Transcript UPlan Update - University of Minnesota Twin Cities

UPlan Medication Therapy
Management (MTM)
MTM Marketing Seminar – 3/15/2011
MTM Discussion Topics
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UPlan Pharmacy Program
UPlan decision to add MTM
MTM program and structure
MTM communications and target
marketing
 MTM Preliminary Information
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UPlan Pharmacy Program
UPlan Medical Program
1. Two Medical Administrators — Medica &
HealthPartners / Five Plan Types
2. Carve Out Pharmacy Program — Prime
Therapeutics (originally RxAmerica/CVS
Caremark)
3. Wellness Program — through Healthways and
StayWell
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UPlan Pharmacy Program
 Pharmacy Contract is completely pass through /
transparent
 Formulary Development
• Utilize PBM formulary with University input
• Rely on College of Pharmacy Expertise
 New Specialty Program effective 1/1/2011
• High cost medications for complex conditions
• Fairview Specialty Pharmacy, Fairview hospital or clinic
pharmacies
• SMDC or St. Luke’s in Duluth
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Pharmacy Program Statistics
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39,000 Members
30,300 Members with Prescriptions
370,800 Prescriptions
$33 Million Total Drug Cost
Focus on Generic Medications
• 50.4% : January – December 2005
• 74.2% : January – December 2010
• 75.1% : December 2010
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Pharmacy Benefit Design
Copay Structure
Generic Plus
$8
Brand Formulary
$25
Non-Formulary
$50
Non-Covered
Full Cost
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UPlan Decision to Add MTM
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Decision to Add MTM
 UPlan decisions:
• Made by administration committee — AWG
• Reviewed with employee committee — BAC
 UPlan focus on evidence-based medicine
 Outcomes & ROI
• Ashville, NC Results
• 2008 U of M Study — Isetts, Schondelmeyer et al
• BCBS/Fairview MTM Patients
 Pilot Program: UMD, November 2007 to February
2009
• Helped determine structure & operation of new MTM
program
 All UPlan MTM program — March 2009
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MTM Program & Structure
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MTM Eligibility
 UPlan active employees, early retirees,
dependents
 Four or more UPlan covered medications
• Not specific disease focused but most
patients have chronic conditions
• 10,000 Eligible Members
 Physician Referral
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$8 MTM Copay Reductions
Without MTM
Generic Plus
$8
With MTM 6 Months
$0
Brand Formulary
$25
$17
Non-Formulary
$50
$34
Not Covered
Full Cost
Full Cost
Participating in MTM
 Participants select MTM pharmacist from
Directory and make appointment
 Participants sign Participation Agreement and
enroll through PBM
 Pharmacy visits are face-to-face
• Option for tele-med visits for out of area
participants
 Encourage three or more visits first year / two or
more visits subsequent years
 No cost to member for Pharmacy visits
• Pharmacist claims paid by two medical plans
using MTM procedure codes
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UPlan MTM Network
 Developed internally with College of
Pharmacy
• Same MTM network for both Medical
Plans
 101 Pharmacists, 146 locations, 30
contracting entities
• Includes pharmacists for U of M, major
local care systems, and local chain &
independent pharmacies
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MTM Program Structure
 MTM Network Manager & Coordinator
• Credential and contract network pharmacists for
the University
• Manage activities of Peer Advisory Committee
• MTM pharmacist coaching
• Peer Review process
 MTM Executive Committee
• College of Pharmacy and Employee Benefits
• Responsible for:
• MTM program operations
• Communications and target marketing,
• Program evaluation
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MTM Communications &
Target Marketing
MTM General Communications
 Written Communications
• Newsletters, brochures, letters
• Emails
 Employee Benefits website
• www.umn.edu/ohr/benefits/pharmacy/mtm/
• Network Directory, Enrollment Form, PowerPoint
Presentation
 Customer Service Communications
• Employee Benefits, Health Plans, PBM
 Pharmacy Network Communications
• Emails, newsletters, website
• www.umn.edu/ohr/benefits/pharmacy/mtmproviders/
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MTM Target Marketing
 Target Marketing — Pilot Program
• University of MN — Duluth
• Letters & brochures, plus 2 follow-up phone calls
• Handled by RxAmerica as PBM
 Target Marketing — UPlan-wide Program
• Letters & brochures, plus 2 follow-up phone calls
• Handled by each member’s medical plan
• Better response through medical plan target
marketing
 Enrollment results
• 722 members (about half from target marketing)
• 10,000 eligible / 7% overall participation
• 56 of 722 still have incentives remaining
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MTM Preliminary
Information
(data from Medica members only)
Comparative Predicted
Risk Score
+340%
Members not in
MTM
Members in MTM
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Source: Johns Hopkins Adjusted Clinical Group Analysis
% of members with multiple chronic
conditions
Chronic Disease Comorbidity
40%
43%
Members not in MTM
Members in MTM
24%
20%
24%
24%
22%
16%
13%
10%
5%
0%
2%
2%
0%
0
1
2
3
4
5+
number of chronic conditions
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Source: Johns Hopkins Adjusted Clinical Group Analysis
Types of Visits
43%
57%
1st Visit
Follow Up
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Source: Claims review Jan – Aug 2010
MTM – from a Patient’s Perspective
 Initially enrolled due to copay reductions
 True value — excellent advice from MTM
pharmacist
 Helped me understand how medications work
• Side-effects
• Interaction with over-the-counter medications
 Communicated regularly with my physician
 Helped me make important decisions about my
medications and my health care
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UPlan Medication Therapy
Management (MTM)
MTM Marketing Seminar – 3/15/2011