the maryland p 3 program: a collaborative solution to medication therapy management

The Maryland P3 Program: A Collaborative Solution to

Medication Therapy Management

Magaly Rodriguez de Bittner, PharmD, BCPS, FAPhA, CDE

Professor and P3 Director

© 2006 University of Maryland School of Pharmacy. All rights reserved.

OutlinePharmacy Education

Program Overview

Preliminary Program Results

Impact on Public Health Needs


Patients Pharmacists Partnerships (P3) Program

An effective solution to patient-centered health education, medication adherence, and chronic disease management


Informed,Activated Patients

ProductiveInteractions

Prepared,ProactivePractice Team

DeliverySystemDesign

Decision Support

ClinicalInformation

Systems

Self-Management

Support

Health System:

Resources and Policies

Community: Health Care Organization

Chronic Care Model


Maryland P3 (Patients, Pharmacists, Partnerships)

Maximizes the role of the pharmacist (medication expertise)

Pharmacists serving as “coaches” to stress self-management education

Delivery system design (aligned incentives, convenient location)Decision support working collaborative with the

patient’s physician and other health care providersData Collection System-MedPath


• This pharmacist-delivered diabetes management initiative arose out of an effort to improve patient health and reduce employer health costs

• Began in 2006 with one employer in Western Maryland• Now involves 6 employers and ~500 employees• Support from DHMH and the Maryland Legislature

• Patients engaged in self-management• Employers provide benefits and waive co-pays• Pharmacists deliver care and coordinate care with primary care providers and specialists

The Partnership

The History


medication experts on the health care team

• Meet face-to-face with patient 5-7 times depending on patient needs

• Counsel patients on medication adhering and self-management• Educate patients on medication, and possible drug interactions, as

well as adverse effects • Coach patient in self-management skill development• Help with personal goal setting (therapeutic indicators)• Coordinate referrals for necessary

laboratory tests and specialist visits (annual eye and foot exams, and dental check ups)• Immunizations for pneumococcal

and influenza

American Diabetes Association Clinical Care Guidelines (2011)

The Pharmacists


Patients

Pharmacists Partnerships• Maryland

Pharmacists Association

• P3 Pharmacy Network

UMB School of Pharmacy

Network CoordinationTraining

PSM System/Reporting

Self-management of chronic disease

• Department of Health and Mental Hygiene

• Maryland General Assembly

• Employers/Payers


Results From Early Program Implementations

Total Healthcare Costs (Rx and Medical)Mission Hospitals & City of Asheville

Combined

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

Prior to Program 1997 1998 1999 2000 2001

Prior to program & each year of the program for 1st 5 yearsnote 10 participants were new employees that did not have baseline economic data

Avg

. / D

iabe

tes

patie

nt /

Year

Other RxDiabetes RxMedical Claims

$7,042

$4,669$4,288

$4,677

$4,129$4,371

Avg. U.S. 7,008 U.S. 7,239 U.S. $7,485 U.S. $7,762U.S. $8,088

U.S. $8,468

ALL plan employees

National avg. ALL employees

n = 164 n = 47 n = 72 n = 131 n= 147 n = 174


Baseline, Year 1, 2 and 3 compared toProjected Costs*

Average Annual Costs to Employer for Participants

$0$2,000$4,000$6,000$8,000

$10,000$12,000$14,000

Pharmacist $0 $414 $268 $240 Medication $1,667 $3,045 $3,748 $3,093 Medical $7,368 $5,454 $4,786 $4,157

Baseline 2002 Year 1 Actual Year 2 Actual Year 3 Actual

Total costs $9,035 $8,913 $8,802$7,490

Yr 3 savingsPer Patientfrom projected Costs

$6,250from Baseline Costs

$1,545

Yr 1 Projected

$10,390

Year 3 Projected

$13,740

*for 63 patients with baseline,1st, 2nd and 3rd year results

Baseline

$9,035

Year 2 Projected

$11,948


Patient Self-Management ProgramSM

for Diabetes: First Year Cost SavingsJ Am Pharm Assoc. 2005; 45: 130-137

Average Cost Per Patient

$0

$2,000

$4,000

$6,000

$8,000

$10,000

MTMS $0 $351Medication $3,128 $3,373Medical $6,254 $4,740

Projected Year 1 Actual Year 1

AverageCost SavingsPer Patient$918

Align the Incentives, Empower the Patient, Control the CostsSM

Combined data from Mohawk, VF, Manitowoc, OSU, Kroger (n=165)


The Diabetes Ten City ChallengeInterim Results: n=914, 10.2 months

Through 30-Sep-07, 29 employers, 10 cities: – Charleston, South Carolina– Chicago, Illinois– Colorado Springs, Colorado

–Cumberland, Maryland– Honolulu, Hawaii– Milwaukee, Wisconsin– Northwest Georgia– Pittsburgh, Pennsylvania– Los Angeles, California– Tampa Bay, Florida J Am Pharm Assoc 2008;48:181-190.


CAN THE P3 PROGRAM MODEL IMPROVE CLINICAL

OUTCOMES AND DECREASE HEALTH CARE COSTS FOR PEOPLE WITH DIABETES?


Key < 130/80 < 140/90

Figure 4. Blood Pressure at Therapeutic Levels (mmHg)


Results 2009 (N= 159 patients )

Alc 8.1-9 A1c 7.0 to 8.0 Alc 6.6 to 6.9 Alc < or = 6.50

5

10

15

20

25

30

35

40

P3 Participants HbA1c Status Pre and Post In-tervention

PrePost


Results 2009 (N=159)


Results 2009 (N=159)

A1c Control < 8.0% BP Control < 130/80 mm Hg

BP Control <140/90 mm Hg LDL < 100 mg/dL0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Comparison of National HEDIS Commercial Rates (2009) vs. P3 Participants

P3 ParticipantsNational HEDIS Commercial


Cost Savings for the Maryland P3 Program

On average our employers are saving approximately $900 per employee per year ($495-$3,281).


Track Record of Success:Clinical outcomes:

improvement in clinical indicators such as A1C and LDL measures

Economic outcomes: reduced overall costs of care

Satisfaction results: high employee satisfaction with the program and

pharmacist care


Implications:Public Health Issues1. Underserved Populations2. Health care Reform- Patient Centered

Medical Home and Transitioned of Care3. Team-based Care4. Access to Health Care and Prevention

Services


2010 Recipient of the APhA Foundation Pinnacle Award


Conclusions/Lessons Learned 1. Pharmacists are an innovative and effective solution to

control chronic disease by improving clinical, humanistic and economic outcomes

2. Pharmacists accessibility and geographic location-in every patient’s neighborhood- has a significant strategic potential

3. Collaboration between the Departments of Health/Office of Chronic Diseases, academic institutions, professional organizations and private employers have proven to be effective maximizing resources and increasing efficiency of chronic disease initiatives

the maryland p 3 program: a collaborative solution to medication therapy management

Documents

diabetes selfmanagement

quality of care

maryland p3 program

maryland p3 patients

primary care

health systems improvement

public health needs

p3 director