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Comprehensive Health Management Pharmacist-Delivered Model: Impact on Healthcare Utilization and Costs
Leticia R. Moczygemba, PhD, PharmD; Ahmed M. Alshehri, PhD; L. David Harlow III, PharmD; Kenneth A. Lawson, PhD; Debra A. Antoon, BSPharm; Shanna M. McDaniel, MA; and Gary R. Matzke, PharmD
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Comprehensive Health Management Pharmacist-Delivered Model: Impact on Healthcare Utilization and Costs

Leticia R. Moczygemba, PhD, PharmD; Ahmed M. Alshehri, PhD; L. David Harlow III, PharmD; Kenneth A. Lawson, PhD; Debra A. Antoon, BSPharm; Shanna M. McDaniel, MA; and Gary R. Matzke, PharmD
Pharmacist-provided comprehensive medication management led to a significant difference in emergency department visits and a cost savings of $2.10 to $2.60 for every $1.00 spent relative to a comparator group.
Outcomes

Study outcomes were the differences in numbers of unplanned hospital admissions and ED visits between the CHaMPS and comparator groups in the preintervention and postintervention periods. The preintervention period was defined in 2 ways: the periods 180 and 365 days before the first CHaMPS visit (CHaMPS group) or assigned index date (comparator group). The postintervention period was also defined in 2 ways: the periods 180 and 365 days after the first CHaMPS visit or assigned index date. The type and number of pharmacist interventions are also reported. A benefit-cost ratio was calculated based on absolute differences in estimated cost savings between the 2 groups. Because the CHaMPS intervention was a comprehensive approach to managing chronic conditions, the impact of the intervention on condition-specific unplanned hospital admissions and ED visits was not examined.

Statistical Methods

Descriptive statistics were calculated for all variables. Paired t tests or McNemar tests examined baseline differences between the matched CHaMPS and comparator groups on demographic variables (age, gender, race, insurance type) and health-related variables (CCI score; current smoker status [yes/no]; BMI; diagnosis [yes/no] of diabetes, CHF, hypertension, hyperlipidemia, and/or asthma/COPD; baseline hospitalization and ED visits, defined as number of visits 1 year before enrollment or index date). Paired t tests or independent samples t tests were used to assess pre–post differences for ED visits and unplanned hospital admissions within each group. Generalized linear models determined differences between the CHaMPS and comparator groups for number of unplanned hospital admissions at 180 and 365 days in the post­intervention period and number of ED visits at 180 and 365 days in the preintervention period. For all analyses, the primary independent variable was CHaMPS enrollee (yes/no) and covariates included the aforementioned demographic and health-related variables. All analyses were conducted using SAS 9.4 (SAS Institute; Cary, North Carolina). Results were significant at P <.05.

A benefit-cost analysis was conducted to determine the difference in hospital and ED costs between the preintervention and postintervention periods of the CHaMPS and comparator groups. Program inputs included direct costs, which were comprised of CHaMPS personnel salary and fringe benefits using estimates from the 2017 Bureau of Labor Statistics data15-18 and a 30% fringe benefit rate. Program costs for 2015 and 2016 are reported, and the average of the 2 years was used to calculate the program costs for the 1-year intervention period. Pharmacist salaries and fringe benefits were calculated for direct patient care and implementation activities. Time spent delivering CHaMPS patient care was converted to full-time equivalents (FTEs) assuming that 1.0 FTE equaled 2080 hours per year. Implementation activities included developing protocols and working with clinic and information technology (IT) staff to introduce the program and customize the EHR for CHaMPS, respectively. CHaMPS personnel included a program manager (responsible for patient and data management), administrative assistants (responsible for tasks such as scheduling and rooming patients), and IT staff (responsible for customizing the EHR and maintaining reports to track outcomes). Indirect costs, such as overhead and rent, were excluded because these expenses were absorbed by the CHaMPS clinics. Program outputs included the cost estimates of hospitalizations and ED visits using mean per event costs from the 2016 Medical Expenditure Panel Survey.19 Cost estimates were adjusted to 2017 dollars using the Medical Consumer Price Index. Other studies that have examined the cost benefits of pharmacist services have used a similar approach for estimating utilization costs.14,20 The benefit-cost ratio was calculated using the following formula: net benefit (absolute value of difference between CHaMPS and comparator groups in pre–post change in ED and hospital costs) divided by CHaMPS program costs. A value greater than 1 indicated a positive benefit. Given that program implementation costs are generally amortized over a 5- to 10-year period, the benefit-cost ratio was calculated with and without implementation costs.

RESULTS

A total of 624 patients (312 in the CHaMPS group and 312 in the comparator group) were included. Table 1 describes demographic and health-related variables for the matched CHaMPS and comparator groups. At baseline, the CHaMPS and comparator groups had similar mean (SD) ages at 65.6 (11.1) years and 67.2 (12.5) years, respectively. The gender composition was about half women and half men in both groups. The majority in both groups were white and had Medicare/Medicaid insurance. There was a statistically significant difference in the proportion of patients with diabetes between the 2 groups (94.9% in CHaMPS vs 90.1% in comparator). The most marked difference at baseline was the significantly higher proportion of patients with hyperlipidemia in the CHaMPS group (74.7%) versus the comparator group (33.3%).


 
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