PHARMACY SERVICES/MTM ECONOMIC OUTCOMES

Question 1

(This will be on Exam)

ECONOMIC VALUE OF PHARMACY SERVICES

Economic value can be generated via:

reduction in urgent care use via improvements in ambulatory care and medication use (e.g., ____________)

Improved ____________ and integration

Optimization of medication use via
_______________ (particularly relevant in older
adults)

Answer 1

treatment adherence

care coordination

deprescribing

Question 2

EVIDENCE ON ECONOMIC VALUE OF TRANSITIONS OF CARE

Pharmacist case
manager providing:

admission medication
reconciliation

in-patient medication
recommendations to the hospital
team

patient education

post-discharge information to
community physicians

post-discharge telephone call to patients did not affect medication appropriateness, adverse
events or post-discharge healthcare utilization (Farris et al)

Pharmacist-home visits to Medicare beneficiaries discharged from a hospital and 30-day
readmissions -> no difference in readmission between intervention and control groups
(Shcherbakova et al)

Question 3

When developing and implementing pharmacy services, careful considerations should be given to continuity of ____ and building relationships with patients’ ___________

Answer 3

care

primary care teams

Question 4

DISEASE MANAGEMENT PROGRAMS
Prevalence of chronic conditions
Economic impact of chronic diseases
Targets for disease management: diabetes,
heart failure, COPD, hypertension

Question 5

(This will be on Exam)

DISEASE MANAGEMENT PROGRAMS
Well-designed programs may:
Reduce ___________
Increase quality of care
Improve _____________
Have high patient satisfaction

Answer 5

costs

outcomes

Question 6

KEY PROVIDERS OF DISEASE MANAGEMENT SERVICES
Nurses
Advanced Practice Nurses
Pharmacists

Question 7

BASICS OF PROGRAM EVALUATION
Timely data collection (utilization rates, health outcomes (both short & long term), ______, patient satisfaction)

Internal outcomes evaluation to determine which program refinements may be needed

Independent evaluation of the outcomes (to provide _________ assessment)

Answer 7

costs

bias-free

Question 8

PHARMACIST-RUN DIABETES MANAGEMENT PROGRAM SHOWED
REDUCTIONS IN ALL HEALTHCARE UTILIZATION: MEDICATIONS, URGENT CARE AND OUTPATIENT CARE. THE PROGRAM SHOULD BE IMPLEMENTED NATION-WIDE TO CONTROL HEALTHCARE COSTS.
A. True
B. False

Question 9

THE REPORT SHOWS THAT ER ADMISSIONS FOR APPENDICITIS DROPPED SIGNIFICANTLY AFTER PHARMACIST-RUN ADHERENCE MANAGEMENT PROGRAM FOR PATIENTS WITH HYPERTENSION. THE ANTIHYPERTENSIVE ADHERENCE REDUCED URGENT HEALTHCARE UTILIZATION.
A. True
B. False

Question 10

THE DIABETES MANAGEMENT PROGRAM VENDOR
STATES IN ITS REPORT THAT THE PROGRAM
REACHED COST REDUCTIONS OF 200%. THE
RESULTS:
A. Indicate an extremely
effective program
B. Indicate a serious red
flag and call for thorough
examination of the
outcomes evaluation
methodology

Question 11

BASIC RULES FOR EVALUATION
1. An evaluation metric cannot be reduced by more than
100%
2. All evaluation outcomes cannot improve at the same
time
3. The 25% rule of thumb for voluntary programs (not
financially incentivized)
4. Dose-response relationship (costs cannot fall faster
than quality indicators improve )
5. Improvement (e.g., ↓inpatient care use) has to be
related to intervention (e.g., improved adherence,
preventive care use)
6. Control group equivalency

Question 12

RULE #1:AN EVALUATION METRIC CANNOT BE REDUCED BY MORE THAN 100%
PCMH Effectiveness: The Proof Is In
HI-WIRE
George Miller
January 04, 2010
A five-year prospective evaluation of the
model yields a 129% increase in patients
receiving optimal diabetes care and a 48%
increase for heart-disease patients. The model
also achieved a 350% reductionin
appointment waiting time, as reported by the
Institute for Healthcare Improvement.

This study is FALSE

Question 13

RULE #2 :ALL EVALUATION OUTCOMES CANNOT IMPROVE AT THE SAME TIME
Insulating your house saves money on heat, but not on insulation

Question 14

PROBLEMS WITH EARLIER SLIDE?
North Carolina Medical Home focused on
common chronic disease

Medicaid babies weren’t enrolled in the
medical home program

Question 15

1. A number cannot decline >100%
2. The Every Metric Can’t Improve Rule – people have
   to get their care from somewhere
3. The 25% Savings Rule – Nothing declines by a
   quarter or more in a voluntary non-incentivized
   program
4. The Nexus Rule—reduction has to be related to
   intervention
5. The Quality Dose–Cost Response Rule—costs can’t
   fall faster or more than quality indicators improve
6. The Control Group Equivalency Rule—“matched
   controls” and “pre-post historic vs. non-disease trend”
   are not appropriate because because participants will always
   outperform non-participants