Utah Developing a Utah Pharmacotherapy Risk Management System with an Electronic Surveillance Tool (Utah ePRM)
In 2007, 27 states received Medicaid Transformation Grants under Section 6081 of the Deficit Reduction Act of 2005. The grants were rewarded to states that proposed innovative methods which in the end of the two years are designed to produce better health outcomes at lower cost.
The Center for Health Transformation is highlighting states that have received these Medicaid Transformation Grants, and will be following their progress for the next two years. In order for key decisionmakers and industry leaders from around the country to learn from others’ successes, it is our intention to provide this resource in order to showcase innovative practices from across the nation. In the future, this site will be interactive, allowing program directors to submit updates and comments regarding their program.
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ABSTRACT: We propose to develop a Utah Medicaid Pharmacotherapy Risk Management System with an electronic tool (ePRM) to improve the quality and safety of medication use while simultaneously controlling costs and detecting fraud and abuse. The project has two objectives:
(1) Refine and implement a computerized surveillance and trigger tool to support medication therapy and risk management services. The ePRM tool will be used to (1) identify potential drug-therapy problems, which include quality, safety and cost-related problems; (2) select patients and providers for in-depth clinical reviews and possibly direct intervention (i.e., letter, phone call, Medication Therapy Management Services (MTMS), or Academic Detailing); (3) identify potential fraud and diversion of controlled substances; and (4) track patterns of medication use and evaluate ePRM performance, identify improvements, and direct policy change.
(2) Conduct innovative multi-pronged interventions that are guided by ePRM trigger tool. Clincial areas chosen for review include diabetes therapy, hypertension, asthma, antipsychotic therapy, pain management (opioid narcotics and anticonvulsants) and anticoagulation/antiplatelet drugs. Interventions in these areas will address potential under and overuse, or patient safety concerns. Clinical pharmacists and physicians will implement five types of inter-related interventions: a) provider level reviews, which includes prescribers’ for high-risk patients; c) phone consultation and Academic Detailing with outlier prescribers; d) MTMS; and e) detecting and pursuing suspected fraud and abuse cases.
The estimated budget total for developing and implementing the ePRM is approximately $2,882,162 with $1,435,539 for Year 1 and $1,446,123 for Year 2.
The ePRM system will benefit about 174,000 non-institutionalized Medicaid members by improving medication therapy and, subsequently improving health status. Targeted clinical reviews will impact nearly 4,800 patients with high-risk medication therapies. As many as 600 of the high risk patients will receive the MTMS consultation. About 2,500 prescribers will receive feedback and recommendation for appropriately prescribing medications, with approximately 100 also receiving Academic Detailing visits. The ePRM team will conduct statewide surveillance and mailing/telephone interventions. Face-to-face interventions will be limited to the Wasatch Front area.
We intend to achieve the following outcomes for patients: a) increased diuretic prescriptions among hypertensive patients; b) increased appropriate use of diabetic and asthma medications; c) improved compliance with antipsychotics; d) reduced adverse events among patients using narcotics, anticonvulsants, anticoagulation and antiplatelet drugs; and e) improved quality of care and health outcomes in patients referred to the MTMS. We expect substantial overall cost savings as a result of these modifications to the drug delivery and management system.
The Utah ePRM will make contributions to transform Medicaid pharmacy programs in the nation by piloting an electronically enhanced pharmacotherapy risk management system and making the ePRM tool to be available for free adoption by other Medicaid, Medicare part D, Veterans Administration, and other language pharmacy programs.
