Establishing a Web-based program for reimbursement for medication therapy management services.
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Hospitals, University↗
Biomedical subjects
Patty Kumbera
Publications and source records attributed to Patty Kumbera.
Workplace-based cardiovascular risk management by community pharmacists: impact on blood pressure, lipid levels, and weight.
STUDY OBJECTIVE: To assess the effectiveness of a community pharmacist-delivered cardiovascular case-management program by comparing body mass index (weight), systolic and diastolic blood pressure, and full lipid profile at the beginning of the program with these outcome measures at the end of the program. DESIGN: Retrospective data analysis using billing data submitted between July 1, 2001, and October 31, 2004, with a pre-post design in which subjects served as their own controls. SETTING: Manufacturing workplace in rural Iowa. PARTICIPANTS: Fifty-six workers with risk factors for cardiovascular disease (mean age 40.67 yrs), 37 had diabetes mellitus and 19 did not. INTERVENTION: During visits to the workers, pharmacists provided education about cardiovascular disease, identification of drug therapy problems, and importance of routine blood pressure, pulse, and weight measurements; they communicated with participants' physicians as needed. MEASUREMENTS AND MAIN RESULTS: The number of pharmacist visits/participant ranged from 1-13 (mean +/- SD 6.97 +/- 3.05). Outcome measures were weight, systolic and diastolic blood pressures, full lipid profiles (in patients with diabetes), and percentage of patients achieving treatment goal by the end of the 3 years. Statistically significant differences between the first and last visits were achieved for both systolic (124.12 +/- 11.07 and 120.36 +/- 14.39 mm Hg, respectively, p=0.016) and diastolic (80.4 +/- 9.01 and 77.43 +/- 9.14 mm Hg, respectively, p=0.019) blood pressure. The 19 patients without diabetes showed a statistically significant improvement in diastolic blood pressure (p=0.039), but the 37 patients with diabetes did not show a significant difference. A nonsignificant increase was seen in the percentage of patients with diabetes achieving low-density lipoprotein cholesterol (LDL) level goal between the first and last visits (p=0.06). CONCLUSION: A cardiovascular case-management program delivered in the workplace to middle-aged working adults by community pharmacists improved blood pressure and reduced LDL levels. The program was not effective, however, in weight reduction.
Adult↗
An evaluation of managing and educating patients on the risk of glucocorticoid-induced osteoporosis.
OBJECTIVE: To assess the impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis. METHODS: Ninety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies. Patients in the control group received usual and customary care. Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis. In addition, the treatment group pharmacists monitored the patients' drug therapy, to identify and address drug-related problems. Data including the glucocorticoid taken by the patient, medications, and osteoporosis risk factors were collected at baseline and after 9 months of monitoring, via Web-based survey completed in the pharmacy. Using an intent to treat approach, the pre-post frequency changes were compared with contrasts for presence of bisphosphonate therapy, presence of estrogen therapy, presence of calcium supplement, discussion of glucocorticoid-induced osteoporosis risk, discussion of bone density test, presence of bone mineral density test, reported inactivity, and reported low calcium diet. RESULTS: The contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement (Control [-6.9%] vs. Treatment [17.1%], P < 0.05). No other contrast was significant. CONCLUSIONS: Community pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis. Pharmacists who educate at-risk patients can impact the self-care of these patients.
Adult↗
Financial analysis of cardiovascular wellness program provided to self-insured company from pharmaceutical care provider's perspective.
OBJECTIVES: To perform a retrospective financial analysis on the implementation of a self-insured company's wellness program from the pharmaceutical care provider's perspective and conduct sensitivity analyses to estimate costs versus revenues for pharmacies without resident pharmacists, program implementation for a second employer, the second year of the program, and a range of pharmacist wages. DESIGN: Cost-benefit and sensitivity analyses. SETTING: Self-insured employer with headquarters in Canton, N.C. PATIENTS: 36 employees at facility in Clinton, Iowa. INTERVENTIONS: Pharmacist-provided cardiovascular wellness program. MAIN OUTCOME MEASURES: Costs and revenues collected from pharmacy records, including pharmacy purchasing records, billing records, and pharmacists' time estimates. METHODS: All costs and revenues were calculated for the development and first year of the intervention program. Costs included initial and follow-up screening supplies, office supplies, screening/group presentation time, service provision time, documentation/preparation time, travel expenses, claims submission time, and administrative fees. Revenues included initial screening revenues, follow-up screening revenues, group session revenues, and Heart Smart program revenues. RESULTS: For the development and first year of Heart Smart, net benefit to the pharmacy (revenues minus costs) amounted to dollars 2,413. All sensitivity analyses showed a net benefit. For pharmacies without a resident pharmacist, the net benefit was dollars 106; for Heart Smart in a second employer, the net benefit was dollars 6,024; for the second year, the projected net benefit was dollars 6,844; factoring in a lower pharmacist salary, the net benefit was dollars 2,905; and for a higher pharmacist salary, the net benefit was dollars 1,265. CONCLUSION: For the development and first year of Heart Smart, the revenues of the wellness program in a self-insured company outweighed the costs.
Cardiovascular Diseases↗
Outcomes-based pharmacist reimbursement: reimbursing pharmacists for cognitive services part 1.
OBJECTIVES: (1) Describe the structure of an outcomes-based method of pharmacist reimbursement for cognitive services, (2) outline the structure of an intervention program, (3) explain a mechanism to increase the provision of pharmacists. cognitive services, and (4) summarize findings from the first year of operations of this outcomes-based pharmacist reimbursement program (OBPR). METHODS: A cross-sectional descriptive study was completed using the claims submitted by pharmacists to summarize findings from the first year of operations of this OBPR. The program involves collaboration between pharmacy benefit managers (PBMs) and community pharmacists to improve medication use. Pharmacists were reimbursed for (1) converting therapeutic regimens to generic drugs or preferred formulary medications when a prescriber contact is required; (2) conducting patient education and follow-up after initiation of new medications, changes in drug therapy, or following an over-the-counter (OTC) consultation; and (3) resolving drug-therapy problems. An efficient, no-cost billing system was created. Pharmacies participating in this program are located in cities throughout Iowa, ranging in population from a few hundred to more than 100,000. The main outcome measures were descriptive statistics of prescriptions, intervention claims, and pharmacist participation in the program. Frequency distributions and descriptive statistics were used to summarize the first year of claims. Comparisons of averages were completed with t tests. Chi-square tests were used to compare frequency distributions. RESULTS: Data analysis for the first year of operation, July 1, 2000, through June 30, 2001, showed that 11,326 enrollees obtained 124,768 prescriptions. The majority of individuals (n=8335, 74%) received some intervention service. The majority (90%) of intervention services were patient education and follow-up on new prescriptions or changes in prescriptions. More than 200 individuals had drug-related problems. There was variability in the level of service per pharmacy as the median number of intervention services was 30, while the mean was 113?188, among those providing any interventions. CONCLUSION: This unique system of outcomes-based pharmacist reimbursement permits community pharmacists to document and bill for cognitive services. It has demonstrated that PBMs and community pharmacists can work together to improve drug therapy, and it may reduce health care costs.
Journal Article↗