Program helps docs improve prescribing for Medicaid patients

A program funded by Eli Lilly in 19 states is improving the quality of care Medicaid patients receive by aligning physician prescribing of mental health medications with national, evidence-based best prescribing practices.

The Behavioral Health Pharmacy Management Program, carried out by Comprehensive NeuroScience Inc. and state agencies, evaluates Medicaid pharmacy claims for all mental health medications to identify prescribing patterns that are inconsistent with national evidence-based prescribing practices. The program educates doctors who deviate from the best practices.

Some of the inconsistent prescribing patterns addressed include duplicative prescribing of medication by different doctors for the same patient; premature, rapid switching from one medication to another; failure of patients to fill their prescriptions in a timely manner; prescribing multiple medications from the same therapeutic class; and prescribing above or below recommended dosing levels.

Since its implementation, the program has resulted in 190,000 prescriber and 1.3 million patient care improvement interventions nationwide. In addition to information about specific patients, doctors receive regular information bulletins about special topics related to mental health medications, such as behavioral health medication for children. Doctors who continue to experience the same issues over time are offered a peer consultation to discuss prescribing practices.

"We know that educating physicians on prescribing patterns for drugs that treat mental illness is an excellent way to improve the overall quality of mental health treatment within our Medicaid program," says Michigan Department of Community Health director Janet Olszewski. "Through this project, many opportunities for coordination of care have been identified, resulting in improved quality of care and enhanced quality of life for [people] with mental illness."

Each program is customized to meet the needs of the participating states. Comprehensive NeuroScience provides these examples of program results:

  • Michigan. The Michigan Department of Community Health's Pharmacy Quality Improvement Project demonstrated improvement in the quality of care provided to Michigan patients with mental illness. The project is planned as a three-year educational program that analyzes the prescribing of mental health medications for Medicaid adult and child members and identifies prescribing patterns that are inconsistent with evidence-based guidelines. An impact analysis was performed comparing claims cost before and after the program and showed a 22% reduction in claims and a 21% reduction in cost from May 2005 through January 2006.
  • Missouri. An analysis of the Missouri Mental Health Medicaid Pharmacy Partnership Program covered 1,911 Medicaid recipients whose physicians received notification for at least one of the program's quality indicators during two consecutive written communications. Individuals similar to those patients were selected for a comparison group. The study compared the two groups six months pre-intervention and six months post-intervention.
    The researchers found that hospital admissions for those in the intervention group decreased by 43%, compared to a 1% decrease in the comparison group. A 1,813 decrease in total hospital days was recorded for the intervention group, compared to a 688-day decrease in the comparison group. And a $1,238 decrease in cost per person for the intervention group was seen, compared to a $312 decrease in the comparison group.
    "We had two landmark findings," says Missouri Department of Mental Health chief clinical officer Joseph Parks. "First, that focusing on improving quality really is an effective way to control costs. And second, even though we were only focusing on improving prescription practices for psychiatric medications, we found greater savings in reductions of costs of hospitalization, outpatient treatment, and other medications. You really have to look at the total health care impact to understand what a difference improving quality can make. The partnership is a model for reducing hospitalizations, containing pharmacy costs, improving prescribing practices, and maintaining open access to psychiatric medications through collaboration and education."
  • New Jersey. The New Jersey HealthyLiving Behavioral Pharmacy Management program is a collaborative project within the state's Department of Human Services Division of Medical Assistance and Health Services and the Division of Mental Health Services. Although the program has just started, positive trends reportedly have been seen in the area of children's mental health.