Actual Versus Projected Cost Avoidance for Clinical Pharmacy Specialist -Initiated Medication Conversions in a Primary Care Setting in an Integrated Health System

Kroner, Beverly A.; Billups, Sarah J.; Garrison, Kathleen M.; Lyman, Alfred E.; Delate, Thomas

doi:10.18553/jmcp.2008.14.2.155

Cited by 10 publications

(10 citation statements)

References 15 publications

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“…While the Kaiser Permanente Northern California automated databases have been shown to be comprehensive and accurate,8 9 we conducted a validation study of the diagnoses of malformations by comparing the diagnoses between medical charts and our clinical databases. We randomly selected 237 maternal-infant pairs for a validation study.…”

Section: Methodsmentioning

confidence: 99%

Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study

Yang

Andrade³

et al. 2011

BMJ

182

142

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Objective To examine a reported association between use of angiotensin converting enzyme (ACE) inhibitors during the first trimester and risk of malformations in offspring.Design A population based, retrospective cohort study linking automated clinical and pharmacy databases including comprehensive electronic medical records.Participants Pregnant women and their live born offspring (465 754 mother-infant pairs) in the Kaiser Permanente Northern California region from 1995 to 2008. Main outcome measure Congenital malformation in live births.Results The prevalence of ACE inhibitor use in the first trimester only was 0.9/1000, and the use of other antihypertensive medications was 2.4/1000. After adjustment for maternal age, ethnicity, parity, and obesity, use of ACE inhibitors during the first trimester only seemed to be associated with increased risk of congenital heart defects in offspring compared with normal controls (those with neither hypertension nor use of any antihypertensives during pregnancy) (15/381 (3.9%) v 6232/400 021 (1.6%) cases, odds ratio 1.54 (95% confidence interval 0.90 to 2.62)). A similar association was observed for use of other antihypertensives (28/1090 (2.6%) cases of congenital heart defects, odds ratio 1.52 (1.04 to 2.21)). However, compared with hypertension controls (those with a diagnosis of hypertension but without use of antihypertensives) (708/29 735 (2.4%) cases of congenital heart defects), neither use of ACE inhibitors or of other antihypertensives in the first trimester was associated with increased congenital heart defects risk (odds ratios 1.14 (0.65 to 1.98) and1.12 (0.76 to 1.64) respectively).Conclusions Maternal use of ACE inhibitors in the first trimester has a risk profile similar to the use of other antihypertensives regarding malformations in live born offspring. The apparent increased risk of malformations associated with use of ACE inhibitors (and other antihypertensives) in the first trimester is likely due to the underlying hypertension rather than the medications.

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Section: Methodsmentioning

confidence: 99%

Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study

Yang

Andrade³

et al. 2011

BMJ

182

142

View full text Add to dashboard Cite

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“…In addition, a recent (2008) study of pharmacist interventions, conducted by Kroner el al., found that projected medication cost savings overstated actual cost savings by 14%. 17 However the Kroner et al study was limited to medication conversion savings and did not include cost-saving analyses of other resources, such as physician visits and hospitalizations, which were included in the present study. Second, the absence of a comparison group makes this a descriptive report without the ability to attribute outcomes to the pharmacist interventions; there is no way to determine if the billed MTM intervention would have been performed without the MTM administrative services company's network, either by another health care provider or by a patient representative.…”

Section: Limitationsmentioning

confidence: 99%

Analysis of Pharmacist-Provided Medication Therapy Management(MTM) Services in Community Pharmacies Over 7 Years

Barnett

Frank²,

Wehring³

et al. 2009

JMCP

158

116

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BACKGROUND: Although community pharmacists have historically been paid primarily for drug distribution and dispensing services, medication therapy management (MTM) services evolved in the 1990s as a means for pharmacists and other providers to assist physicians and patients in managing clinical, service, and cost outcomes of drug therapy. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003) and the subsequent implementation of Medicare Part D in January 2006 for the more than 20 million Medicare beneficiaries enrolled in the Part D benefit formalized MTM services for a subset of high-cost patients. Although Medicare Part D has provided a new opportunity for defining the value of pharmacist-provided MTM services in the health care system, few publications exist which quantify changes in the provision of pharmacist-provided MTM services over time.OBJECTIVES: To (a) describe the changes over a 7-year period in the primary types of MTM services provided by community pharmacies that have contracted with drug plan sponsors through an MTM administrative services company, and (b) quantify potential MTM-related cost savings based on pharmacists' self-assessments of the likely effects of their interventions on health care utilization.METHODS: Medication therapy management claims from a multistate MTM administrative services company were analyzed over the 7-year period from January 1, 2000, through December 31, 2006. Data extracted from each MTM claim included patient demographics (e.g., age and gender), the drug and type that triggered the intervention (e.g., drug therapeutic class and therapy type as either acute, intermittent, or chronic), and specific information about the service provided (e.g., Reason, Action, Result, and Estimated Cost Avoidance [ECA]). ECA values are derived from average national health care utilization costs, which are applied to pharmacist self-assessment of the "reasonable and foreseeable" outcome of the intervention. ECA values are updated annually for medical care inflation.RESULTS: From a database of nearly 100,000 MTM claims, a convenience sample of 50 plan sponsors was selected. After exclusion of claims with missing or potentially duplicate data, there were 76,148 claims for 23,798 patients from community pharmacy MTM providers in 47 states. . During the 7-year period, pharmacistprovided MTM interventions changed from primarily education and monitoring for new or changed prescription therapies to prescriber consultations regarding cost-efficacy management (Pearson chi-square P < 0.001). Services also shifted from claims involving acute medications (e.g. penicillin antibiotics, macrolide antibiotics, and narcotic analgesics) to services involving chronic medications (e.g., lipid lowering agents, angiotensin-converting enzyme [ACE] inhibitors, and beta-blockers; P < 0.001), resulting in significant changes in the therapeutic classes associated with MTM claims and an increase in the proportion of older patients served (P < 0.001). These trends resulte...

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“…We used a simple approach of differences between projected and actual expenditures during the performance year as this study's primary outcome variable. 12 Alternative values for projected expenditures were calculated using 4 alternative inflation or cost-trend assumptions (other factors remaining constant). The most locally relevant analysis used Georgia's own cost-trend assumptions for their non-dually-eligible disabled Medicaid population.…”

Section: Analytic and Statistical Methodsmentioning

confidence: 99%

Economic Impact of a Medicaid Population Health Management Program

Rust

Strothers

Miller

et al. 2011

Population Health Management

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A population health management program was implemented to assess growth in health care expenditures for the disabled segment of Georgia's Medicaid population before and during the first year of a population health outcomes management program, and to compare those expenditures with projected costs based on various cost inflation trend assumptions. A retrospective, nonexperimental approach was used to analyze claims data from Georgia Medicaid claims files for all program-eligible persons for each relevant time period (intent-to-treat basis). These included all non-Medicare, noninstitutionalized Medicaid aged-blind-disabled adults older than 18 years of age. Comparisons of health care expenditures and utilization were made between base year (2003)(2004) and performance year one (2006)(2007), and of the difference between actual expenditures incurred in the performance year vs. projected expenditures based on various cost inflation assumptions. Demographic characteristics and clinical complexity of the population (as measured by the Chronic Illness and Disability Payment System risk score) actually increased from baseline to implementation. Actual expenditures were less than projected expenditures using any relevant medical inflation assumption. Actual expenditures were less than projected expenditures by $9.82 million when using a conservative US general medical inflation rate, by $43.6 million using national Medicaid cost trends, and by $106 million using Georgia Medicaid's own cost projections for the non-dually eligible disabled segment of Medicaid enrollees. Quadratic growth curve modeling also demonstrated a lower rate of increase in total expenditures. The rate of increase in expenditures was lower over the first year of program implementation compared with baseline. Weighted utilization rates were also lower in high-cost categories, such as inpatient days, despite increases in the risk profile of the population. Varying levels of cost avoidance could be inferred from differences between actual and projected expenditures using each of the health-related inflation assumptions. (Population Health Management 2011;14:215-222)

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Actual Versus Projected Cost Avoidance for Clinical Pharmacy Specialist -Initiated Medication Conversions in a Primary Care Setting in an Integrated Health System

Cited by 10 publications

References 15 publications

Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study

Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study

Analysis of Pharmacist-Provided Medication Therapy Management(MTM) Services in Community Pharmacies Over 7 Years

Economic Impact of a Medicaid Population Health Management Program

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