Establishing Solid Partnerships and Superior Quality
Initiatives to Provide the Best Possible Outcomes for Members
Introduction
Recent advances in pharmaceuticals have revolutionized health care, making new medications available all the time and resulting in greatly improved health outcomes. However, all of these changes add a significant challenge for health plans in managing medical costs. This is particularly true of behavioral health medications whose continuing evolution is increasing health plan pharmacy costs by 10% to 20% each year.
CompCare's behavioral pharmacy systems utilize targeted psychopharmacological management strategies. These strategies allow our clients to maximize benefits from recent innovations while achieving the most cost-effective use of their pharmacy dollar. We offer programs that will be customized to meet specific health plan needs. These include:
- Analysis of behavioral health medication prescribing practices compared to nationally recognized clinical practice guidelines
- Physician education using nationally recognized clinical practice guidelines and consultation
- High-risk case management for identified members whether served by the Primary Care Physician or the Psychiatrist in a behavioral health network
- Behavioral health formulary management
Advantages of the program include:
The ability to effectively manage behavioral health medication utilization and decrease costs
Consultation to prescribers regarding appropriate behavioral health prescription patterns.
Enhanced case management opportunities for complex cases which inevitably involve multiple behavioral health medications and providers
CompCare works with the Pharmacy Benefit Management (PBM) contracted to health plans to avoid duplicate data management
Over the last two years, PBM has become one of the most widely used Medicaid specialty behavioral pharmacy management systems in the nation.
Scope
BPM utilizes Quality IndicatorsTM to track physician prescribing practices for more than 130 psychotropic drugs, comparing those practices to evidence-based and nationally-recognized best-practice prescribing standards. A small number of outlier physicians in each state account for a high percentage of possible deviations from best practice standards. These outlier physicians, flagged by the BPM Quality IndicatorsTM, receive educational alerts, information comparing their prescribing practices to those of their peers (benchmarking), and peer-to-peer consultations.
While some behavioral pharmacy standards are based on the hard evidence of clinical research, multiple new psychotropic drugs have recently been approved by the Food and Drug Administration (FDA), yet there has not yet been adequate time for longitudinal evaluation. To fill the gap and guide the use of these medications in real-world situations, the following standards and guidelines are used: The Texas Medication Algorithm Program (TMAP), and the American Psychiatric Association (APA).
Four key factors drive the cost of prescription drugs in the Medicaid programs:
1. Medicaid enrollment changes, particularly in the Aged, Blind and Disabled populations;
2. The introduction of new pharmaceutical products to market;
3. Product inflationary increases for existing drugs; and
4. Prescriber choices in product utilization.
While state Medicaid agencies have only limited control of 1-3 above, experience shows they can significantly influence physician prescribing practice and product utilization. It is in the area of prescribing practice that BPM will help the health plan focus their attention on core issues for resolution.
Copyright © 2005-2006 Comprehensive Behavioral Care, Inc. (CompCare)
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