Currently Viewing:
The American Journal of Managed Care November 2019
Population Health Screenings for the Prevention of Chronic Disease Progression
Maren S. Fragala, PhD; Dov Shiffman, PhD; and Charles E. Birse, PhD
Currently Reading
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
Value Assessment and Heterogeneity: Another Side to the Story
Steven D. Pearson, MD, MSc
From the Editorial Board: Joshua J. Ofman, MD, MSHS
Joshua J. Ofman, MD, MSHS
Multimodality Cancer Care and Implications for Episode-Based Payments in Cancer
Suhas Gondi, BA; Alexi A. Wright, MD, MPH; Mary Beth Landrum, PhD; Jose Zubizarreta, PhD; Michael E. Chernew, PhD; and Nancy L. Keating, MD, MPH
Medicare Advantage Plan Representatives’ Perspectives on Pay for Success
Emily A. Gadbois, PhD; Shayla Durfey, BS; David J. Meyers, MPH; Joan F. Brazier, MS; Brendan O’Connor, BA; Ellen McCreedy, PhD; Terrie Fox Wetle, PhD; and Kali S. Thomas, PhD
Cost Analysis of COPD Exacerbations and Cardiovascular Events in SUMMIT
Richard H. Stanford, PharmD, MS; Anna D. Coutinho, PhD; Michael Eaddy, PharmD, PhD; Binglin Yue, MS; and Michael Bogart, PharmD
CKD Quality Improvement Intervention With PCMH Integration: Health Plan Results
Joseph A. Vassalotti, MD; Rachel DeVinney, MPH, CHES; Stacey Lukasik, BA; Sandra McNaney, BS; Elizabeth Montgomery, BS; Cindy Voss, MA; and Daniel Winn, MD
Importance of Reasons for Stocking Adult Vaccines
David W. Hutton, PhD; Angela Rose, MPH; Dianne C. Singer, MPH; Carolyn B. Bridges, MD; David Kim, MD; Jamison Pike, PhD; and Lisa A. Prosser, PhD
Prescribing Trend of Pioglitazone After Safety Warning Release in Korea
Han Eol Jeong, MPH; Sung-Il Cho, MD, ScD; In-Sun Oh, BA; Yeon-Hee Baek, BA; and Ju-Young Shin, PhD
Multipayer Primary Care Transformation: Impact for Medicaid Managed Care Beneficiaries
Shaohui Zhai, PhD; Rebecca A. Malouin, PhD, MPH, MS; Jean M. Malouin, MD, MPH; Kathy Stiffler, MA; and Clare L. Tanner, PhD

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.
Unplanned Hospital Admissions and ED Visits

As summarized in Table 2, in the CHaMPS group, the mean (SD) number of unplanned hospital admissions decreased from 0.29 (0.68) in the 180-day preintervention period to 0.19 (0.53) in the 180-day postintervention period (P = .01). Unplanned admissions also decreased from 0.41 (0.95) in the 365-day preintervention period to 0.33 (0.80) in the 365-day postintervention period, although not significantly. In the comparator group, the mean number of unplanned admissions increased slightly from 0.18 (0.66) in the 180-day preintervention period to 0.21 (0.68) in the 180-day postintervention period (not significant) and from 0.29 (1.15) in the 365-day preintervention period to 0.35 (1.14) in the 365-day postintervention period (not significant). The change in the mean number of unplanned admissions between the CHaMPS and comparator groups, while controlling for demographic and health-related variables, was not significant at the 180- or 365-day postintervention periods.

In the CHaMPS group, the mean (SD) number of ED visits remained constant for both the 180-day (0.26 [0.64] for the 180-day preintervention period and 0.26 [0.62] for the 180-day postintervention period) and 365-day (0.44 [0.89] for the 365-day preintervention period and 0.43 [0.92] for the 365-day postintervention period) periods, resulting in no significant difference in the number of ED visits within the CHaMPS group from the preintervention to postintervention periods. However, in the comparator group, the mean number of ED visits increased significantly in both the 180-day (0.16 [0.55] for the 180-day preintervention period and 0.29 [0.79] for the 180-day postintervention period; P = .002) and 365-day (0.30 [0.97] for the 365-day preintervention period and 0.48 [1.24] for the 365-day postintervention period; P = .003) periods. The change in the mean number of ED visits between the CHaMPS and comparator groups, while controlling for demographic and health-related variables, was significant at the 180- and 365-day postintervention periods (P = .03 for both).

Type and Number of Pharmacist Interventions

Table 3 summarizes the type and number of MRP interventions, as well as education-related and medication reconciliation–related interventions. There were 1218 MRP interventions (3.9 per patient), with the most common being increasing dose (20.8%), refilling a drug (16.8%), and ordering a laboratory test (11.0%). A total of 3113 education interventions (10.0 per patient) were delivered. The majority (72.2%) of these interventions involved patient education about lifestyle factors to improve chronic condition management. Pharmacists made 1374 medication reconciliation interventions (4.4 per patient). The most common were deleting medications that patients were no longer taking from the medication list (33.7%), updating directions (29.8%), and adding current medications to the list (26.9%). Outcomes were documented for 3505 interventions, and they primarily focused on outcomes for MRP and education interventions given that medication reconciliation interventions were made in the EHR in real time and thus immediately resolved. Most (97.5%) of the interventions were considered to have resolved the respective problem identified. The majority of problems (54%) were resolved by directly interacting with the patient, and one-third were resolved by interactions with the care team.

Table 419 summarizes the CHaMPS and comparator group costs for ED and hospital use and benefit-cost ratio. The ED and hospital costs were $2,063,083.03 in the preintervention period and $1,672,371.90 in the postintervention period for the CHaMPS group—a decrease of $390,711.13 ($1252.28 less per patient). The ED and hospital use costs were $1,469,297.21 in the preintervention period and $1,779,306.79 in the postintervention period for the comparator group—an increase of $310,009.58 ($993.62 more per patient). Table 515-18 summarizes the CHaMPS program direct costs for 2015 and 2016. Considering this, the net benefit of the CHaMPS program during a 1-year intervention period was $700,720.71 ($390,711.13 decrease for CHaMPS group + $310,009.58 increase for comparator group) and the CHaMPS program cost, comprised of salary and fringe benefits for personnel listed in Table 5,15-18 during a 1-year intervention period with implementation costs was $329,365.43, resulting in a benefit-cost ratio of 2.1:1 ($700,720.71/$329,365.43). The CHaMPS program cost during a 1-year intervention period without implementation costs was $266,071.80, resulting in a benefit-cost ratio of 2.6:1 ($700,720.71/$266,071.80). Thus, for every $1.00 spent on the CHaMPS program, $2.10 to $2.60 was saved in ED and hospital costs for the CHaMPS participants. Refer to Table 419 for a summary of the benefit-cost ratio calculation.


 
Copyright AJMC 2006-2020 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up