Improving the Value of an EAP Through a Coordinated Drug Intervention

Transcription

1 It's all about employees; always has been, always will be. Improving the Value of an EAP Through a Coordinated Drug Intervention Presenters: Fred Newman Mike Hoffman What the Media are Reporting A significant proportion of individuals with behavioral health problems are treated exclusively in the general medical setting,which has become the de-facto mental healthcare system significant quality problems have been found with general medical providers screening, treatment, and monitoring practices. An Employer s Guide To Behavioral Health Services, released by the National Business Group on Health, December Only 12.7% of individuals seeking mental health treatment in the general medical setting received minimally adequate care compared to 43.87% of patients treated in the specialty mental health sector. National Co-morbidity Survey Replication. Archives of General Psychiatry (Also reported in the M/H parity regs) 2

2 What the Media are Reporting More Americans are being prescribed multiple psychiatric medications for use at the same time, but most people diagnosed with recent depression don t get adequate treatment, according to two independent studies published Monday. Studies: Mental Ills Are Often OvertreatedOr Undertreated, Wall Street Journal, January 5, The effectiveness of a dozen popular antidepressants has been exaggerated by selective publication of favorable results.... doctors unaware of the unpublished data are making inappropriate prescribing decisions that are not in the best interest of their patients. There is a view that these drugs are effective all the time... I would say they only work 40 percent to 50 percent of the time based on reviews of the research at the FDA. Excerpts from a January 17, 2008, Wall Street Journalarticle regarding a review published the same week in The New England Journal of Medicine. 3 Clinical Gaps in Care For most individuals seeking M/H care in the general medical setting, the following clinically accepted guidelines are not being followed: Quality assessments of mental health problems Ongoing screenings to evaluate the effectiveness of treatments Medication management to determine most effective drug and/or dosage Medication monitoring to insure drug compliance Patient education regarding treatment and compliance Psychotherapy for those dealing with mental health stressors Feedback to patients regarding change in their condition 4

3 Scope of the Problem 79% of prescriptions for antidepressants were written by nonpsychiatrists and 87% of prescriptions for anxiolytics were written by non-psychiatrists. Open Minds,September 24, 2009, reporting on a study in which researchers reviewed 472,173 prescriptions filled between August 2006 and July 2007 from the IMS National Prescription Audit Plus database Between 10 and 25 percent of health plan members will have filled a script in a recent 12-month period for a subgroup of psychotropic drugs that are primarily prescribed in the general medical setting. This subgroup includes antidepressants, anxiolytics, and sleep-aids. These members are not showing up as mental health claims under the health plan. In fact, most health plans are currently spending more on this subgroup of psychotropic drugs (prescribed by general medical doctors) than they are on treatment from mental health providers. 5 Top 5 Therapeutic Classes by Prescriptions DISPENSED PRESCRIPTIONS MN TOTAL US MARKET 3, , , , , Lipid Regulators Antidepressants Narcotic Analgesics Beta Blockers (Plain& Combo) Ace Inhibitors Source: IMS Health, National Prescription Audit, Dec 2010 Updated April 7,

4 Rates of Recovery Diminish with Duration of Major Depressive Episode Cumulative Percent (%) Recovery y Rate N=431 1% 6% 11% 16% 54% 6 Months 1 Year 2 Years 4 Years 5 Years Only 1% of patients with depression for 4 years were able to recover after 5 years Recovery rate for patients with depression at previous assessment Cumulative recovery rate Recovery = 8 weeks of Psychiatric Status Rating (PSR) 1 or 2 Recovery = sustained remission Keller MB, et al. Arch Gen Psychiatry. 1992;49: Depression Has an Impact on Mean Health Scores More Than Other Chronic Conditions Depression had the largest effect on worsening mean health scores Mean Health Score (0-100) *P<.0001 * * * Depression Only * * 73 P< N=245,404 One Chronic Condition Depression + One Chronic Condition * Depressed respondents had lowest mean score among all chronic conditions (P<.0001) Depressed respondents with another chronic condition had lower mean health scores than respondents with the chronic condition alone (P<.01) = No Chronic Condition Conditions 1. Asthma 2. Angina 3. Arthritis 4. Diabetes Moussavi S, et al. Lancet. 2007;370:

5 Solution Pharmacy Intervention Protocol () Patented process to address the quality of care issues associated with mental health treatment in the general medical setting: A two-way secure data feed to the pharmacy benefit manager (PBM) to exchange drug and compliance information Effective outreach to potential candidates based on filtering ofdrug data Financial incentives involving drug co-pays to encourage participation Telephonic screenings to determine candidates for participation Daily electronic reporting of compliance/noncompliance to the PBM Outreach and partnering with prescribing physicians to improve standards of care and treatment outcomes 9 Solution (patented) Ongoing standardized screenings completed with all participants to score and measure change in the severity of their symptoms (frequency based on severity) Educational materials provided to participants so they better understand the conditions for which they are being treated, including the need for medication compliance during treatment Recommendations to treating physicians and participants around med-management and other treatment modifications based on screening outcomes, drug compliance, and treatment history Coordination with the EAP for free short-term psychotherapy when appropriate Outcome reporting on quality improvement Monitoring of drug compliance through ongoing reviews of drug data Results of standardized screenings provided to participants and physicians 10

6 Compliance for Initial Screening Several thousand members in data sample 11 Compliance for Candidates 12

7 Outcomes Global Analysis Scoring of change in symptoms segregated by the severity of the initial HAD 89% 69% 52% 1% 10% 13% 13 Average Medication Compliance 3643 Members with >1 year of data (22,785 scripts) 14

8 St. Joseph s Hospital and Medical Center, et al. Outcome Data Presented By: Mike Hoffman Arizona Benefit Plans, Inc. 15 Outcome Data Hospital System 60.3%of participants scored a reduction in symptoms over 3.75 years of in place 16

9 Outcome Data Hospital System Annual EAP Utilization 17 Outcome Data Hospital System 35%pepmreduction in drug spend for target drugs over 3.75 years 18

10 Outcome Data Hospital System Rx count for target drugs over 3.75 years (pepm calculation) 19 Average Medication Compliance 2802 Plan Members with > 1 year of data (17,017 scripts) 20

11 Outcome Data Hospital System Overall medical claims costs comparison for year after intervention vs. prior year for compliant vs. non-compliant members 21 22