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Paper Calls for Patient-Centered Approaches to MTM for Medicaid Patients

Findings published in AJMC show higher rates of hospitalization in heart failure patients on Medicaid; authors advocate for pharmacists’ involvement in managing medications

By Laura Bogart
March 4, 2015

In a paper published in the American Journal of Managed Care, Fadia T. Shaya, PhD, MPH, professor and vice-chair for academic affairs in the Department of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy, advocates for new patient-centered approaches to medication therapy and treatment planning that can prevent hospitalizations for heart failure patients on Medicaid. Typically, these patients bear the high costs of frequent hospitalizations—and not just financial costs (which often trickle down to other tax payers and health care consumers), but the costs in time and quality of life. Heart failure is a leading cause of death in the U.S., and it can disproportionately impact people with low incomes, as well as minorities.

Shaya’s paper, titled “Disease-Modifying Therapy and Hospitalization Risk in Heart Failure Patients,” was co-authored with Ian M. Breunig, PhD, senior analyst – U.S. Health at Abt Associates Inc, and Mandeep R. Mehra, MD, FACC, FACP, professor at Harvard Medical School. The team investigated the leading causes of hospitalization for heart failure among Maryland Medicaid recipients who were enrolled in one of seven prepaid state-contracted managed care organizations or fee-for-service programs. They found that two factors contributed most consistently and most directly to hospitalizations: issues with medications and the presence of co-morbidity, like renal failure. Their research shows that developing clinical strategies to address these co-morbidities, and refining the use of medications as disease-modifying therapies in patients with heart failure, are crucial first steps in reducing health care costs and generating Medicaid savings.

In conducting their research, Shaya and her team recorded patient demographics (such as age, gender, and race), dates of service (such as physician visits, hospitalizations, and medication dispenses), and primary through tertiary classifications of diseases (via the ICD-9 –CM code). They reported on the prevalence of co-morbidities in a cohort of Medicaid patients and constructed survival analysis models to look at the impact of first-line therapies on the rates of hospitalization. They estimated a patient’s risk of hospitalization, adjusting for demographic risk factors and the presence of co-morbidities. From there, they determined the cost-per-patient. They write, “Given the high cost burden of hospitalization … our findings, in a unique Medicaid population, call for attention to strategies to attend to co-morbidities and optimize use of disease-modifying therapies.”

According to Shaya, one way to incorporate more strategic and effective medication therapies is to leverage pharmacists as health care providers and empower them to use patient-centered approaches in the care they deliver. “Utilizing the pharmacist’s expertise in ensuring that the proper medications are being administered and being administered more accurately could save Medicaid more than $1 million a year,” adds Shaya. “By focusing elements of care on the patients’ experiences, feelings, and needs, health care providers like pharmacists can ensure that these patients are more compliant with their medication and treatment plans.

Shaya sees this push to “prioritize patients” as having “large policy implications for Medicaid.” She says that helping Medicaid patients with heart disease and heart failure avoid hospitalizations and enhance their overall health also has the power to change other aspects of their lives. When these patients, who fall within the poverty line, are feeling healthier and stronger, they might be able to transition to meaningful employment and out of poverty.

“Our hope is that this research has far-ranging political ramifications, but, most importantly, that it is able to better the lives of individual patients around the country,” she says.

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