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Adding Value to Healthcare Adding Value to Healthcare Management: Management:

Patient Self-Management: Diabetes

MICHPHA

September 20, 2007

Brooke Bliss, R.Ph.

Clinical Pharmacy Consultant

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HealthPlus of Michigan

Membership: 202,000

Employer-sponsored:102,000Medicaid: 64,000Other Government Programs: 36,000

Service Area:Ten full counties in Mid-Michigan plus 8 partial counties

Pharmacy Network:1,500 Pharmacies statewide50,000 plus pharmacies nationwide

An independent regional health plan providing services for over 200,000 Michigan Commercial HMO, PPO, and government program members.

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HealthPlus of Michigan

Physician HMO-Network:900 Primary Care Physicians1800 Specialists 29 Contracted hospitals

Physician PPO-Network:60,000 Providers regionally and nationally

An independent regional health plan providing services for over 200,000 Michigan Commercial HMO, PPO, and government program members.

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HealthPlus Vision

“A Healthier Community”How does HealthPlus intend to achieve that vision?

By being dedicated to improving the value of health care services for our members and purchasers. By working in partnership with providers to improve the quality and cost effectiveness of health care services.

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A one year pilot program based on the highly successful “Asheville Project” with a twist:

For the first time, HealthPlus, as a HMO, will reimburse certified pharmacists for counseling services provided to patients about their disease.

The Patient Self-Management: Diabetes (PSM: Diabetes) Program

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PSM: Diabetes Goals

Improve clinical outcomes, productivity and quality of life for participating individuals with diabetes.

Reduction of overall health care costs associated with diabetes.

Demonstrate value related to pharmacist-driven medication therapy management services as part of a disease management team.

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Patients:Invited to participate in the pilot program based on targeted clinical criteria. Choose to “opt-in” based on program description

Agree to meet with chosen pharmacist educator once per month for the first 3 months then at least quarterly there after in order to continue having copays waived (patient pays ZERO co-payment for all diabetic medications, ACE inhibitor/ ARB class of medication and diabetic testing supplies)

Key Players and Their Roles:

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HealthPlus:Solicit and encourage community pharmacists to participate in the Patient-Focused Diabetes Education Program

Administer a scheduled fee to pharmacists who have completed a diabetes certificate program and provide clinical services to identified members

Provide incentive for member participation

Provide collaboration between patients, physicians, educators, and pharmacists

Key Players and Their Roles:

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American Pharmacist Association (APhA) Foundation:Provides a written outline of the process of care to pharmacists for program implementation

Provides a curriculum with which to educate members and prepare them to participate actively in their own diabetes care and treatment

Provide access to a secure website for submission of outcome data by pharmacy educators

Provide monthly reports based on outcomes data

Key Players and Their Roles:

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Michigan Pharmacist Association (MPA):Provision of initial and continuous diabetic certificate CE program for participating pharmacists

Physician:Confer with pharmacist educator to establish collaborative practice:

Individualized patient goals

Guidelines for treatment/ referral

Receive patient visit summary/ SOAP note

Key Players and Their Roles:

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Pharmacy Network Educator (Certified Pharmacist):Comprised of 20 independent and chain pharmacists who attended and passed a Diabetes Certificate Program

Located throughout Genesee, Bay, Saginaw, and Shiawassee Counties

Key Players and Their Roles:

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Pharmacist Role:Act as coach to encourage active patient involvement in

his or her care and discuss/educate regarding patient self-

management using motivational interviewing technique

Provide written and/or verbal progress reports to the patient’s primary care physician or specialist to establish collaborative practice using SOAP notes

Document all pharmacist/patient interactions and interventions that take place throughout the project, and forward this data as required

Key Players and Their Roles:

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Criteria:Commercial line of business

Diabetic as defined by HEDIS

Meet 1of 2 targeted clinical criteria arms Disease Management Arm

• No connectivity with disease management program vendor AND

• Glycosylated hemoglobin A1c (HbA1c) 7.0 or no HbA1c on record

Pharmacy Management Arm

• Non-adherent (medication possession ratio (MPR) of 80%) with oral diabetic medications AND

• Total number of medications 5 (based on pharmacy claims) AND

• HbA1c 7.0 or no HbA1c on record

Member Selection

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The APhA Foundation will provide a data summary analysis to HealthPlus based on de-identified information from the web-based documentation system used by the pharmacist educatorsHealthPlus will do additional analysis to compare the treatment group vs. the control group* HEDIS Related Measures:

• HbA1c screening/ control (<7% & >9%)• LDL screening/ control (<100 mg/dL)• Urine albumin• Eye exam (retinal) performed• Blood pressure control (<130/80 mmHg & <140/90 mm/Hg)

* The treatment group is defined as those members who are enrolled and managed in the program. The control group is defined as members with the same criteria who did not participate in the program.

Outcome Measures

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Non-HEDIS Related Measures:

• Prescription claims for Ace inhibitors/ ARB Medication class

• Prescription claims for “statin” medication class

• Routine foot exams

• Medication adherence

• Total medical costs (pharmacy and medical)

• Body Mass Index (BMI)

• Overall return on investment (ROI)

Outcome Measures Continued

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Members being proactive and enrolling in the programMembers keeping scheduled appointmentsCommunity pharmacist comfort level in the role of clinical educatorPharmacist ability to meet time commitmentPharmacist comfort level communicating with physicians on a peer-to-peer levelChain-store contract signatures/ legal consultsPharmacist documentation in the web-based systemPhysician’s willingness to communicate on a peer-to-peer level and share lab data with pharmacist

Challenges