JMCP Research Articles

Framework for Pharmacy Services Quality Improvement-A Bridge to Cross the Quality Chasm.

To review the literature on the subject of quality improvement principles and methods applied to pharmacy services and to describe a framework for current and future efforts in pharmacy services quality improvement and effective drug therapy management. The Academy of Managed Care Pharmacy produced the Catalog of Pharmacy Quality Indicators in 1997, followed by the Summary of National Pharmacy Quality Measures in February 1999. In April 2002, AMCP introduced Pharmacy's Framework for Drug Therapy Management in the 21st Century. The Framework documents include a self-assessment tool that details more than 250 specific "components" that describe tasks, behaviors, skills, functions, duties, and responsibilities that contribute to meeting customer expectations for effective drug therapy management. There are many opportunities for quality improvement in clinical, service, and cost outcomes related to drug therapy management. These may include patient safety; incidence of medical errors; adverse drug events; patient adherence to therapy; attainment of target goals of blood pressure, glucose, and lipid levels; risk reduction for adverse cardiac events and osteoporotic-related fractures; patient satisfaction; risk of hospitalization or mortality; and cost of care. Health care practitioners can measure improvements in health care quality in several ways including (a) a better patient outcome at the same cost, (b) the same patient outcome at lower cost, (c) a better patient outcome at lower cost, or (d) a significantly better patient outcome at moderately higher cost. Measurement makes effective management possible. A framework of component factors (e.g., tasks) is necessary to facilitate changes in the key processes and critical factors that will help individual practitioners and health care systems meet customer expectations in regard to drug therapy, thus improving these outcomes. Quality improvement in health care services in the United States will be made in incremental changes that rely on a structure-process-outcome model. The structure is provided by evidence created from controlled randomized trials and other studies of care and system outcomes that are based on the scientific method. The process portion is created by the application of evidence in the form of clinical practice guidelines, clinical practice models, and self-assessment tools such as Pharmacy's Framework for Drug Therapy Management. Incremental changes in structure and process will result in the desirable outcome of meeting customer needs for more effective drug therapy and disease management. Authors Richard N. Fry and Steven G. Avey are employed by the Foundation for Managed Care Pharmacy, a nonprofit charitable trust that serves as the educational and philanthropic arm of the Academy of Managed Care Pharmacy; author Frederic R. Curtiss performed the majority of work associated with this manuscript prior to becoming editor-in-chief of the Journal of Managed Care Pharmacy. This manuscript underwent blinded peer review and was subject to the same standards as every article published in JMCP.

The Evolution of Disease State Management: Historical Milestones and Future Directions.

Twenty-five years ago, the Journal of Managed Care Pharmacy introduced its readers to disease state management, which attempted to break the siloed culture of the U.S. health care system. Disease state management has been transformed, in part, to population health management. This shift was marked by 3 main inflection points: the rise of the web-enabled smartphone, the Patient Protection and Affordable Care Act (ACA), and the adoption of artificial intelligence (AI). The introduction of smartphones filled the communication gap through improved patient engagement and accessible mobile applications, giving patients access to their clinical data. In addition, through the ACA, bundled payment models moved away from a volume-based to a value-based payment approach and attempted to incorporate population health concerns, such as the social determinants of health. The advancement of AI will allow the health care system to collect comprehensive health data and to predict the population at higher risk. Despite these advancements, some challenges from 25 years ago remain, yet rapid technology advancements may expedite the next wave of change. DISCLOSURES: No funding contributed to the writing of this article. The authors have nothing to disclose with respect to research, authorship, and/or publication of this article.

Understanding the Relationship between Primary Care Provider (PCP) Encounter Cadence, Medication Adherence, and Diabetes Control

Introduction: Regular PCP encounters are associated with wellbeing; there is limited evidence to support the ideal PCP encounter cadence to optimize patient outcomes. The aim of this study was to measure the association between PCP encounter cadence and medication adherence and diabetes control, among those newly diagnosed with T2DM. Methods: A cohort of 7,106 persons enrolled in a Medicare Advantage health plan and newly diagnosed with T2DM between 7/1/12-6/30/13, was identified and followed for 36 months. Two methods measured PCP encounter cadence: total PCP encounters (frequency) and quarters with PCP encounter (regularity). Proportion of days covered (PDC) assessed noninsulin diabetes medication (NIDM) adherence (PDC ≥80.0%). Diabetes control was defined as A1c ≤ 8.0%. Logistic regression was used to measure the relationship between PCP encounter cadence and outcomes (NIDM adherence, diabetes control). Covariates included patient demographics, Charlson Comorbidity Index score, chronic conditions, healthcare utilization, insulin use, and prior NIDM adherence and diabetes control. Results: Overall, 5,212 and 326 people met inclusion criteria for the NIDM adherence and diabetes control analyses, respectively. Adjusted models indicated that each additional PCP encounter was associated with a 12.3% increase in the likelihood of NIDM adherence (95% CI 1.10, 1.15), and each additional quarter with a PCP encounter was associated with a 27.4% increase in the likelihood of NIDM adherence (95% CI 1.22, 1.33). PCP encounters (OR 1.06; 95% CI 1.00, 1.12) and quarters with a PCP encounter (OR 1.13; 95% CI 0.98, 1.30) were directionally associated with diabetes control. Conclusion: Our findings suggest that frequency and regularity of PCP encounters were associated with medication adherence. This study contributes to the data needed to establish evidence-based guidelines for PCP encounter cadence, for those newly diagnosed with T2DM. Disclosure S.E. Wixson: None. J. Dobbins: Employee; Self; Humana Inc. T.A. Cordier: Employee; Self; Humana Inc.. Stock/Shareholder; Self; Humana Inc.. G. Haugh: None. A. Renda: None. L.E. Happe: Employee; Self; Humana. Other Relationship; Self; Journal of Managed Care Pharmacy. A. Turchin: Research Support; Self; Sanofi-Aventis. Advisory Panel; Self; Merck Sharp & Dohme Corp., Monarch Medical Technologies. Stock/Shareholder; Self; Brio Systems. Research Support; Self; Eli Lilly and Company.

Meeting Abstracts - Academy of Managed Care Pharmacy Nexus 2017.

The AMCP Abstracts program provides a forum through which authors can share their insights and outcomes of advanced managed care practice through publication in AMCP's Journal of Managed Care & Specialty Pharmacy (JMCP). Abstracts that have been reviewed are published in the JMCP Meeting Abstracts supplement. Poster presentations for AMCP Nexus 2017 are scheduled for Wednesday, October 18, from 12:00 pm to 2:45 pm. For each poster, at least 1 author is available during the poster presentations to discuss findings. Posters will also be displayed on Tuesday, October 17, from 4:15 pm to 6:15 pm, during the opening night reception in the Exchange. The AMCP Nexus 2017 meeting in Dallas, Texas, is expected to attract more than 2,400 managed care pharmacists and other health care professionals who manage and evaluate drug therapies, develop and manage networks, and work with medical managers and information specialists to improve the care of all individuals enrolled in managed care programs.

Meeting Abstracts - AMCP Managed Care & Specialty Pharmacy Annual Meeting 2017.

The AMCP Abstracts program provides a forum through which authors can share their insights and outcomes of advanced managed care practice through publication in AMCP's Journal of Managed Care & Specialty Pharmacy (JMCP). Poster presentations are Tuesday, March 28, from 5:45 pm to 7:30 pm. The posters will also be displayed on Wednesday, March 29, from 11:45 am to 2:45 pm. Podium presentations for the Platinum award-winning abstracts are Wednesday, March 29, from 4:30 pm to 5:45 pm. The reviewed abstracts are published in the JMCP Meeting Abstracts supplement. The AMCP Managed Care & Specialty Pharmacy Annual Meeting 2017 in Denver, Colorado, is expected to attract more than 2,000 managed care pharmacists and other health care professionals who manage and evaluate drug therapies, develop and manage networks, and work with medical managers and information specialists to improve the care of all individuals enrolled in managed care programs.

Meeting Abstracts - Academy of Managed Care Pharmacy Nexus 2016.

The Academy of Managed Care Pharmacy (AMCP) Abstracts program provides a forum through which authors can share their insights and outcomes of advanced managed care practice through publication in AMCP's Journal of Managed Care & Specialty Pharmacy (JMCP). Poster presentations are Tuesday, October 4, at 4:00 pm. The posters will also be displayed on Wednesday, October 5. The reviewed abstracts are published in the JMCP Meeting Abstracts supplement. The AMCP Nexus 2016 Meeting in National Harbor, Maryland, is expected to attract more than 2,000 managed care pharmacists and other health care professionals who manage and evaluate drug therapies, develop and manage networks, and work with medical managers and information specialists to improve the care of all individuals enrolled in managed care programs.

Meeting Abstracts - Annual Meeting 2016.

The AMCP Abstracts program provides a forum through which authors can share their insights and outcomes of advanced managed care practice through publication in AMCP's Journal of Managed Care & Specialty Pharmacy (JMCP). Most of the reviewed and unreviewed abstracts are presented as posters so that interested AMCP meeting attendees can review findings and query authors. The Student/Resident/ Fellow poster presentation (unreviewed) is Wednesday, April 20, 2016, and the Professional poster presentation (reviewed) is Thursday, April 21. The Professional posters will also be displayed on Friday, April 22. The reviewed abstracts are published in the JMCP Meeting Abstracts supplement. The AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016 in San Francisco, California, is expected to attract more than 3,500 managed care pharmacists and other health care professionals who manage and evaluate drug therapies, develop and manage networks, and work with medical managers and information specialists to improve the care of all individuals enrolled in managed care programs. Abstracts were submitted in the following categories: Research Report: describe completed original research on managed care pharmacy services or health care interventions. Examples include (but are not limited to) observational studies using administrative claims, reports of the impact of unique benefit design strategies, and analyses of the effects of innovative administrative or clinical programs. Economic Model: describe models that predict the effect of various benefit design or clinical decisions on a population. For example, an economic model could be used to predict the budget impact of a new pharmaceutical product on a health care system. Solving Problems in Managed Care: describe the specific steps taken to introduce a needed change, develop and implement a new system or program, plan and organize an administrative function, or solve other types of problems in managed care settings. These abstracts describe a course of events; they do not test a hypothesis, but they may include data.

Meeting Abstracts - Nexus 2015.

The AMCP Abstracts program provides a forum through which authors can share their insights and outcomes of advanced managed care practice through publication in AMCP's Journal of Managed Care Specialty Pharmacy (JMCP). Of the abstracts accepted for publication, most are presented as posters, so interested AMCP meeting attendees can review findings and query authors. The main poster presentation is Tuesday, October 27, 2015; posters are also displayed on Wednesday, October 28, 2015.The AMCP Nexus 2015 in Orlando, Florida, is expected to attract more than 3,500 managed care pharmacists and other health care professionals who manage and evaluate drug therapies, develop and manage networks, and work with medical managers and information specialists to improve the care of all individuals enrolled in managed care programs.Abstracts were submitted in the following categories:Research Report: describe completed original research on managed care pharmacy services or health care interventions. Examples include (but are not limited to) observational studies using administrative claims, reports of the impact of unique benefit design strategies, and analyses of the effects of innovative administrative or clinical programs.Economic Model: describe models that predict the effect of various benefit design or clinical decisions on a population. For example, an economic model could be used to predict the budget impact of a new pharmaceutical product on a health care system.Solving Problems in Managed Care: describe the specific steps taken to introduce a needed change, develop and implement a new system or program, plan and organize an administrative function, or solve other types of problems in managed care settings. These abstracts describe a course of events; they do not test a hypothesis, but they may include data.

Meeting abstracts - 27th annual meeting expo.

Abstracts provide a forum through which authors can share their insights and outcomes of advanced managed care practice through publication in AMCP's Journal of Managed Care Specialty Pharmacy (JMCP). Of the abstracts accepted for publication, most are presented as posters, so interested AMCP meeting attendees can review the findings and query authors. The main poster presentation is Thursday, April 9, 2015; posters are also displayed on Friday, April 10, 2015.The AMCP 2015 Annual Meeting Expo in San Diego, California, is expected to attract more than 3,500 managed care pharmacists and other health care professionals who manage and evaluate drug therapies, develop and manage networks, and work with medical managers and information specialists to improve the care of all individuals enrolled in managed care programs.

Academy of managed care pharmacy 2014 nexus meeting abstracts.

Abstracts provide a forum during which authors can share their insights and outcomes to advance managed care practice through publication in AMCP's Journal of Managed Care Specialty Pharmacy (JMCP). Of the abstracts accepted for publication, most are presented as posters, so interested AMCP meeting attendees can review the findings and query authors.

Abstracts from the Academy of Managed Care Pharmacy 26th Annual Meeting and Expo, April 1-4, 2014, Tampa, Florida.

s provide a forum during which authors can share their insights and outcomes to advance managed care practice through publication in AMCP’s Journal of Managed Care & Specialty Pharmacy (JMCP). Of the abstracts accepted for publication, most are presented as posters, so interested AMCP meeting attendees can review the findings and query authors. The main poster presentation is Thursday, April 3, 2014; posters are also displayed on Friday, April 4, 2014. Some posters were also selected for podium presentations. The 26th Annual Meeting & Expo in Tampa, Florida, is expected to attract more than 4,000 managed care pharmacists and other health care professionals who manage and evaluate drug therapies, develop and manage networks, and work with medical managers and information specialists to improve the care of all individuals enrolled in managed care programs.

Impact of the NCCN biomarkers compendium on managed care pharmacy.

"Impact of the NCCN Biomarkers Compendium on Managed Care Pharmacy." Journal of Managed Care Pharmacy, 19(1), pp. 68–69

Abstract 198: Assessing Performance Perceptions And Realities In Outpatient Atrial Fibrillation Care

Introduction: Clinician self-perception is the basis of assessments of care quality in the absence of frequent, quantitative reports on clinical guideline adherence. However, physicians’ self-assessments may reflect an unconscious upward bias. We suspect that gaps exist between clinician perception of care and the care that patients actually receive. We focus on outpatient treatment of atrial fibrillation (AF) patients, as performance measure (PM) rates are variable in AF, and because the introduction of novel anticoagulants has the potential to impact established stroke prevention regimes. Hypothesis: This study investigates the gaps between provider perceptions of AF care and documented performance on outpatient AF treatment. We hypothesize that perceptions of performance on AF outpatient PMs will exceed documented performance. Methods: A survey of PINNACLE Registry participants, including 37 physicians, 6 NPs, 3 PAs and 4 RNs was conducted July-August 2011 to assess clinician perception of outpatient AF treatment. Responses were compared to data collected in the ACC’s PINNACLE Registry, an outpatient registry with 222,451 AF patients from over 300 sites. Results: Gaps were revealed between provider perceptions of AF care and in documented care from PINNACLE. Providers overestimated the time spent in the therapeutic INR range, stating that their patients are in the optimal range 70.2% of time (average of 49 responses providing individual percentage range). Best estimates from literature indicate that patients, on average, are in the therapeutic range 55% of time 1 . Clinicians also overestimated the percent of time that they prescribe anticoagulants, estimating that they were prescribed to 93% of eligible patients (average of 49 responses providing individual percentage range). According to PINNACLE, only 60.4% (38841 of 64318) of eligible patients are receiving anticoagulants, leaving 21,225 patients at possible risk for stroke. Finally, clinicians predicted that 66.7% of their patients with AF have two or more risk factors for stroke. Yet, only 13% (11091 of 85433) of patients had their thromboembolic risk factors documented. Conclusion: There is a discrepancy between the care patients with AF should be receiving and the care they actually receive in practices, as documented in the PINNACLE Registry. The gap between clinician perception and reality highlights the importance of CV registries and of regular feedback reporting on clinician performance. 1. The PINNACLE Registry does not measure time spent in therapeutic INR range. This statistic from Baker, WL, Cios DA, Sander SD et al. Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. Journal of Managed Care Pharmacy . 2009;15:244_52.

Glycemic control was unchanged in Veterans Health Administration patients converted from glyburide to glipizide.

"Glycemic Control Was Unchanged in Veterans Health Administration Patients Converted from Glyburide to Glipizide." Journal of Managed Care Pharmacy, 18(1), p. 73

Reapplication Requirements for Prescription Assistance Program Mischaracterized

"Reapplication Requirements for Prescription Assistance Program Mischaracterized." Journal of Managed Care Pharmacy, 13(8), p. 687

Introduction: Targeted Evidenced-Based Colorectal Cancer Therapies: Shifting the Patient Outcome

"Introduction: Targeted Evidenced-Based Colorectal Cancer Therapies: Shifting the Patient Outcome." Journal of Managed Care Pharmacy, 13(6 Supp C), pp. 3–4

Pharmacy Benefits Management and the Medicare Modernization Act

"Pharmacy Benefits Management and the Medicare Modernization Act." Journal of Managed Care Pharmacy, 11(4), pp. 350–351

JMCP - July/August 1995 through June 2005

JMCP - July/August 1995 through June 2005

JMCP - July/August 1995 through November/December 2004

JMCP - July/August 1995 through November/December 2004

Life-And-Death Matters

When I grow up, I want to be a bioethicist. It would give me the opportunity to weigh in on all manner of life-and-death matters, mostly for liberal foundations and health care companies that are, in the main, irritated by the fact that we spend too much money on health care. The only thing stopping me is that in the end, as bioethicist Daniel Callahan calls for in What Price Better Health? I would be left supporting antismoking campaigns instead of research on a cure for spina bifida. According to Callahan, the research imperative is a philosophical view that regards medical research as more important than any other moral value or as a justification for certain “wrongs,” which for him is the “high” (we never find out relative to what) price of pharmaceuticals. In other words, Callahan believes that people (such as I) who see medical progress as the key to increasing life span, improving the quality of life, easing pain, and boosting productivity also believe that medical research has an absolute moral value that cannot be trumped by other concerns. He explains: “As health has improved, and mortality and disability declined, the drive for research has increased, not decreased. There seems to be no such thing as enough, no level of...health that leads to a reduction in research aspiration. A naive witness to discussions of American health might think that we have never been worse off, with a long...list of miseries still to be dealt with” (p. 33). On the one hand, Callahan believes that the research imperative is really fueled by a foolish desire by people who are not really sick, who are really healthy, to become absurdly and wastefully healthier still. But what about the fact that most of the research dollars in both the public and private sectors are devoted to finding better ways to prevent, treat, or cure diseases such as AIDS, Alzheimer’s, cancer, heart disease, diabetes, and mental illness? Or that genetic research is allowing scientists to more quickly translate molecular disease mechanisms into potential drugs or vaccines? On the other hand, Callahan believes that “as the success of research...portends, oldfashioned fatalism seems to have, so to speak, received a fatal blow.” There is no reason to accept any disease or disability with stoicism, more’s the pity, according to the author. Either way, Callahan seems to believe that the research imperative moves medical research in a wrong-headed direction: We spend too much money on health care in general instead of more socially useful things. But I digress. The research imperative, Callahan asserts, is to blame for people mistreating human subjects and lab animals alike in medical experiments. In making this assertion, he ignores a whole body of psychological research on the effects of environment on behavior (remember the Zimbardo prison experiment?), let alone the horrific “research” conducted by Nazi scientists on Jews without the research-imperative excuse. But this is not Callahan’s big beef. Rather, he has it in for drug companies, which he complains make way too much money, charge prices that are way too high, and try to get away by invoking the research imperative. B o o k R e v i e w s