Medication therapy management seen as promising path to Rx efficacy, savings
by Bruce Shutan
Critics of the U.S. health care system have long lamented the clinical disconnect among hospitals, doctors, pharmacies, health plans and patients, especially when it comes to treating those who are most in need of prescription drugs for chronic conditions.
But Walgreens Health Initiatives (WHI), a leading pharmacy benefit manager with a network of more than 62,000 retail and mail-order pharmacies, is leading the way toward more efficacious Rx treatment programs that ultimately will result in improved pharmaceutical care and savings in both Medicare Part D and commercially insured populations.
About three years prior to the 2006 enactment of the Medicare Part D program, WHI recognized that a sea change was expected in the PBM industry and used this as an opportunity to develop clinical and technology benchmarks for medication therapy management (MTM). Medicare would use these programs to target seniors with multiple diseases on several maintenance medications who spent at least $4,000 a year on prescription drugs.
Targeting polypharmacy patients
Jim Langman, WHI’s vice president, clinical services, says geriatric populations comprise the lion’s share of so-called polypharmacy patients, who run the risk of developing adverse reactions and health events associated with taking multiple medications.
Complicating matters is that many of these patients have about half a dozen doctors and get their prescriptions filled at multiple pharmacies. These clinicians often may have an incomplete view of their medical history because e-prescribing and electronic medical records are not widely used. Moreover, sometimes patients don’t remember or wish to share all of their information with every doctor.
MTM provides added safety and quality measures across all markets, particularly the small groups of high-utilizing claimants who are typically the sickest patients. A significant team of clinicians and scientists at WHI teamed up to overcome this hurdle. “We needed a holistic view of each patient, but once we had it, the challenge was how to take care of all those patients” Langman says.
In search of lasting solutions to these patient-management difficulties, WHI developed patented technologies: a merged claims database and analytic engine that brings together medical and pharmacy claims, regardless of which provider is the source of that information. The claim-merging process includes assessment of the therapeutic treatment prescribed for individuals instead of only using demographic factors, which historically contain the most errors.
The integrated data is then analyzed by a proprietary utilization management system that features more than 100,000 rule sets on pharmacy data and nearly 2,500 additional rules available to govern over medical claims. The analysis encompasses disease states, drug interactions, treatment guidelines and other factors that can affect care.
On average, polypharmacy patients, who account for roughly 4% of the population, are responsible for about 30% of total drug spend and receive more than 100 prescriptions a year. WHI’s model for coordinating the care of these complex patients is to leverage technology and highly trained MTM pharmacists to deliver a personal medication record and medication action plan directly to patients and their personal pharmacists. To ensure the remaining non-MTM patients are receiving optimal care, WHI provides a second service, MedMonitor®, to keep close tabs on the other 96% of the population. MedMonitor® is an enhanced capability beyond traditional retrospective drug utilization review tools.
WHI also offers extensive support and resource materials to facilitate MTM-related interactions with pharmacists, prescribers and patients. These steps include a comprehensive implementation manual for the pharmacists in more than 15,000 pharmacies participating in WHI’s MTM network.
Pharmacists and technicians can also access the Walgreens continuing education Web site, which is available free of charge and includes the American Society of Consultant Pharmacists’ geriatric-patient series.
2.5:1 ROI
The multi-pronged effort has yielded an impressive return on investment (ROI), despite its relative newness to the marketplace. A year ago, WHI published results for 2006 in peer-reviewed literature demonstrating more than $600 a year in pure pharmacy dollar drug savings for polypharmacy patients, with a 2.5:1 ROI in the program’s first year.
“We want this service to be done in community pharmacies, not just Walgreens or by a clinical call center, but all pharmacies where personal, point-of-care service is provided directly to patients,” Langman explains.
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