Economic assessment of changes to an existing medication therapy management program of a large regional health plan.

BACKGROUND: Although medication therapy management (MTM) has specific eligibility criteria and is mandated for specific Medicare Part D enrollees, some health plans have expanded MTM eligibility beyond the minimum criteria to include other Medicare Part D enrollees, Medicaid, and commercial health plan patients. Differences exist in the mode of delivery, location of services, type of personnel involved in managing the service, and the subsequent outcomes. The type and intensity of MTM services delivered have evolved with time to more streamlined and robust interventions, necessitating ongoing evaluation of the effect on clinical and economic outcomes. OBJECTIVE: To assess the effect of changes to an existing MTM program on cost of care, utilization, and medication adherence. METHODS: UPMC Health Plan made changes to an existing MTM program by expanding eligibility (customized by the type of health plan), intervention types, pharmacist involvement, and patient followup contacts. After matching our intervention cohort (identified January 2017-June 2018) with the pre-2016 MTM historical controls (patients identified January 2014-June 2015 who would have been eligible if we used the intervention cohort eligibility criteria), we estimated that the effect of the program changes with a difference-in-difference model (preintervention [2014-2016] and postintervention [2017-2019]). Outcomes of interest included cost (total cost of care including medical, pharmacy, and unplanned care [i.e., unscheduled health care use such as emergency department visits] in 2017 U.S. dollars); utilization; medication adherence (proportion of days covered); and return on investment (ROI). Target population included continuously enrolled patients aged ≥ 21 years in the commercial, Medicare, and Medicaid health plans. RESULTS: Total propensity score-matched members was 10,747, 55% of which were in the historic control group. The average (SD) ages after matching the groups were similar (historical control group: 57.08 years [14.23], intervention group: 56.79 years [14.21]) and the majority was female (57%). Comorbidities identified most for patients included hypertension (77%), dyslipidemia (70%), and diabetes (52%). Forty-one percent were in the commercial, 37% in the Medicaid, and 23% in the Medicare health plans. Proportion of care activities undertaken in the intervention period compared with the control period were significantly different: "sent letter to physician" (67% vs. 87%), "sent letter to member" (15% vs. 0%), "pharmacist phone call to physician" (15% vs. 0.1%), and "pharmacist phone call to member" (13% vs. 7%). There were statistically significant reductions in unplanned care across all health plans especially in the Medicare population, in total cost of care, and increases in medication adherence in 4 therapeutic classes: anticoagulants (OR = 1.25, P = 0.005), cardiac medications (OR = 1.20, P < 0.001), statins (OR = 1.21, P < 0.001), and antidepressants (OR = 1.15, P < 0.001). There was a positive ROI of $18.50 per dollar spent, which equated to a cumulative net savings of $11 million over 24 months. CONCLUSIONS: In a large health plan, expanding MTM eligibility, intensifying patient follow-up contact and pharmacist involvement, and improving provider awareness had favorable clinical and economic benefits. DISCLOSURES: There was no funding for this project except employees' time. All authors are employees of UPMC and have no conflicts of interest to report.

UPMC MyHealth: managing the health and costs of U.S. healthcare workers.

BACKGROUND: Workplace wellness programs hold promise for managing the health and costs of the U.S. workforce. These programs have not been rigorously tested in healthcare worksites. PURPOSE: To evaluate the impact of MyHealth on the health and costs of UPMC healthcare workers. DESIGN: Five-year observational study conducted in 2013 with subgroup analyses and propensity-matched pair comparisons to more accurately interpret program effects. SETTING/PARTICIPANTS: UPMC, an integrated health care delivery and financing system headquartered in Pittsburgh, Pennsylvania. Participants included 13,627 UPMC employees who were continuously enrolled in UPMC-sponsored health insurance during the study period and demonstrated participation in MyHealth by completing a Health Risk Assessment in both 2007 and 2011, as well as 4,448 other healthcare workers employed outside of UPMC who did not participate in the program. INTERVENTION: A comprehensive wellness, prevention, and chronic disease management program that ties achievement of health and wellness requirements to receipt of an annual credit on participants' health insurance deductible. MAIN OUTCOME MEASURES: Health-risk levels, medical, pharmacy, and total healthcare costs, and Healthcare Effectiveness Data and Information Set performance rates for prevention and chronic disease management. RESULTS: Significant improvements in health-risk status and increases in use of preventive and chronic disease management services were observed in the intervention group. Although total healthcare costs increased significantly, reductions in costs were significant for those who moved from higher- to the lowest-risk levels. The contrast differences in costs between reduced- and maintained-risk groups was also significant. Matched pair comparisons provided further evidence of program effects on observed reductions in costs and improvements in prevention, but not improvements in chronic disease management. CONCLUSIONS: Incorporating incentivized health management strategies in employer-sponsored health insurance benefit designs can serve as a useful, though not sufficient, tool for managing the health and costs of the U.S. healthcare workforce.