Strategies to Modernize State Medicaid Programs, Utah’s Medicaid Transformation By Lisa V. Hulbert R.Ph. Transformation Program Manager Utah Medicaid Program

Electronic Pharmacotherapy Risk Management (ePRM) Adopt innovative methods to improve effectiveness and efficiency in providing medical assistance under title 1903 of the Social Security Act. Objectives Refine and Implement a computerized surveillance tool to support risk management. Conduct innovative multi-pronged interventions with providers of health care.

Statement of Need Spending Increases Patient Noncompliance up to 3.8 times the risk for death 1.5 times the risk for hospital admission Adverse drug events associated with: 13.3% of all hospitalizations

Who is involved? Utah Division of Health Care Finance Utah College of Pharmacy, Drug Regimen Review Center (DRRC) Utah Office of Health Care Statistics Salt Lake VA Medical Center, Informatics Decision Enhancement And Surveillance (IDEAS) Center Utah School of Medicine, Division of Clinical Epidemiology Utah School of Medicine, Department of Pediatrics

The Tool: A computerized surveillance and trigger tool which supports medication therapy and risk management services. Will be used to identify potential drug-therapy problems. Quality (under-utilization by patient, sub-therapeutic dosing, etc…) Safety (duplications within same class, multiple prescribers, etc…) Cost-related problems (Brand Issues, NDC billing issues) Will be used to identify providers for in-depth clinical reviews and direct interventions. Letters Phone calls Medication Therapy Management Services (MTMS) – targeted disease management education provided in an easy access environment. Academic Detailing (MD/Pharm. D.)

The Tool: Will be used to identify potential fraud and diversion Will be used to track... pattern of medication use/diagnosis evaluate performance to direct policy change

Medication Therapy Clinical areas chosen for review include: Diabetes therapy – high incidence of preventable adverse events Hypertension therapy – high occurrence of under use of diuretics Asthma therapy – high incidence of preventable adverse events Antipsychotic therapy – high use Pain Management – high over use, ineffective use Anticonvulsant therapy – high unlabeled use Anticoagulation/antiplatelet therapy – high incidence of preventable adverse events

Risk Management Services Pharmacist provided Medication Therapy Management Services Found to reduce: Unscheduled physician visits Emergency department visits Over all costs Direct Feedback to providers Letters, Telephone Calls, Academic Detailing.

Patient Education Visits to Clinical Pharmacists Goals Enhance the patient’s understanding of appropriate drug use Increase compliance with medication therapy Improve in the detection of adverse drug events Core Components Medication Therapy Review Medical Record for patient Medication Action Plan Intervention and Referral to Prescriber (when needed) Documentation and Follow-up Focus 4 or more chronic diseases Multiple drug therapy potential problems At high risk for drug adverse events

Over-All Project Time-line Quarter 1 Finalize work plan & architecture for trigger system-VA/UCP Quarter 2 - Quarter 7 Quarterly deploy newly-developed triggers-VA/UCP Implement direct patient & prescriber intervention-UCP Quarter 2 – Quarter 4 Develop support tools for MTMS-VA Certify Pharmacist Develop Documentation Requirements Implement Payment System Using Pharmacy Provider #/ $30 - $90/per visit

Project Time-line Continued Quarter 3 – Quarter 7 Phone intervention & academic detailing-VA/UCP/USM Quarter 5 - Quarter 8 Certified pharmacists provide MTMS Quarter 1 – Quarter 8 Evaluation-OHCS Quarter 8 Sustainable proposal to Medicaid-VA/UCP

Impact 175,000 non-institutionalized Medicaid members 4,800 will receive targeted interventions due to high risk medications 3,000 prescribers will receive intervention material 600 will receive MTMS 120 prescribers will receive academic detailing

Outcomes 1) increased diuretic prescriptions among hypertensive patients 2) increased appropriate use of diabetic and asthma medication 3) improved compliance of antipsychotics 4) reduced adverse events among patients using narcotics, anticonvulsants, anticoagulation and antiplatelet drugs 5) improved quality of health care and health outcomes in patients referred to the MTMS