1. Using Real-time Pharmacy Data and Telephonic Management to Improve
Medication Adherence in a Bipolar Population
Neil Krohn, PhD; Marty Waters, LCSW; HMC - Denver, CO, USA
Annual Research Meeting ARM | June | Chicago, IL
1. Under outcomes section change the - (little hash marks) to small round bullet points. 2. Under types of APN interventions can you change the small round bullet points to the red diamonds.
Discussion (cont.)
Abstract
Results
Introduction
Adherence to a medication regimen is one of the most important factors in the effective treatment of Bipolar Disorder.1 Non-adherence to Bipolar medications presents an important quality of care concern that negatively impacts short-term recovery, long-term stability, and the cost of care associated with treatment.2,3 This study measured the clinical effectiveness of a program designed to improve bipolar medication adherence through telephonic management. For a one-year evaluation period, medication adherence, defined as the percentage of on-time medication refills, improved 22 percent relative to baseline levels. Preliminary cost analyses showed significant decreases in behavioral health utilization. Results suggest that real-time monitoring of medication refill patterns, coupled with personalized educational and support intervention, represents an effective means of addressing medication treatment issues and can result in decreased utilization of more costly behavioral health services.
This medication adherence program directly targets members with overdue refills and intervenes immediately with the member to circumvent prolonged periods without medication treatment. Given that 80-90% of members with Bipolar Disorder experience recurrent episodes3 and that 90% of the total cost of treating Bipolar Disorder is attributable to inpatient admissions,6 timely intervention to help maintain stability in these members represents an effective clinical and cost savings strategy.
Bipolar patients have high rates of medication non-adherence, including late or suspended refill patterns. As patients fail to sustain continuous medication supplies, they become increasingly at risk for longer and more severe recurrent episodes of the illness.4,5 This study sought to determine whether using real-time pharmacy data to drive targeted clinical outreach to Bipolar patients would be an effective means of increasing medication adherence and improving clinical stability.
For a one-year evaluation period, medication adherence, defined as the percentage of on-time medication refills, improved 22 percent relative to baseline levels.
Behavioral health utilization decreased in Year 1 of the Bipolar program, compared to baseline.
Methodology
The study included individuals 18 years of age and older in a California Commercial health plan who had a primary diagnosis of Bipolar Disorder, and who filled a medication used to treat Bipolar Disorder (N=838).
Medical claims were queried for Bipolar diagnosis codes to determine program eligibility. Daily pharmacy refill data was linked to eligible program members who were five days late refilling Bipolar medications. The program then provided telephonic medication-related assessment and education via a behavioral health clinician for these late-refilling members, as well as case management services for higher-acuity members.
Analyses compared one-year changes in medication adherence and utilization variables for the program cohort compared with an equivalent baseline comparison group of individuals with a diagnosis of Bipolar Disorder identified via annual qualification.
Conclusions
The Bipolar Condition Care program in California demonstrated the effectiveness of a real-time pharmacy-based clinical intervention strategy by a marked improvement in medication adherence rates. Real-time monitoring of medication refill patterns, coupled with personalized patient interventions, represents an effective means of addressing medication adherence treatment issues. Program members experienced greater clinical stability with fewer psychiatric hospitalizations while participating in the program. The program demonstrated cost effectiveness by reducing behavioral health utilization, and by contributing to the stabilization of the most at-risk members in this population.
About HMC
57% of savings were directly from Bipolar services, which included inpatient admissions, outpatient and ER visits, and other intensive services.
Behavioral Health inpatient services decreased 14% from the baseline year.
HMC is one of the nation’s largest, most experienced managers of integrated care and total health solutions. We help members navigate the complexity of health care – from the most difficult, costly and debilitating medical conditions that increase health care costs, to the wellness programs that help prevent them.
Founded in 1983, HMC is a pioneer and leader in providing health solutions for employers, insurance companies, and government entities. We are a wholly owned subsidiary of WellPoint, serving as both partner and proprietor in the delivery of innovative health care programs and services nationwide.
Through our Life² total-health solution, we give people the tools they need to take control of their health and see positive results, whether they’ve just started careers, are planning families or are nearing retirement. Our population-based yet individualized approach to health care encompasses prevention, lifestyle and condition management and complex care.
Nearly 24 million eligible members reside within HMC’s scope of care.
Discussion
References
Comparison of utilization trends showed that total behavioral health costs for members with a Bipolar diagnosis fell about 5% during the intervention period, relative to baseline. The largest utilization reduction was due to behavioral health inpatient costs, which decreased 14% for the intervention period. This reduction was, however, partially offset by an increase in other lower intensity behavioral health services that were intended to circumvent inpatient admissions. Bipolar medication use was virtually unchanged, reflecting more timely, consistent refilling of the most effective medications and dosages.
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2. Adams, J. and Scott, J. (2000). Predicting medication adherence in severe mental disorders. Acta Psychiatrica Scandinavica, 101 (2):
3. Bryant-Comstock, L., Stender, M., & Devercelli, G. (2002). Health care utilization and costs among privately insured patients with bipolar I disorder. Bipolar Disorders, 4:
4. Scott, J. and Pope, M. (2002). Self-reported adherence to treatment with mood stabilizers, plasma levels, and psychiatric hospitalization. American Journal of Psychiatry, 159 (11):
5. Svarstad, B., Shireman, P. and Sweeney, J.K. (2001). Using drug claims data to assess the relationship of medication adherence with hospitalization and costs. Psychiatric Services, 52 (6):
6. Simon, G.E. and Unutzer, J. (1999). Health care utilization and costs among patients treated for Bipolar Disorder in an insured population. Psychiatric Services, 50 (10):
Acknowledgments: We would like to thank Griselda Chapa and Jen Clair for their help with data interpretation and presentation.