Eli Lilly and Company - Behavioral Pharmacy Management
As an alternative to preferred drug lists, fail first approaches, case management or prior authorizations for psychiatric medications, the Behavioral Pharmacy Management (BPM) intervention was designed and implemented in the State of Missouri in partnership with Comprehensive Neuroscience Inc. and Eli Lilly and Company, as a quality improvement tool that also produces cost savings by aligning outlier physician prescribing practices with best practices.
Situation
Prescription drugs account for 11% of the national health care spending. Expenditures for drugs have been growing at an annual rate of 15% which is higher than the increases seen in either physician and clinical services or hospital care. Medications to treat psychiatric conditions are among the most costly drugs to Medicaid programs.
Solution
As an alternative to preferred drug lists, fail first approaches, case management or prior authorizations for psychiatric medications, the Behavioral Pharmacy Management (BPM) intervention was designed and implemented in the State of Missouri in partnership with Comprehensive Neuroscience Inc. and Eli Lilly and Company, as a quality improvement tool that also produces cost savings by aligning outlier physician prescribing practices with best practices. This is done by retrospectively analyzing pharmacy claims databases and is advantageous in that it allows full access to medications and permits the physician to individualize therapy. By using information technology, the intervention uses a new and unique approach to managing the issue of rising prescription drug costs. The assumption is that physicians’ prescribing practices will become more aligned with best practices guidelines after the BPM intervention, and that service utilization and cost of care will be positively impacted.
Missouri Medicaid recipients whose physician received a BPM intervention mailing during January and February 2004 were used as intervention cases for this analysis. After these specific inclusion and exclusion criteria were applied, there were 1911 cases in Missouri, respectively. A similar comparison group was created by matching on key variables to ensure that the intervention and comparison group had similar patient characteristics and were comparable.
Better Health & Lower Costs
This study found statistically significant differences between the pre- and post-exposure periods for all of the primary outcomes of interest—rates of hospitalizations, mean number of admissions to a hospital, total patient hospital days and total non-pharmacy charges. The rate of hospitalization among intervention cases showed a change from the pre-exposure to the post-exposure period with rates of 16.8% and 9.5%, respectively. The mean number of hospital admissions among intervention cases decreased from 0.31 in the pre-exposure period to 0.16 in the post-exposure period for an overall reduction of 0.15 admissions per recipient. Finally, intervention cases demonstrated a reduction in charges of $1239 with an average six-month charge total of $5109 in the post-exposure period compared to $6347 in the pre-exposure period. There were no significant changes in any of the primary outcomes within the comparison group between the two time periods which indicates that there were no time influences on admissions or payments during the time period of analysis.
Two major findings emerged from this study. First, the BPM physician-oriented intervention is associated with a decrease in hospitalizations as evidenced by reductions in the overall rates of admission, the mean number of admissions per patient and the total patient days. Second, there is an overall reduction in the total average medical services cost of care for Medicaid recipients. As hypothesized, the BPM intervention does not cause a disruption in care and appears to play a role in the overall reduction in hospital utilization and cost of care for the patients.
