Clinical and economic outcomes of medication therapy management services: The Minnesota experience

doi:10.1331/JAPhA.2008.07108

Journal of the American Pharmacists Association

Volume 48, Issue 2, March–April 2008, Pages 203-214

https://doi.org/10.1331/JAPhA.2008.07108 Get rights and content

Abstract

Objectives

To (1) provide medication therapy management (MTM) services to patients, (2) measure the clinical effects associated with the provision of MTM services, (3) measure the percent of patients achieving Healthcare Effectiveness Data and Information Set (HEDIS) goals for hypertension and hyperlipidemia in the MTM services intervention group in relationship to a comparison group who did not receive MTM services, and (4) compare patients’ total health expenditures for the year before and after receiving MTM services.

Design

Prospective study.

Setting

Six ambulatory clinics in Minnesota from August 1, 2001, to July 31, 2002.

Patients

285 intervention group patients with at least 1 of 12 medical conditions using prestudy health claims; 126 comparison group patients with hypertension and 126 patients with hyperlipidemia were selected among 9 clinics without MTM services for HEDIS analysis.

Intervention

MTM services provided by pharmacists to BlueCross BlueShield health plan beneficiaries in collaboration with primary care providers.

Main outcome measures

Drug therapy problems resolved; percentage of patients goals of therapy achieved and meeting HEDIS measures for hypertension and hypercholesterolemia. Total health expenditures per person were measured for a 1-year period before and after enrolling patients in MTM services.

Results

637 drug therapy problems were resolved among 285 intervention patients, and the percentage of patients' goals of therapy achieved increased from 76% to 90%. HEDIS measures improved in the intervention group compared with the comparison group for hypertension (71% versus 59%) and cholesterol management (52% versus 30%). Total health expenditures decreased from $11,965 to $8,197 per person (n = 186, P < 0.0001). The reduction in total annual health expenditures exceeded the cost of providing MTM services by more than 12 to 1.

Conclusion

Patients receiving face-to-face MTM services provided by pharmacists in collaboration with prescribers experienced improved clinical outcomes and lower total health expenditures. Clinical outcomes of MTM services have chronic care improvement and value-based purchasing implications, and economic outcomes support inclusion of MTM services in health plan design.

Section snippets

Objectives

The objectives of this evaluation project were to: (1) provide MTM services to patients, (2) measure the clinical effects associated with the provision of MTM services, (3) measure the percent of patients achieving Healthcare Effectiveness Data and Information Set (HEDIS; formerly Health Plan Employer Data and Information Set) goals for hypertension and hyperlipidemia in the MTM services intervention group in relationship to a comparison group that did not receive MTM services, and (4) compare

Methods

This article reports data from a 1-year prospective study of an MTM services intervention group and a 1-year retrospective period that served as a historical control. Patients receiving MTM services were continuously enrolled, with a health insurance benefit provided by BlueCross BlueShield of Minnesota (BCBSM). Institutional review board oversight and approval occurred through the University of Minnesota Human Subjects Protection Program, and informed consent was obtained from patients.

Results

A total of 285 patients received MTM services in the intervention group (188 women and 97 men; 40 patients [14%] 65 years of age or older), and a total of 684 MTM encounters (2.4 per patient) occurred during the 1-year study period.

Discussion

This study evaluated the outcomes of MTM services provided to a group of high—resource-use patients included in an MTM health benefit design. The percentage of patients meeting selected HEDIS criteria was higher in the intervention group. The percentage of patients’ goals of therapy achieved and the number of drug therapy problems resolved in intervention group patients are consistent with previous studies in which comprehensive MTM services were provided within the practice of pharmaceutical

Limitations

This study and the generalization of its results are subject to the following limitations: (1) selection bias influencing use of the MTM services benefit by patients; (2) selecting the MTM group of patients based on high health resource use, high health care expenditures, or complex drug therapy needs; and (3) using insurance payment claims to measure total annual health expenditures.

First, patients with pressing medical care concerns and drug-related needs may be more likely to use MTM

Conclusion

This practice-based research project combined the interests of an academic health center, integrated health care system, and health insurers to study the outcomes of face-to-face MTM services. MTM services address drug-related morbidity and mortality by creating a process for ensuring the safe, effective, and appropriate use of medications. This study provided evidence that pharmacists working in collaboration with primary care providers identified and resolved drug therapy problems in a manner

Twelve medical conditions included in the study:Identification of medical conditions using ICD-9-CM codes or generic code numbers for prescription drugs

Medical conditions were identified from facilities and professional claims using ICD-9-CM codes published in The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Certain medical conditions were identified by from prescription claims using Generic Code Numbers (GC3 codes) reported in the National Drug Data File (NDDF) published by First DataBank (Hearst Publishing Co.). The following is a list of medical conditions included in this study with the

Classification and grouping of insurance claims by place of service for Blue Cross Blue Shield of Minnesota

The BCBSM facilities claims for study subjects were grouped by place of service as follows:

(1)
hospital inpatient [X-ray, laboratory (excludes allergy), consultation, hemodialysis, surgery, assistant surgeon, Durable Medical Equipment (DME) rented supplies, other supplies, anesthesia, medical visit, allergy services, injectables (excludes chemotherapy/allergy), immunizations/vaccines, chiropractic, room & board, physical therapy, other ancillaries, psychotherapy, radiation therapy, drugs];
(2)
hospital

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Disclosure: Dr. Cipolle has an equity interest and serves on the Board of Directors for Medication Management Systems, Inc., the company licensed to distribute the Assurance pharmaceutical care documentation system used by pharmacists in this study. The other authors declare no conflicts of interests or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

Funding: This project was supported by a grant from the University of Minnesota–Academic Health Center/Fairview Health System Joint Funding Program.

Acknowledgments: To Bruce Lindgren and Dorothee Appeli, Biostatistics Consulting Laboratory, University of Minnesota, for providing advice on the statistical analysis; and Nancy Hardie, Program Analyst and Richard Pham, Graduate Program in Health Informatics, University of Minnesota, for database management and analysis; and to Amanda Brummel, Kerry Close, Molly Ekstrand, Mike Frakes, Carolyn Kilgore, Nicole Paterson, and Paull Rukavina, pharmaceutical care practitioners, for ensuring the integrity of informed consent and providing care to patients.

Previous presentation: Preliminary project results presented at the BlueCross BlueShield Association Best Practices in Medical and Pharmacy Management Meeting, October 9, 2003, Chicago.

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Special FeatureClinical and economic outcomes of medication therapy management services: The Minnesota experience

Abstract

Objectives

Design

Setting

Patients

Intervention

Main outcome measures

Results

Conclusion

Section snippets

Objectives

Methods

Results

Discussion

Limitations

Conclusion

Twelve medical conditions included in the study:Identification of medical conditions using ICD-9-CM codes or generic code numbers for prescription drugs

Classification and grouping of insurance claims by place of service for Blue Cross Blue Shield of Minnesota

J Am Pharm Assoc.

J Am Pharm Assoc.

J Am Pharm Assoc.

J Am Pharm Assoc.

Jt Comm J Qual Improv.

J Am Pharm Assoc.

Res Social Adm Pharm.

Quality of pharmaceutical care in hospitals

Am J Hosp Pharm.

Levels of pharmaceutical care: a theoretical model

Am J Hosp Pharm.

Quality assessment of a collaborative approach for decreasing drug- related morbidity and achieving therapeutic goals

Arch Intern Med.

Report to the Congress: Medicare coverage of nonphysician practitioners

Current Procedural Terminology: CPT 2006

Current Procedural Terminology: CPT 2008

an insider's view

Chicago: American Medical Association;

Pharmaceutical care services and results in Project ImPACT: Hyperlipidemia

J Am Pharm Assoc.

A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP)

Arch Intern Med.

Pharmacists' ability to influence outcomes of hypertension therapy

Pharmacotherapy.

Implementation of pharmaceutical care services for patients with dyslipidemias by independent community pharmacy practitioners

Ann Pharmacother.

Pharmacist participation on physician rounds and adverse drug events in the intensive care unit

JAMA.

Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units

Arch Intern Med.

Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs

Arch Intern Med.

Special Feature
Clinical and economic outcomes of medication therapy management services: The Minnesota experience