Comprehensive medication management

Community Care of North Carolina. Clinical Program Analysis. May 2015

Assessed impact of primary care case management programs (i.e. medical homes) within the network that includes collaboration of care managers, a pharmacist, psychiatrist, medical director, and other health care professionals on Medicaid reimbursement.

Improved access to primary care and preventative services, and better management of chronic conditions.

The Medicaid program
generates $3 in savings for every $1 invested.

Estimated Cost-Effectiveness, Cost Benefit, and Risk Reduction Associated with an Endocrinologist-Pharmacist Diabetes Intense Medical Management "Tune-Up" Clinic

 

To estimate the cost-effectiveness and cost benefit of a collaborative endocrinologist-pharmacist Diabetes Intense Medical Management (DIMM) "Tune-Up" clinic for complex diabetes patients versus usual primary care provider care from 3 perspectives (clinic, health system, payer) and time frames.

Estimated medical cost avoidance due to improved A1c

  • $8793 per patient cared for by DIMM

  • ROI of $9.01 per dollar spent

DIMM patients had:

  • Estimated lower total medical costs

  • Greater number of QALYs gained

  • Risk reductions for diabetes related complications over 3-, 5-, and 10-year time frames.

A Sustainable Business Model for Comprehensive Medication Management in a Patient-Centered Medical Homec

 

The study assessed the impact of embedding pharmacists into a patient-centered medical home by analyzing interventions made, patient outcomes, and cost avoidance by having a pharmacist in the practice. The majority of interventions made by the pharmacist included medication reconciliation, identifying/clarifying/preventing
medication allergies, ordering and evaluating laboratory tests, switching/adding medication, altering medication dose, identifying and fixing adverse medication reactions, and providing therapeutic lifestyle change counseling.

A pharmacist would make, on average, 1075 interventions during 225 patient encounters per month.

This estimates to a cost avoidance of:

  • $164,551.50 per month

  • More than $1.9 million annually

The Asheville Project: Long-Term Clinical and Economic Outcomes of a community Pharmacy Diabetes Care Program

 

A Quasi-experimental, longitudinal pre-post cohort study that was designed to assess the clinical and economic outcomes of a community pharmacist-led care service for patients with diabetes. Interventions included education by certified diabetes educators, long-term community pharmacist follow-up using scheduled consultations, clinical
assessment, goal setting, monitoring, and collaborative drug therapy management with physicians.

Total mean direct medical costs decreased by $1,200 to $1,872 per patient per year compared with baseline.

The Asheville Project: Long-Term Clinical, Humanistic, and Economic Outcomes of a Community-Based Medication Therapy Management Program for Asthma

 

To assess clinical, humanistic, and economic outcomes of a community-based pharmacist-led asthma control medication therapy management
program. Interventions included Education by a certified asthma educator; regular long-term follow-up by pharmacists using scheduled consultations, monitoring, and recommendations to physicians.

  • Direct cost savings averaged 725/patient/year

  • Indirect cost savings were estimated to be $1,230/ patient/ year

  • Emergency department visits decreased from 9.9% to 1.3%

  • Hospitalizations decreased from 4.0% to 1.9%

  • Patients were 6 times less
    likely to have an ED/ hospitalization event after interventions

Evaluation of Pharmacist-Managed Diabetes Mellitus Under a Collaborative Drug Therapy Agreement

Am j health syst pharm. 2008 oct 1; 65(19):1841-5

Pharmacists provided diabetes management and education to analyze
patient outcomes and hospital admission rates.

Average costs for inpatient
hospitalization and ED  admissions were significantly higher pre-intervention for patients with diabetes as the primary or secondary diagnosis ( $2434 versus $636, respectively).

Health Care Expenditures and Therapeutic Outcomes of a Pharmacist-Managed Anticoagulation Service versus Usual Medical Care

 

To evaluate the differences in health care expenditures and therapeutic outcomes of patients receiving warfarin therapy management by a pharmacist-managed anticoagulation service compared with
those receiving warfarin management by usual medical care. Medical claims data compared were direct anticoagulation cost and overall medical care costs, anticoagulation-related adverse events, hospitalizations and emergency department visits, frequency of international normalized ratio (INR) testing, and quantity of warfarin refills. Operational costs of the anticoagulation service were also calculated.

  • Total claims paid for usual medical care group: $1,480,661

  • Total claims paid for anticoagulation services group: $754,191

    • Demonstrated
      improved anticoagulation
      control, fewer adverse
      events, hospitalizations, and ER visits

  • Overall net medical care costs savings = $647,024 ($3697/patient/year)

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