Managed Healthcare Executive - April 2009 - (Page 25) statement announcing the new measures. with at least one heart condition was just “They guide us to areas of opportunity 1.9%, relative to 1.6% for the population where we can do better—and our patients as a whole, with or without heart-condibene t from that.” tions or events. While earlier randomized studies REHAB: PUSHING showed longer rehab can improve longterm outcomes, “this study shows it can COMPLIANCE Cardiac rehabilitation is essential to pa- be done in a normal clinical setting,” says tients’ recovery, but just over one-third lead researcher Ray Squires. “We look at of myocardial infarction survivors partici- coronary disease as a chronic condition. pate in outpatient cardiac rehabilitation, We don’t think it makes much sense to according to a nationwide survey released put a patient in a three-month program last year by the Centers for Disease Control and then say, ‘You’re done.’” and Prevention (CDC). But even rehabilitation, as it’s currently PHARMACISTS: OFFERING provided, may not be enough. Most carFRIENDLY REMINDERS diac rehab programs are limited to 36 Adhering to prescribed drug therapy is essessions or about three months. Upon sential to heart health. A recent study of discharge from the programs, many pa- more than 1,000 heart patients by CVS tients stop complying with their medi- Caremark found nearly half were not takcation therapy and resume many of their ing their medications as prescribed, nearbad health habits, such as smoking, poor ly doubling their risk of rehospitalization diet and lack of exercise. within a year. In a recent study published in the Journal In an e ort to improve compliance, of Cardiopulmonary Rehabilitation and Preven- managed care organizations and PBMs tion, the Mayo Clinic found patients who are working to enhance patient underparticipated in a three-year cardiac reha- standing of the importance of drug therapy bilitation program demonstrated better and mining claims data to identify opportherapy adherence and heart health. Par- tunities to improve care. ticipants initially followed a typical rehab CVS Caremark’s Adherence to Drug pattern of supervised exercise sessions, Therapy Program includes face-to-face advice on exercising at home and group rst ll counseling, interactive voice reeducation meetings with a case manager. sponse communication, Web re ll reSubsequently they met with non-physician minders, pharmacist calls and other outcase managers every three to six months for reach methods. According to the company, three years to discuss risk factor manage- the outreach program helps approximately ment, proper use of prescribed medicines 88% of enrolled patients with heart failand lifestyle factors. ure maintain optimal adherence to their At the end of the three years, the re- medications. searchers found 91% of patients still took On the PBM side, CVS Caremark’s aspirin and cholesterol-lowering statins, clients have access to the AccordantCare 78% were taking beta-blockers to con- Health Management Program for Heart trol blood pressure and 76% were still on Failure, which evaluates care in light of angiotensin-converting enzyme blockers nationally recognized guidelines. Troyen to control blood pressure. What’s more, Brennan, MD, executive vice president most had increased their level of exercise, and chief medical o cer, expects outreach quit smoking and achieved their blood e orts to become increasingly e ective pressure and LDL cholesterol treatment as pharmacy organizations learn to tailor goals. Patient mortality among enrollees interventions with greater precision. 2 In 2007, PBM Medco organized its pharmacies into Therapeutic Resource Centers, which feature specialized pharmacists in seven areas, including heart conditions. Only specially trained pharmacists dispense the related heart drugs, while managing patient needs at the condition level instead of the script level. 4 CONSUMER ADVOCATES: PROVIDING INFORMATION 3 Heart patients are ultimately responsible for their own self management, and advocates providing more helpful data to inform patients’ decisions. For example, the Consumers Union publishes a list of Best Buy Drugs, evaluated by the Oregon Health and Science University in Portland, Ore., to help consumers maximize their drug spending. It published “Best Drugs For Less” in print and online just a few weeks ago. When it comes to heart disease, the applea-day approach wins. “Ours is a plodding, non-sexy approach to going after risk factors,” says Mike Taylor, MD, medical director for health promotion at Caterpillar. Caterpillar o ers free onsite physicals, biometric screenings, health coaching and blood pressure monitoring stations. It supplies smokers with free nicotine patch programs, telephonic support and, if prescribed, medication. To encourage better drug therapy compliance, Caterpillar began o ering free generic prescriptions through Wal-Mart, a move that increased compliance among patients taking statins from 70% to 80%. These programs are helping to contain Caterpillar’s healthcare cost increases to about 1% annually since 2002. MHE 5 EMPLOYERS: TAKING A PROACTIVE APPROACH FOR MORE INSIGHT See more Health Management on managedhealthcareexecutive.com APRIL 2009 25 http://www.managedhealthcareexecutive.com
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