Upper Peninsula Pharmacy and Therapeutics Committee
- Need: Healthcare entities in the Upper Peninsula region of Michigan were using different formularies, missing opportunities for group purchasing power and consistent care.
- Intervention: The Upper Peninsula Health Plan and the Upper Peninsula Health Care Network developed a regional partnership for managing prescription costs and quality pharmaceuticals in rural, upper Michigan.
- Results: More informed pharmaceutical decisions and lowered pharmaceutical costs for Upper Peninsula Health Plan member organizations.
In 2003, the Upper Peninsula Health Care Network (now known as Upper Peninsula Health Care Solutions — UPHCS) and the Upper Peninsula Health Plan (UPHP) recognized that healthcare facilities in Michigan’s Upper Peninsula were using different formularies, missing opportunities for group purchasing power and consistent care. In order to address this issue, the Upper Peninsula Pharmacy and Therapeutics Committee was formed with one doctor and one pharmacist from each of the participating UPHP network hospitals, the UPHCS project coordinator, the UPHP medical director, and the UPHP pharmacy director.
The goal of the partnership was to make available clinically-appropriate, rational, cost-effective, and safe pharmaceutical care to Michigan’s Upper Peninsula residents. In order to achieve this goal, the committee:
- Implemented a cooperative formulary-management system
- Developed evidence-based clinical guidelines with pharmaceutical recommendations for targeted disease states associated with major drug classes
- Decreased UPHCS hospital pharmaceutical costs by negotiating drug expenditures through contract pricing for the entire group
- Decreased UPHP per-member-per-month pharmaceutical costs by 21% from 2003 to 2006
Using teleconferencing, the committee met bimonthly, with most of the research being performed in small groups or individually. A website was developed to store the committee’s reports and reviews. Partners had access to this site to reference protocols and drug reviews. In 2008 this initiative received the Rx Benefit Innovation Award from the Pharmacy Benefit Management Institute.
Much of the funding for this project came through a Rural Health Network Development Grant from the Federal Office of Rural Health Policy. Staff and resources were provided as in-kind services from UPHP and UPHCS.
In 2015, a pharmacy director survey still indicated the members saw value in committee work other than pricing issues: 78% felt the drug class reviews were very useful, and 89% felt the collegial discussions by the committee were very useful.
With these survey results supporting ongoing committee activity, the members continue to meet quarterly, but with an organized systems of care (OSC) focus. With OSC, primary care physicians, specialty physicians, and care providers from hospitals and other facilities coordinate care for patients across all clinical settings.
Currently, the committee utilizes its structure and relationships to focus on OSC and pharmacy-related initiatives related to population health management. System-wide initiatives are the focus, resulting in improved care coordination, health outcomes, and cost containment. From a pharmacy perspective, this includes optimizing medication management in all healthcare settings.
Other topic areas can be evaluated by leveraging UPHP’s robust information infrastructure. For example, comprehensive medication reviews and reconciliation can occur in a timely manner. Another focus is guideline adherence and reduction of medication-related hospital admissions. Other similar pharmacy-lead initiatives will enhance Accountable Care Organization initiatives.
- Evidence-based reviews of drug classes, pricing focus, efficacy, simplicity, and tolerance
- Guidelines for targeted disease states
- Moving forward with a new focus, the committee hopes to show value or outcomes for OSC
- Evidence-based clinical reviews, allowing practitioners and network hospitals an additional information source other than that provided by pharmaceutical companies.
- The committee continues to recommend formulary placement, review drug classes and individual drugs.
- Increased usage of specialty biologic and immunologic agents, such as cancer drugs, which are expensive and not available through contract pricing by pharmaceutical companies.
- Time commitment from Critical Access Hospitals due to limited physician and pharmacy staffing. Meetings were initially monthly, then changed to bimonthly, and are now quarterly. Attendance remains an issue due to directors’ time constraints.
- A telehealth network continues to be used for meetings, while additional online options are explored to allow committee members and directors to attend meetings using their own computers rather than relocate to a telehealth room for videoconferencing.
- Finding a unified new focus providing value for all member organizations.
- It is important to routinely survey committee members for feedback.
- Project results and achievements should be reported frequently to boards of directors.
- Transparency and flexibility is a must as healthcare delivery changes
Janey Joffee, MBA, Manager, Upper Peninsula Health Care Solutions
Upper Peninsula Health Plan
Critical Access Hospitals
Pharmacy and prescription drugs
May 30, 2010
July 12, 2017
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