Managed Care - November 2008 - (Page 15)

MEDICATION MANAGEMENT panies now market, and pharmacists will be able to offer a degree of coordination, especially for patients with chronic diseases, that no other provider, including physicians, is as readily able to provide,” says Keckley. “Plans should consider paying for that service.” According to Deloitte, the primary populations served by DM programs are patients with “high-prevalence/high-cost” diseases such as asthma, diabetes, congestive heart failure, chronic obstructive pulmonary disorder and coronary artery disease. These populations “benefit from self-care coaching,” says Keckley, “and they trust their pharmacists.” “There is great potential for pharmacists as care coordinators,” Cahill agrees.“That’s part of the promise that medication therapy management holds for the quality of care.” “There is a huge set of costs associated with lack of proper medication mismanagement,” says Keckley,“resulting from wrong doses, drugdrug complications, or even bad handwriting. Focusing on medication management as a core element of disease management, something pharmacists at the retail level are professionally prepared to do, could improve the accuracy of diagnosis, the appropriateness of scripts and improve patient adherence.” Keckley says that even within the DM process as it exists today, pharmacists are being underutilized. And given that $330 billion a year is spent on drugs, encouraging pharmacists to play an active role in the care management process for chronic diseases already makes good business sense. “Pharmacists already have access to a patient’s drug history, including over-the-counter medications, through insurance data,” says Keckley. “This data can provide a strategic advantage in disease management, an advantage that is currently underutilized.” Deloitte expects the market for disease management services to reach $30 billion within five years as a result of the nation’s aging population, increased incidence of chronic diseases, increased enrollment in Medicare and Medicaid programs, and continuing pressure to contain health care costs. Research shows that only 1 in 4 diagnosed patients with chronic condi- tions takes medication as directed, “so medication management is a significant determinant of chronic care management outcomes and cost avoidance,” says Keckley. Another element of all this is that although “the centricity of the physician-patient relationship is a fundamental premise of disease management, the degree to which physicians are involved in the actual coaching process varies widely,” says Keckley, in spite of strong evidence that a higher degree of treatment compliance occurs when physicians are involved. “EMRs will play a role in that,” says Keckley, “because they can assist in more accurate diagnoses and appropriate treatment plans and can make that information more available to pharmacists, who many patients view as highly trustworthy.” Keckley adds that vendors of disease management services do not use currently available patient-tracking and other information technology software effectively. He adds that plans are paying DM companies for operating models that are inefficient and nonscalable. And right now, although more than 70 million individuals (almost 40 percent of the adult population) have one or more chronic diseases, with seniors routinely diagnosed with three or more, only 20 million of those patients participate in any disease management program. “For pharmacists to play a pivotal part in care management,” says Judy Cahill, executive director of the Academy of Managed Care Pharmacy, “[access to] the medical record is essential.” Medicare The federal government has a stake in this. More than 80 percent of Medicare enrollees have one or more chronic conditions. Health expenditures for Medicare increased to $401 billion in 2007, including a 19.8 percent increase in prescription drugs. As a result of these trends — improved technology and a growing demand for improved DM services — Keckley says that “health plans and Medicare will pay retail pharmacies for disease management services that result in improved patient care and lower costs.” “Reimbursement for disease management services will be accepted by commercial plans and tested by Medicare via pilot programs,” he says. “It’s already happening. Placing pharmacists in that scenario is not a big jump.” MC NOVEMBER 2008 / MANAGED CARE 15

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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