Featured Health Business Daily Story, Jan. 4, 2017

Highmark Adds Clinical Pharmacists To Its Care Management Teams

Reprinted from DRUG BENEFIT NEWS, biweekly news and proven cost management strategies for health plans, PBMs, pharma companies and employers. Sign up for an $86 two-month trial subscription today.

By Angela Maas, Managing Editor
December 23, 2016Volume 17Issue 24

One health plan recently added clinical case management pharmacists to its care management teams with an eye on offering an extra level of care to its members. Highmark Inc. says that the new additions will provide members with a range of services to better manage their health care needs, including helping to prevent medication errors.

The Highmark teams take a holistic approach to member management, offering not only physical care but also emotional and mental help. And their focus is on keeping people well, tending to them not only when they are sick, so the wellness approach includes helping people eat right and exercise to help manage chronic conditions such as asthma and diabetes. The newly added pharmacists can help recommend the best treatments in terms of safety and efficacy, flag any potential drug interactions, assist with medication adherence, address therapies’ side effects and identify misuse of drugs. Some medication-specific issues such as drug interactions may require the pharmacist to contact a patient’s physician. And when a patient has multiple physicians prescribing numerous medications, the pharmacist will help manage the providers and prescriptions.

Drug Benefit News

Pharmacists Will Offer Patient Education

“In some cases, the pharmacists will directly provide counseling to the patient on side effects, more effective use of medications, drug-administration techniques, managing multiple medications, interactions and possible duplications,” says Highmark, as well as educate patients to make sure they know how to properly store and handle medications and understand all that their disease state entails. “They will also advise patients on how to save money on their prescription drugs through the use of formulary alternatives, patient-assistance programs and mail-order opportunities.”

“The multidisciplinary team addresses the full person…[and] is able to meet clinical, social and behavioral needs,” explains Aaron Billger, a spokesperson for Highmark Health. “We’ve made a geographically based model to build intimate knowledge of members, providers, facilities, partners, community resources and services in an area.”

Billger tells DBN that the pharmacists — who are Highmark employees — “all have very diverse backgrounds including, but not limited to, retail, hospital, managed care, utilization management, long-term care, consulting and specialty pharmacy.” As far as their training, when they start “with the case management team, these pharmacists go through multiple weeks of training on all systems used here at Highmark. They also attend week-long training on motivational interviewing. The pharmacists shadow other case management pharmacists as well as other disciplines that they work closely with.”

The pharmacists will work with Medicare Advantage and individual members, he explains. They will join multidisciplinary care teams consisting of a “complex case manager, behavioral health specialist, social worker, disease manager,…medical director and non-clinical coordinator. The complex case manager and disease manager are nurses.”

Preventable Drug Errors Kill 1.3 Million Annually

According to Ryan Cox, director of clinical pharmacy services for Highmark, “Every day, preventable medication errors cause at least one death, and every year, they result in injury to approximately 1.3 million people in the U.S. In fact, it is the third leading cause of death in the United States. That’s why it was so important for Highmark Inc. to add clinical case management pharmacists to its care management teams. We want our members to get the same comprehensive, individualized care and personal attention they receive relative to their medical care on matters related to their prescription drugs.”

Cox compares the pharmacists to a “concierge service” that helps both the care team and patients address complex health issues. “It’s just one more way for us to serve our members proactively, and also for members to get important information and answers to questions they need to successfully manage their health.”

Billger tells DBN that Highmark’s PBM is Express Scripts Holding Co. The care management team “is able to access our members’ pharmacy claims via Express Scripts to help them better understand their claims,” he explains. “In addition, the case management pharmacists, via an Express Scripts software application, proactively identify complex members and provide outreach to help them better manage their disease states and medications.”

Multiple studies have shown improved health outcomes and costs when clinical pharmacists are added to care management teams. For example, a May/June 2011 article in American Health & Drug Benefits describes the study results from pharmacy residents at the OptumHealth Care Solutions Pharmaceutical Solutions Pharmacy Residency program at OptumHealth who sought to prove the value of adding a pharmacist to a case 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.”

The researchers identified “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.”


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