MO HealthNet, Missouri’s Medicaid program, is a proponent of encouraging health education of its participants. By giving them information about their health issues and how to manage them, the participants can avoid more serious issues later on.
One example is the state’s Medication Therapy Management initiative, which uses outreach and education from healthcare providers that increases participants’ knowledge about their conditions and care. This improves adherence rates and health outcomes, which avoids future costs of care.
Most of the state’s healthcare costs were incurred by participants with chronic health issues such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart failure, hypertension and osteoporosis. MO HealthNet found that, while these participants did receive wellness guidance and education from their primary care providers, they did not see their providers very often. Without educational reinforcement, this group had a higher risk of sub-optimal adherence rates– and elevated healthcare costs.
Further research showed that MO HealthNet participants saw pharmacists much more often than physicians. But these visits usually consisted of picking up medications and learning how to take them. MO HealthNet saw an opportunity to move beyond these basic interactions. By equipping pharmacists with the right tools, the state can provide educational opportunities and reinforcement, and help participants improve adherence to their medication regimens.
The Solution: Pharmacists Get the Info That Their Patients Need
DirectCarePro is Xerox’s Web-based platform that gives pharmacists access to participants’ health history.
To begin, MO HealthNet assigned participants with 10 pre-selected chronic conditions to local pharmacists. DirectCarePro allows pharmacists to access up to 36 months of a participant’s pharmacy and medical claims history. This information allows them to review the effectiveness of current drug therapies and potential conflicts with other medications, as well as uncover potential gaps in participant care. Pharmacists use DirectCarePro to develop an updated plan of care for the participant, and then relay this information to the participant’s primary care physician. The physician responds to the pharmacist’s recommendations, and they agree upon a more effective treatment.
DirectCarePro also helps pharmacists identify appropriate educational materials that are easy to understand, and participants are able follow the directions. This helps the participants manage their care better – and because pharmacists have more encounters with the participants, the pharmacists are able to reinforce this knowledge and continue to improve outcomes.
To date, around 200 pharmacists have enrolled in the program. Combined with the efforts of primary care physicians, the initiative has generated a savings of $35.07 per member, per month, in prescription costs as compared to the control population. Gross savings for the 12 months of 2013 were $149,417. Including $29,510 for the cost of Medication Therapy Management payments to local pharmacists, the program produced a net savings of $119,507 for 2013.
The state has expanded the program to include additional chronic conditions, and enable pharmacists to provide additional services to improve disease management. MO HealthNet has shown that pharmacists can provide a great amount of value as the most frequent point of contact for participants – and that they have a great role to play in controlling program costs.