PharmacistCARE: A Model for Pharmacist-Coordinated Medication Therapy Management Services for a University Health Plan
Holly Divine, Pharm.D., CGP, CDE, Carrie Johnson, Pharm.D., CDE, Amy Nicholas, Pharm.D., CDE
University of Kentucky HealthCare, Lexington, Kentucky
Employers face increasing challenges in providing affordable healthcare benefits that enable employees to maintain good health at a reasonable cost. The University of Kentucky College of Pharmacy, in partnership with the benefits department of the University, created a novel set of services for health plan members of this self-insured entity.
PharmacistCARE is a free-standing pharmacist-managed clinic located in the primary ambulatory care facility owned by the University of Kentucky HealthCare. The services provided are unique when compared with most other disease management services because medication therapy management (MTM) is the foundation for all patient encounters. Regardless of the targeted disease state, each patient visit entails complete MTM in addition to disease specific education. These services are offered as a free health plan benefit to all adult members of the University’s Health Plan (UHP) who have been diagnosed with the target disease state(s). The most highly utilized service is DiabetesCARE.
The program’s success was measured using clinical and financial outcomes parameters. The clinical study period was March 2003-October 2006. Out of 236 participants, 101 were included in the clinical analysis because they were continuously enrolled in the program and had one full year of follow-up data. There was a significant reduction in A1c, LDL, triglycerides, and total cholesterol between baseline and one-year post-enrollment. HDL was significantly increased. Comparisons of the diabetes Health Plan Employer and Information Set (HEDIS) parameters were made between one year pre-DiabetesCARE enrollment and one year post-DiabetesCARE enrollment. Adherence to the HEDIS monitoring parameters showed a statistically significant increase after DiabetesCARE enrollment for the A1c test, lipid panel, and microalbuminuria screen. Eye examinations were the exception.
For the financial analysis, a pre-post, control group design was used to compare the change in expenditures for active participants in the DiabetesCARE program to a control group of diabetes patients within the UHP over a 10-quarter (30-month) period. The pre-period (baseline) for the intervention group was the 4 quarters prior to enrollment in DiabetesCARE. The intervention period consisted of the first 2 quarters after enrollment and the post-period (follow-up) was the 4 quarters that occurred after the intervention period (i.e., quarters 7-10). The baseline, intervention, and follow-up periods for the control group were selected for an equivalent time period during 2003 through 2005. The total annual expenditures for both groups increased at a similar rate. However, the control group experienced a decline in ambulatory medical care and diabetes drug utilization that was followed by a considerable increase in spending on inpatient and emergency department services. In contrast, the DiabetesCARE patients increased their use of medications and ambulatory care during the intervention period and decreased spending in inpatient and emergency department services.
The PharmacistCARE MTM service improves clinical outcomes for persons with diabetes and meets a need for its own employer.
View a pdf of the poster from the Midyear Meeting (1.86 MB).