How can advanced pharmacy care management, enabled by analytics and technology, improve health and reduce costs when caring for doubles eligible in Medicare Advantage (MA) and managed Medicaid?
In a session at the Pharmacy Quality Alliance 2022 Annual Meeting in Baltimore, Maryland, UPMC Health Plan, owned by the University of Pittsburgh Medical Center (UPMC), RxAnte and Mosaic Pharmacy Services, outlined how they are managing drug-based pharmaceutical care. value management program within the Medicaid Long-Term Services and Supports (LTSS) program operated by Community HealthChoices, Pennsylvania.
RxAnte, an analytics company that is an independent company within UPMC Enterprises, uses predictive analytics to manage drug use; in 2019, it launched Mosaic Pharmacy Service, which evaluates treatment regimens of at-risk patients, conducts drug reviews, examines the pitfalls of adherence, and delivers drugs sorted by day and time.
According to Patricia Powers, PharmD, BCPS, director of clinical services at Mosaic, trends in Alzheimer’s show why more intensive management of pharmaceutical care is needed.
The number of people in special needs plans has more than tripled since 2010, with more beneficiaries with chronic or disabling medical conditions, he said, and accounts for a larger percentage of healthcare spending. At the same time, there is an increase in drug waste, estimated by one study to be around $ 528 million annually.
Traditional paid models do not allow “our ability as pharmacists to provide services such as patient counseling, follow-up and have created limited opportunities for full drug reviews,” Powers said.
Not all CHC participants are referred to their service, he said: Using analytics, they focus on those who have quality care shortages and unscheduled care visits.
These members must be interested in the service, at which point they are registered over the phone. Medicines are reconciled and Mosaic also identifies issues related to the social determinants of health. Members are being contacted every month and pharmacists are checking for transitions in care, for example after a hospitalization. They also coordinate with suppliers, Powers said.
“Most of our patients have between 10 and 25 medications and you can imagine that usually translates to 3 or 4 prescribers,” he said.
As an example of their service, Powers presented the case of a beneficiary, aged 71, who otherwise would not have qualified for a traditional drug therapy management program, as she was taking only 6 prescriptions: aripiprazole 2 mg QHS; duloxetine 60 mg 2 capsules QD; potassium chloride 10 meq QD; gabapentin 100 mg 2 capsules TID; clonazepam 1.5 mg once daily; and hydrozine 50 mg BID prn.
He was low-income, had no transportation, lacked a high level of education, and suffered from treatment-resistant depression, generalized anxiety disorder, sciatic nerve pain, and hypokalemia.
“None of your chronic illnesses state that we typically think about who needs this kind of service,” Powers said.
Despite these issues, she was in charge of caring for her 4-year-old grandson and reported dizziness, sleepiness, confusion and had 1 recent fall. She had adherence problems with clonazepam and duloxetine and had not seen her as a psychiatrist in some time due to the pandemic and lack of transportation.
Mosaic coordinated with the psychiatrist, who saw her via telemedicine, and the dosages of duloxetine and hydroxyzine were reduced. She was also advised how to take clonazepam appropriately.
The changes meant less anxiety and more alertness for the patient, who cut the drug by 3 dosages and the health plan saved $ 300.
Overall, the company’s analysis of customer data shows that when comparing high-risk beneficiaries enrolled in Mosaic to matched controls, you get a savings of $ 426 per member per month, mostly from reduced, unplanned hospitalizations and visits to the emergency room. The percentage of members adhering to their medications was also higher: 11 percent for diabetes medications, for example, and 18.1 percent for blood pressure medications.
In a question and answer session after the presentation, Vanessa Campbell, PharmD, senior manager of pharmaceutical services at UPMC, was asked what prompted them to take a closer look at these members.
If they are in and out of the hospital frequently, he said, “what we see from talking to some of these patients is that they are coming home and they are extremely overwhelmed, because they still have medicines stocked on the counter, they have new drugs that need to be taken and Often, we will see some of these members who do not have a caretaker and do not have the support of the family. “
Powers added that the lack of social support means that “often, our calls are longer than a traditional interaction, because we are providing some social support…. We are often involved in things that have nothing to do with the therapeutic regimen ”.