Health plans seeking to improve their care management programs and reduce costs may wish to add a clinical pharmacist to their care management team, according to results of a study presented at the meeting by a group of pharmacy residents at OptumHealth Care Solutions Pharmaceutical Solutions Pharmacy Residency program at OptumHealth, in Golden Valley, MN.
Many studies have demonstrated over the years the value that clinical pharmacists bring to any healthcare setting. However, according to YK Mach, PharmD, and his pharmacy resident colleagues, no study has yet demonstrated the incremental value, or return on investment (ROI), of adding a pharmacist to a case management team, which is usually overseen by nurses and medical directors.
The group set out to (1) develop work flow and processes for integrating a pharmacist into the case management team, (2) identify opportunities for the pharmacist to improve medication management in this context, and (3) measure the incremental value of including a clinical pharmacist on the management team.
The team of pharmacists performed 42 comprehensive medication reviews between October 2010 and March 2011 of cases referred by the care management team of OptumHealth or from claims that revealed inappropriate prescribing, medication nonadherence, or a patient’s prescription costs exceeding $35,000 annually.
Even for this small number of cases, applying the pharmacists’ medication reviews allowed the team to identify 377 opportunities for improving medication therapy management, involving 130 (34%) occasions for improving medication safety, 130 instances (34%) for reducing medication costs, 99 (27%) opportunities for improving adherence, and 18 times (5%) of facilitating better coordination of provider care. In addition, although medication safety issues are normally detected by automated safety mechanisms, among the 130 medication safety concerns identified in this study, 67% required a review by and an interpretation of a pharmacist.
The economic impact of this pharmacist-directed medication review resulted in total potential savings of $392,806—amounting to an average of $9353 potential cost-saving per case, which translated to a potential ROI of 10:1 and an actual claims-confirmed ROI of 3:1.
These results, the investigators suggest, clearly indicate that adding a pharmacist to care management programs (disease or case management programs) adds a significant clinical and economic value.