Quality and Cost Outcomes of Clinical Pharmacist Interventions in a Capitated Senior Drug Benefit Plan

Abstract

OBJECTIVES: To measure the cost outcomes of interventions by clinical pharmacists in the drug therapy of high-use patients in a Medicare+Choice managed care health plan. DESIGN: Prospective pre/post design without a control group. SETTING: Ambulatory care setting within an integrated health care delivery system. PARTICIPANTS: 80 patients, aged 65 or older, on five or more medications with a limited prescription drug benefit ($1,000 per year maximum). MEASURES: The study evaluated the impact of drug regimen review and subsequent interventions on prescribing alignment with national and local health-system disease management guidelines, drug selection and appropriate dose, prescription costs per-patient--per-month (PPPM), total medical and drug cost PPPM, number of prescriptions PPPM, and provider/patient satisfaction. Medication appropriateness and compliance were assessed through medical records, prescription claims data, and patient interviews. Recommendations were communicated to the primary care provider for each patient. RESULTS: Of 294 patient conditions, 238 (80.9%) cases were in alignment with national guidelines for treatment pre-intervention; 262 (89.1%) were in alignment post-intervention. This represents a 10.2% relative increase in alignment (p=0.001) with national therapy guidelines. Overall, 206 (73.5%) recommendations were implemented. Average PPPM prescription costs (cost incurred by plan) were $175.70 prior to intervention and $158.66 after. This represents a decrease in average prescription costs PPPM of $17.04 ± 7.01 (p=0.012). The average number of prescriptions PPPM decreased from 7.6 to 7.1 (p=0.001). Total cost of care (includes hospitalizations, pharmacy costs, and all medical encounters), medical encounters, and adverse events did not differ statistically from baseline (p=0.146, p=0.077 and p=0.672, respectively). CONCLUSIONS: Drug regimen review and redesign was successful at reducing pharmacy costs without increasing other health care costs. Most important, drug costs were decreased while adherence to evidence-based national guidelines, an intermediate measure of clinical outcome, and a favorable quality outcome improved.