Study Shows How Improving Quality of Psychotropic Prescribing Reduces Hospital Utilization

Innovative program gives patients better care while cutting inefficiencies 


JEFFERSON CITY, Mo., Nov. 16  /PRNewswire-FirstCall/ -- An innovative program appears to play a role in the overall reduction in hospital utilization and cost of care for Missouri Medicaid recipients with severe mental illness.

The Missouri Mental Health Medicaid Pharmacy Partnership Program (MHMPP), the first program of its kind in the United States, evaluates Medicaid mental health prescribing practices.  The program seeks to improve care for Missouri residents by educating doctors about evidence-based best practices for mental health medications and reducing inefficient and ineffective prescribing patterns.

"This is a model on how states can increase the quality of care that Medicaid residents with severe mental illnesses receive while encouraging more efficient use of taxpayer dollars," said Joseph Parks, M.D., medical director of the Department of Mental Health.  "We are excited that we can start sharing data about the success of the program at national medical meetings."

The poster, "Improving Quality of Psychotropic Prescribing Reduces Hospital Utilization" was presented at the recent American Psychiatric Association Institute on Psychiatric Services meeting and the Disease Management Association of America meeting, where it received the Gold Award for first place. Awards are presented to recognize excellence in program design and implementation and leadership in outcomes research and the positive impact on individual health and the disease management industry.

The MHMPP was developed by the Missouri Department of Mental Health and Missouri Department of Social Services, Division of Medical Services, in collaboration with Comprehensive NeuroScience, Inc. (CNS).  Eli Lilly and Company, an Indianapolis-based pharmaceutical company, has been providing the financial support for this program in an effort to promote excellence in patient health care.

The pharmacy partnership program began with the evaluation of Medicaid prescribing records.  With this information, the state identified a small number of doctors who weren't following recommended guidelines for prescribing and reached out to them with educational materials to help change their prescribing habits.  This information is designed to help them make patient care decisions based on the latest medical evidence.

"These changes in prescribing have resulted in better patient care and savings for our Medicaid program.  We begin to see change within 90 days of the first mailing," Parks said.

The study presented at the psychiatric services meeting highlights the success of the program.

Dr. Richard Surles, CNS executive vice president, explained that 1,911 Medicaid recipients whose physicians received notification for at least one of the program's quality indicators during two consecutive mailings were used for the analysis presented at the medical meeting.  Individuals similar to those patients were selected for the comparison group.  They compared a number of factors six months pre-intervention and six months post-intervention.

The researchers found:

*  A 43% decrease in the hospital admissions for those in the intervention group, compared to a .1% decrease in the comparison group.

*  A 1,813 decrease in total hospital days for all cases in the intervention group compared to a 689 decrease in the comparison group.

*  A $1,238 decrease in cost per person for the intervention group and a $312 decrease in the comparison group.

"We were very pleased with the results.  Not only do they show that there was not a disruption in patient care, but the program appears to play a role in the overall reduction in hospital utilization and cost of care for patients," Parks said.  "Thus, this program helps control costs for the states, while it ensures that the patients have access to the appropriate medications and treatments they need."

One factor in the cost reduction was the identification of inefficient prescribing patterns, including:

*  Duplicative prescribing of medication by different doctors for the same patient;

  *  Prescribing multiple medications from the same therapeutic class;
  *  Children on three or more psychotropic medications;
  *  Premature, rapid switching from one medication to another.



Earlier data from the program also is indicative of its success.  An analysis from the program's first year shows: 98 percent reduction of patients who are prescribed the same mental health medications from multiple doctors; 64 percent reduction of patients who are on two or more mental health medications of the same type; 43 percent reduction of children on three or more psychotropic medications; and 40 percent reduction of patients receiving an unusually high dosage of medication.

"Not only did the MHMPP program positively affect the quality of care received by Missourians suffering from severe mental illness, it also allowed Missouri to save $7.7 million in costs the Medicaid program would have incurred in state fiscal year 2004 had the inefficient prescribing patterns not been identified," Parks said.

The MHMPP program is entirely voluntary for Missouri doctors.  All decisions regarding treatment and medications are made privately between the physician and the patient and are completely individualized.

The program also has proven to be popular outside of Missouri.  Twenty- five other states have signed contracts to develop similar programs.

For more information on this project, visit the DMH Web site at http://www.dmh.missouri.gov/index.htm and DMS at http://www.dss.state.mo.us/dms .

(Logo:  http://www.newscom.com/cgi-bin/prnh/20041209/DMHLOGO ) 

http://www.newscom.com/cgi-bin/prnh/20041209/DMHLOGO

DATASOURCE: Eli Lilly and Company



CONTACT:  Janice Chavers of Eli Lilly and Company, [phone],

 

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