this year-long intervention program, PBM pharmacists reviewed profiles of nearly 1,000 members and executed evidencebased prescriber and patient in456 JAPhA | 5 4:4 | JUL /AUG 2 0 1 4
terventions. They worked directly with prescribers and indirectly with members via care managers from the health plan. PBM pharmacists identified medication-related problems in the target populations. Prescriber interventions were addressed directly with the prescriber by the pharmacist, while patient interventions were forwarded to the plan’s case managers. Case-managed patients were counseled by their respective case managers, thereby leveraging existing case manager–patient relationships, streamlining patient contact efforts, and resulting in a seamless managed care experience from the patient perspective. The reader is encouraged to review the freely available manuscript for a more detailed description of methodology and the timings involved. Based on results with project participants who had at least 6 months of follow-up data, these collaborative efforts between pharmacists and care managers led to reduced hospital utilization (emergency department visits and hospitalizations) and substantial health care cost savings (comparing the increases seen in control groups versus the intervention groups). By maintaining outreach efforts to patients, adherence rates rose and hospital visits decreased. By eliminating inappropriate drugs from patient regimens, medication-related problems also decreased.
Caveats to this study should be noted. The inability to determine level of engagement by participants assigned to the intervention group was the greatest threat to the validity of the analysis. Only 43% and 31% of two study subgroups were actively care managed compared with 35% and 25% of the control subgroups, respectively. It would be interesting to know how much benefit could have been realized had participation rates in case management been higher. This manuscript was selected for inclusion in this column as it reflects pharmacist services in the form of drug therapy management delivered indirectly through a pharmacy benefit manager. PBM models of care delivery appear to have sustainability even in the chaotic evolving world of the American health care system. Indirectly influencing outcomes may enhance pharmacists ability to serve larger numbers of patients by working with the other “we’s” with whom pharmacists collaborate on the health care team. References 1. Brophy L, Williams A, Berman EJ, et al. Collaborative DTM reduces hospitalization and healthcare costs in patients with diabetes treated with polypharmacy. Am J Manag Care. 2014; 20:e72– e81. Patrick G. Clay, PharmD, FCCP, CCTI, Professor of Pharmacotherapy, College of Pharmacy, University of North Texas System, Fort Worth, and APhA Science Officer. Acknowledgments: To Lauren Brophy, PharmD, Director of Drug Therapy Management Programs and Outcomes for PerformRx, for graciously providing a summary of this work. doi: 10.1331/JAPhA.2014.14528
The Science Updates column highlights research published in journals other than JAPhA that is of interest to the Journal’s readership. APhA members who have published research are encouraged to forward the PubMed citation or an electronic version of their article, as soon as they appear or ahead of print, to Contributing Editor Patrick G. Clay, PharmD, FCCP, CCTI, at [email protected].
ja p h a.org
Journal of the American Pharmacists Association
How can ‘we’ make health care better? Patrick G. Clay
Who are the “we” who can make health care better? Simply put, “we” are those practicing in team-based, patient-centered care models designed to maximize outcomes while ideally improving efficiency of delivering care. This is not a goal. A goal implies a fixed destination. Instead, “we” must continually seek mechanisms to achieve improvement on the status quo. While some of us may have a personal bias that every positive outcome be the result of a pharmacist directly engaging with patients, in some environments that may not be the best or currently accepted mechanism. A recent publication by Lauren Brody, PharmD, and colleagues1 provides a perspective in which the pharmacist intervenes directly with the provider and case managers to improve outcomes of hospitalized patients with diabetes. Brody and her colleagues at PerformRx published results of a retrospective program investigating the effects of a collaborative drug therapy management (DTM) on hospitalization rates and overall costs of patients with diabetes treated with polypharmacy at high risk for medication-related problems. The program design, quasi-experimental with comparison group, evaluated the effects of a pharmacy benefits manager/health plan collaborative DTM program with both a pharmacist and a care manager assigned to these high-risk patients. The analysis also considered whether the DTM program reduced medical utilization and total pharmacy and medical costs. Through this year-long intervention program, PBM pharmacists reviewed profiles of nearly 1,000 members and executed evidencebased prescriber and patient in456 JAPhA | 5 4:4 | JUL /AUG 2 0 1 4
terventions. They worked directly with prescribers and indirectly with members via care managers from the health plan. PBM pharmacists identified medication-related problems in the target populations. Prescriber interventions were addressed directly with the prescriber by the pharmacist, while patient interventions were forwarded to the plan’s case managers. Case-managed patients were counseled by their respective case managers, thereby leveraging existing case manager–patient relationships, streamlining patient contact efforts, and resulting in a seamless managed care experience from the patient perspective. The reader is encouraged to review the freely available manuscript for a more detailed description of methodology and the timings involved. Based on results with project participants who had at least 6 months of follow-up data, these collaborative efforts between pharmacists and care managers led to reduced hospital utilization (emergency department visits and hospitalizations) and substantial health care cost savings (comparing the increases seen in control groups versus the intervention groups). By maintaining outreach efforts to patients, adherence rates rose and hospital visits decreased. By eliminating inappropriate drugs from patient regimens, medication-related problems also decreased.
Caveats to this study should be noted. The inability to determine level of engagement by participants assigned to the intervention group was the greatest threat to the validity of the analysis. Only 43% and 31% of two study subgroups were actively care managed compared with 35% and 25% of the control subgroups, respectively. It would be interesting to know how much benefit could have been realized had participation rates in case management been higher. This manuscript was selected for inclusion in this column as it reflects pharmacist services in the form of drug therapy management delivered indirectly through a pharmacy benefit manager. PBM models of care delivery appear to have sustainability even in the chaotic evolving world of the American health care system. Indirectly influencing outcomes may enhance pharmacists ability to serve larger numbers of patients by working with the other “we’s” with whom pharmacists collaborate on the health care team. References 1. Brophy L, Williams A, Berman EJ, et al. Collaborative DTM reduces hospitalization and healthcare costs in patients with diabetes treated with polypharmacy. Am J Manag Care. 2014; 20:e72– e81. Patrick G. Clay, PharmD, FCCP, CCTI, Professor of Pharmacotherapy, College of Pharmacy, University of North Texas System, Fort Worth, and APhA Science Officer. Acknowledgments: To Lauren Brophy, PharmD, Director of Drug Therapy Management Programs and Outcomes for PerformRx, for graciously providing a summary of this work. doi: 10.1331/JAPhA.2014.14528
The Science Updates column highlights research published in journals other than JAPhA that is of interest to the Journal’s readership. APhA members who have published research are encouraged to forward the PubMed citation or an electronic version of their article, as soon as they appear or ahead of print, to Contributing Editor Patrick G. Clay, PharmD, FCCP, CCTI, at [email protected].
ja p h a.org
Journal of the American Pharmacists Association
