Managed Care - March 2009 - (Page 31) for the procedure from the physician. Dehmer also says that health plans should use the appropriateness criteria to evaluate the treatment of members who are cardiac patients. “If it turns out that, say, 95 percent of the people that had a coronary revascularization did so for reasons that were judged to be appropriate, I would be very satisfied,” he says. “On the other hand, if there were a large proportion of patients that were getting coronary revascularization that was deemed inappropriate, I would be very concerned.” Free cardiovascular drugs? Researchers at Brigham & Women’s Hospital and Harvard Medical School, with funding from Aetna, are studying whether providing no-cost cardiovascular drugs to high-risk patients increases medication adherence and reduces future hospitalizations for cardiac events. “It would appear to be far more cost-effective to actually ensure that patients take their medicines, and therefore avoid future hospitalizations. That is exactly the question we are studying with Aetna,” says Elliott Antman, MD, a cardiologist at Brigham & Women’s. On paper, Antman says, giving free cardiovascular drugs appears to be a cost-effective — and lifesaving — opportunity for health plans. Results of the randomized clinical trial will not be known for at least a year. In the meantime, Antman hopes other insurers will follow Aetna’s lead in sponsoring health services research. “This may sound a little bit radical, but I am proposing to actually ask health plans to help plan some of the research for the important questions that we need to have answers to,” he says. “Those questions will not be answered by industry, and the National Institutes of Health is not going to be a source in the near-term future. Where else do we turn?” New performance measures An updated set of clinical performance measures to care for heart attack patients was intro- duced in December. The measures — jointly developed by the ACC and AHA — were published in the Dec. 9, 2008, issues of both the Journal of the American College of Cardiology and Circulation. Cardiologists have been at the forefront of developing performance measures, and measures of cardiovascular care were among the first to be included in Hospital Compare (http://www.hospitalcompare.hhs.gov/), the federal government’s Website that encourages patients to monitor the care delivered at their local hospitals. The measures reflect some of the 17 practice guidelines developed by a task force on practice guidelines — a joint effort of ACC and AHA — over the last three decades. “We are moving more and more to guidelines that are disease management guidelines rather than specific procedure-based guidelines like the original effort with pacemakers,” says Antman, the past chairman of the task force on practice guidelines. reminding them of the importance of the monthly tests. Medication reconciliation: After a 2004 pilot program found that many recently hospitalized patients were at risk of adverse drug events because they were taking their medications improperly, Harvard Pilgrim implemented a medication reconciliation program throughout the system. Pharmacists and nurse care managers work together, using an electronic medical record, to make sure newly discharged patients are not prescribed medications that are likely to interact with one another. Within three days of a patient’s discharge, a nurse calls each patient to determine whether the patient is taking medications as prescribed. If problems are identified, the nurse contacts the physician. During the program’s pilot phase, the pharmacists and nurses identified 150 actual or potential medication safety issues — drug-drug interactions, side effects, and compliance issues — in just 241 evaluations. Many of the problems involved warfarin, cardiac medications, and statins. About 17 percent of HPHC members discharged from the hospital in 2008 received medication reconciliation assessments, and potential drug-drug interactions were identified in 79 percent of the cases. “It shows that there is a value and a need for this type of program,” Bernstein says. HPHC’s 80 nurse care managers have been trained to support the medication reconciliation program, and two clinical pharmacists (full-time equivalent of 1.2) and a pharmacy intern work on it. Bernstein estimates the annual cost of the program to be about $115,000, which covers the pharmacy staff time. She believes the program may save the health plan nearly $1.4 million a year in avoided hospitalizations because patients taking warfarin are better managed. MC MARCH 2009 / MANAGED CARE 31 http://www.hospitalcompare.hhs.gov/ http://www.hospitalcompare.hhs.gov/
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