Healthier Medicaid Members through Enhanced Medication Management Abstract - West Virginia

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.

Click here for the complete grant application >>

Healthier Medicaid Members through Enhanced Medication Management will establish an automated prior authorization system which allows the pharmacist to submit claims through a Point of Sale System and significantly reduce cost. This system will encourage more appropriate prescribing; enhance provider relations, and free pharmacists in the Rational Drug Therapy Program to have time for meaningful discussions and skilled clinical review. A web portal will be added to allow prescribes and pharmacists to view medical and pharmacy claims as they are submitted. A clinical rules engine will alert prescribes of clinical expectations and pharmacy management issues.

The West Virginia Bureau for Medical Services is requesting $4,287,110 from the Centers for Medicare & Medicaid Services (CMS) to support Healthier Medicaid Members through Enhanced Medication Management. This initiative will enable pharmacist to complete patient profiles, allow for the identification of chronic disease that is not being treated according to evidenced-based guidelines, as well as preventing the progression of chronic disease. The pharmacist will be integrated into the care team of the Medicaid member and will provide point of sale assistance to the member in preventing and managing the care of chronic disease.