Challenges of program implementation in a managed care environment: a case study in measuring medication persistence.

Abstract

To describe the challenges of implementing a disease management program in a managed care environment. A key element in the successful management of depression is ensuring persistent consumption of medication throughout the duration of a standard course of therapy. However, treating physicians rarely have easy access to the exact records necessary to determine medication persistence. Prescription claims databases do contain this information. Properly identifying problem consumption patterns from these data is one of the most valuable services that managed care pharmacists can provide in a disease management program. The experiences of Aetna Inc. in implementing a depression management program illustrate some of the most important factors to be considered when designing a program: obtaining approval from senior management, measuring baseline performance before program initiation, selecting plan members and physicians based on patterns of consumption in prescription claims data, and quantifying effectiveness. A visual representation of prescription refill dates and quantities available in prescription claims databases allowed member physicians to determine, at a glance, each patient.s medication persistence. Such representations of data are valuable for helping identify problem consumption patterns that require further analysis, such as noncontinuous treatment, low usage, and nonpersistence. However, such data are not recommended for use in a vacuum. that excludes considerations such as therapeutic indication and environment.