Eli Lilly and Company

To assist physicians and other clinicians involved in the care of schizophrenic patients, the Missouri Department of Mental Health (DMH) and the Missouri Division of Medical Services (DMS) partnered with Comprehensive Neuroscience Inc. and Eli Lilly and Company to implement a statewide project called Medical Risk Management (MRM) for Missouri Medicaid recipients with a diagnosis of schizophrenia. This program is a strategy for adapting disease management to behavioral health in Missouri.

Situation

Many states across the country are facing budget constraints. In order to control costs, several states are restricting access to medications in Medicaid, which may unnecessarily jeopardize patient care and add to other increases in health care costs.

To provide a better solution, Eli Lilly and Company along with Comprehensive Neuroscience Inc. have partnered with 28 states to create private-public intervention programs that improve the quality of care for the country’s most vulnerable citizens with severe mental illnesses, while also addressing public payer budget concerns.

Solution

Twenty-five of the private-public partnership programs focus on appropriate-use interventions, which evaluate Fee for Service Medicaid behavioral health prescribing practices of doctors to:

• Identify potentially ineffective, duplicative and inefficient prescribing patterns;
• Improve care for citizens by educating doctors who deviate from national, evidence-based best practices for the prescribing of behavioral health medications; and
• Ensure the most efficient use of taxpayer dollars in state Medicaid programs.

The first of these programs was the Missouri Mental Health Medicaid Pharmacy Partnership (MHMPP), which launched in late-2003 as the first program of its kind in the United States.

Better Health and Lower Cost

Analysis and studies of the Missouri MHMPP have shown the following improvements for patients whose physicians received an educational mailing alerting them to ineffective, duplicative or inefficient prescribing practices:

Improved Patient Care

• 98% reduction in the number of patients who received the same mental health medication from multiple doctors
• 64% reduction in patients who are on two or more mental health medications of the same type
• 40% reduction of patients receiving an unusually high dosage of medication
• 43% reduction in patient hospital admissions
• Reduction of 1,813 total patient hospital days

Missouri Medicaid Savings

• $7.7 million reduction in costs the Medicaid program would have incurred in state fiscal year 2004 had the outlier prescribing patterns not been identified
• $1,238 average reduction in total non-pharmacy costs per patient

With more than half of the country utilizing these private-public partnership programs, additional data demonstrating the national success of the program will be available in the coming months.

For more information on the Missouri MHMPP, please visit: http://www.dmh.missouri.gov/MHMPP/PharmPartnerreleases.htm