Medicaid Drug Therapy Management Program for Behavioral Health

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Medicaid Drug Therapy ManagementProgram for
Behavioral Health
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Conducted by FMHI at USF under a contract with
the AHCA
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Goals of the Presentation

• Provide a brief overview of the Medicaid Drug
  Therapy Management Program for Behavioral Health
• Provide background on the decision to pilot a
  consultation service for pediatricians who are
  treating children with emotional problems
• Describe how we are trying to proceed

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Program Goals Ch. 409.912(39) (a) (10)

• Improve quality of behavioral health drug
  prescribing practices
• Improve patient adherence
• Reduce clinical risk
• Lower costs

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Multifaceted approach

• Tools that if used will encourage evidence based
  prescribing and discourage the opposite
  (Preventive)
• Intervention strategies that will help physicians
  whose prescribing appear to deviate in
  substantial ways from evidence and consensus
  based guidelines (Corrective)

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Interventions

• Medication treatment guidelines
• Letters/ MD reminders
• Decision support tools
• Academic detailing
• Peer to peer consults
• Medical records reviews
• Piloting of quality improvement projects in CMHCs

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Guideline Development

• Guidelines for the pharmacological treatment of
  children with serious emotional disturbances
• Development strategy
• Florida based
• Developed by Floridas medical community
• Revised and updated every two years

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Child and Adolescent Guidelines

• ADHD 6-17 years old
• Major depression 2-6 and 7-17 years
• Bipolar disorder 1 6-17 years
• Chronic impulsive aggression 6-17
• Disruptive behavior disorder or severe aggression
  in children under 6 years old
• Co-occurring psychiatric and developmental
  disabilities

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Guideline Dissemination

• Medical societies and provider trade associations
• Lectures, discussion groups, CMEs
• Medical staff meetings
• Program website
• www.flmedicaidbh.fmhi.usf.edu
• Website links

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Mailing Intervention

• Potential problem indicators derived from
  guidelines
• Quarterly analysis of pharmacy claims against
• indicators
• Targeting prescribers based on volume and of
  prescriptions that hit the indicators
• Intervention letters detailing patients, clinical
  issues and enclosing recommended guidelines
• Request Review medication strategies for
  identified patients
• Invitation to discuss contents and/or receive
  telephone consultation from experts

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Types of Quality Edits 2008-2009

• Polypharmacy (different drug classes)
• High dose stimulants, antidepressants and
  antipsychotics
• Two or more antipsychotics more than 60 days
• Antipsychotic under 6 years old
• Stimulant under 5 years old

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Decision support tools

• Distribution and training to 1,000 MH prescribers
• eMPOWERx technology in PDA and desk top
  applications
• Immediate access to current 100 day patient drug
  histories- multiple prescribers, adherence, drug
  interaction alerts, electronic access to
  guidelines and application of quality edits
• Electronic prescription writing and transmission
  to retail pharmacy
• Monitoring of use and redeployment
• E-prescribing pilot sites

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Monitoring of Prescribing and Follow Up Actions

• Tracking prescribing practices over time
• No apparent change in practices
• Academic detailing
• Medical records reviews
• Referral through AHCA for possible regulatory
  actions

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Lecture/Medical Education
Measurement-based Care Pilots
Analysis and Mailings
GUIDELINES EDITS
Content of EmpowerX and Eprescribing Pilots
Basis for Record Reviews
Basis for Academic Detailing Contacts
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Pediatric Consultation Service
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Percent of Prescriptions
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Percent of Prescribers
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Percentages of Antipsychotic Rx by MD Specialty
Children Under 6 Years Old

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Percentages of Requests for Antipsychotic Use for
Children Under 6 Years Old 4/08-3/09 vs. FY
2004-05
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Early Effort in NE Florida (UF)

• Outreach to pediatric practices in rural areas
• Presentations and descriptions of the service
• 15 practices and 126 medical providers
• Target Complex cases while awaiting expert
  consultation or when it was not feasible
• Four telephone consults provided in Spring of
  2008
• Fifteen face to face consults
• Disbanded/relocated in summer of 2008

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Effort in Tampa Bay Area (USF)

• Implementation of prior authorization of
  antipsychotics children under 6 years old
• Seven presentations to medical groups in early
  2009
• 250 clinicians exposed to the program
• Only a few consult calls to date.
• Two face to face consultations
• Capacity for 75 face to face consults

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Operational Parameters

• Toll free telephone
• Staffed during normal working hours
• Callers have some relationship with consultant
• MD contact within 24 hours
• Long term goal real time access
• Tracking of medication use using Medicaid
  pharmacy claims