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Lessons from States
H. Joseph Byrd, Pharm.D., Chair, Department of Clinical Pharmacy Practice, University of Mississippi Medical Center, Jackson, MI.
Charles D. Kight, Administrator, Florida Agency for Health Care Administration, Tallahassee, FL.
Michelle Whitehurst-Cook, M.D., Associate Professor of Family Medicine, Department of Family Practice, School of Medicine, Virginia Commonwealth University, Richmond, VA.
This session provided examples of leading State disease management initiatives under Medicaid in Mississippi, Florida, and Virginia, focusing on relevant policy and implementation issues.
Dr. Byrd outlined Mississippi's use of pharmacists to manage drug therapy for patients with diabetes, asthma, hyperlipidemia, and coagulation disorders. His presentation focused on utilizing pharmacists as care managers and the difficulties of implementing a disease management program with non-physician providers. The key aspects of Mississippi's managed pharmacy care program include:
- A patient-centered focus on therapeutic outcome versus a traditional product orientation.
- Comprehensive, cost-effective care of patients with specific drug problems.
- Patient referral into the program by a physician.
- Services provided under guidelines established by physicians and pharmacists.
- Services provided by certified pharmacists (disease-specific recertification is required every 2 years).
Mr. Kight spoke about Florida Medicaid's disease management initiatives. Florida's disease management program began in 1997 with authorization from the State legislature. At the time of the authorization, the legislature reduced the Medicaid budget by about $4 million, the amount of projected savings in the first year of the program. In 1998 the legislature reduced the budget by an additional $38 million for continuation and expansion of the program. Similar budget reductions have continued in subsequent years.
Mr. Kight reported that because of pressure to implement disease management quickly, Florida Medicaid did not have time to build or design its own protocols. Florida's program involves a number of contracts with private disease management organizations, which direct programs for individual diseases. Mr. Kight described the current and recent expansions of Florida's program, including disease management for asthma, AIDS, diabetes, hemophilia, congestive heart failure, cancer, and several other diseases. He also outlined the objectives of Florida Medicaid's disease management initiative, including:
- Reduced costs.
- Improved health outcomes.
- More efficient use of health resources.
- Better treatment of chronic medical conditions.
Mr. Kight also discussed methods for evaluating the need for disease management in a given patient population, noting that in Florida, a small percentage of patients, diseases, and drugs account for a majority of the State's Medicaid expenditures. An evaluation of Florida's disease management program is scheduled to begin during 2000.
Dr. Whitehurst-Cook discussed the Virginia Health Outcomes Partnership (VHOP), the disease management program of Virginia Medicaid. Virginia Medicaid has partnered with professional societies, academic medical centers, and the private sector to create a disease management program for certain Medicaid patients. Noting the program's successes since its inception in 1995 in reducing emergency room visits by 25 percent in patients with moderate to severe asthma and achieving a substantial cost savings over traditional Medicaid, Dr. Whitehurst-Cook remarked that the effectiveness of VHOP is due to several specific factors:
- Increased use of clinical guidelines and established protocols.
- A focus on communication and feedback between patients, providers, and payers.
- Integration of pharmaceuticals and educational interventions into clinical guidelines.
- Education of targeted physicians about the guidelines for specific diseases such as asthma.
The Florida Medicaid Disease Management Initiative: A Report on the Florida Medicaid Disease Management Program-Historical Perspective, Start-Up, Activities, Current Operations, Future Operations and Expectations. Florida Agency for Health Care Administration. 2000 Feb.
Current as of October 2000
Previous Section Contents
Using Evidence. User Liaison Program Workshop Brief, May 8-10, 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/evidence/ulpevdnc.htm