The Maryland P 3 Program: A Collaborative Solution to Medication Therapy Management Magaly Rodriguez de Bittner, PharmD, BCPS, FAPhA, CDE Professor and.

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Presentation transcript:

The Maryland P 3 Program: A Collaborative Solution to Medication Therapy Management Magaly Rodriguez de Bittner, PharmD, BCPS, FAPhA, CDE Professor and P 3 Director

© 2006 University of Maryland School of Pharmacy. All rights reserved. Outline Pharmacy Education Program Overview Preliminary Program Results Impact on Public Health Needs

© 2006 University of Maryland School of Pharmacy. All rights reserved. Patients Pharmacists Partnerships (P 3 ) Program An effective solution to patient-centered health education, medication adherence, and chronic disease management

© 2006 University of Maryland School of Pharmacy. All rights reserved. Informed, Activated Patients Productive Interactions Prepared, Proactive Practice Team Delivery System Design Decision Support Clinical Information Systems Self- Management Support Health System: Resources and Policies Community: Health Care Organization Chronic Care Model

© 2006 University of Maryland School of Pharmacy. All rights reserved. Maryland P 3 (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 providers Data Collection System-MedPath

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

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

© 2006 University of Maryland School of Pharmacy. All rights reserved. Patients PharmacistsPartnerships Maryland Pharmacists Association P 3 Pharmacy Network UMB School of Pharmacy Network Coordination Training PSM System/Reporting Self-management of chronic disease Department of Health and Mental Hygiene Maryland General Assembly Employers/Payers

© 2006 University of Maryland School of Pharmacy. All rights reserved. Results From Early Program Implementations

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

© 2006 University of Maryland School of Pharmacy. All rights reserved. Baseline, Year 1, 2 and 3 compared to Projected Costs* Total costs $9,035 $8,913 $8,802$7,490 Yr 3 savings Per Patient from projected Costs $6,250 from Baseline Costs $1,545 Yr 1 Projected $10,390 Year 3 Projected $13,740 *for 63 patients with baseline,1 st, 2 nd and 3 rd year results Baseline $9,035 Year 2 Projected $11,948

© 2006 University of Maryland School of Pharmacy. All rights reserved. Patient Self-Management Program SM for Diabetes: First Year Cost Savings J Am Pharm Assoc. 2005; 45: Average Cost Savings Per Patient $918 Align the Incentives, Empower the Patient, Control the Costs SM Combined data from Mohawk, VF, Manitowoc, OSU, Kroger (n=165)

© 2006 University of Maryland School of Pharmacy. All rights reserved. The Diabetes Ten City Challenge Interim 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:

© 2006 University of Maryland School of Pharmacy. All rights reserved. CAN THE P 3 PROGRAM MODEL IMPROVE CLINICAL OUTCOMES AND DECREASE HEALTH CARE COSTS FOR PEOPLE WITH DIABETES?

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

Key < 130/80 < 140/90 Figure 4. Blood Pressure at Therapeutic Levels (mmHg)

© 2006 University of Maryland School of Pharmacy. All rights reserved. Results 2009 (N= 159 patients )

© 2006 University of Maryland School of Pharmacy. All rights reserved. Results 2009 (N=159)

© 2006 University of Maryland School of Pharmacy. All rights reserved. Results 2009 (N=159)

© 2006 University of Maryland School of Pharmacy. All rights reserved. Cost Savings for the Maryland P 3 Program On average our employers are saving approximately $900 per employee per year ($495-$3,281).

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

© 2006 University of Maryland School of Pharmacy. All rights reserved. Implications:Public Health Issues 1.Underserved Populations 2.Health care Reform- Patient Centered Medical Home and Transitioned of Care 3.Team-based Care 4.Access to Health Care and Prevention Services

© 2006 University of Maryland School of Pharmacy. All rights reserved Recipient of the APhA Foundation Pinnacle Award

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