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

2. 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.

3. 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

4. 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

5. 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.)

6. 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

7. 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

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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