Improving the Value
of an EAP Through a
Coordinated Drug
Intervention
Presenters: Fred Newman
Mike Hoffman
It's all about employees;always has been, always will be.
What the Media are Reporting
“A significant proportion of individuals with behavioral health problems are treated exclusively in the general medical setting, which has become the de-facto mental healthcare system …significant quality problems have been found with general medical providers’ screening, treatment, and monitoring practices.”
“An Employer’s Guide To Behavioral Health Services,” released by the National Business Group on Health, December 2005.
Only 12.7% of individuals seeking mental health treatment in the general medical setting received minimally adequate care compared to 43.87% of patients treated in the specialty mental health sector.
National Co-morbidity Survey Replication. Archives of General Psychiatry. 2005 (Also reported in the M/H parity regs)
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What the Media are Reporting
“More Americans are being prescribed multiple psychiatric medications for use at the same time, but most people diagnosed with recent depression don’t get adequate treatment, according to two independent studies published Monday.”
“Studies: Mental Ills Are Often Overtreated Or Undertreated,”Wall Street Journal, January 5, 2010.
“The effectiveness of a dozen popular antidepressants has been exaggerated by selective publication of favorable results.”
“... doctors unaware of the unpublished data are making inappropriate prescribing decisions that are not in the best interest of their patients.”
“There is a view that these drugs are effective all the time ... I would say they only work 40 percent to 50 percent of the time based on reviews of the research at the FDA.”
Excerpts from a January 17, 2008, Wall Street Journalarticle regarding a review published the same week in The New England Journal of Medicine.
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Clinical Gaps in Care
• Quality assessments of mental health problems
• Ongoing screenings to evaluate the effectiveness of treatments • Medication management to determine most effective drug
and/or dosage
• Medication monitoring to insure drug compliance • Patient education regarding treatment and compliance • Psychotherapy for those dealing with mental health stressors • Feedback to patients regarding change in their condition
For most individuals seeking M/H care in the general medical setting, the following clinically accepted guidelines are not being followed:
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Scope of the Problem
79% of prescriptions for antidepressants were written by non-psychiatrists and 87% of prescriptions for anxiolytics were written by non-psychiatrists.
Open Minds,September 24, 2009, reporting on a study in which researchers reviewed 472,173 prescriptions filled between August 2006 and July 2007
from the IMS National Prescription Audit Plusdatabase
Between 10 and 25 percent of health plan members will have filled a script in a recent 12-month period for a subgroup of psychotropic drugs that are primarily prescribed in the general medical setting. This subgroup includes antidepressants, anxiolytics, and sleep-aids. These members are not showing up as mental health claims under the health plan. In fact, most health plans are currently spending more on this subgroup of psychotropic drugs (prescribed by general medical doctors) than they are on treatment from mental health providers.
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Top 5 Therapeutic Classes
by Prescriptions
DISPENSED PRESCRIPTIONS MN 2010 2009 2008 2007 2006
TOTAL US MARKET 3,995.2 3,949.2 3,866.3 3,824.9 3,706.4
1 Lipid Regulators 255.4 249.7 237.1 228.8 210.4
2 Antidepressants 253.6 246.1 239.8 236.5 231.1
3 Narcotic Analgesics 244.3 241.0 238.6 230.5 220.7
4 Beta Blockers (Plain & Combo) 191.5 167.8 160.7 160.3 156.6
5 Ace Inhibitors 168.7 165.7 160.2 158.0 154.2
Source: IMS Health, National Prescription Audit, Dec 2010 Updated April 7, 2011
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7 0 20 40 60 80 100
6 Months 1 Year 2 Years 4 Years 5 Years
Keller MB, et al. Arch Gen Psychiatry.1992;49:809-816.
Rates of Recovery Diminish with Duration of Major Depressive Episode
Recovery = 8 weeks of Psychiatric Status Rating (PSR) 1 or 2 Recovery = sustained remission
Recovery rate for patients with depression at previous assessment C u m u la ti v e P e rc e n t (% ) R e c o v e ry y R a te Cumulative recovery rate N=431 54% 16% 11% 6% 1%
Only 1% of patients with depression for 4 years were able to recover after 5 years
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Depression Has an Impact on Mean Health Scores More Than Other Chronic Conditions
80 80 79 79
73
67 66 65
59 50 60 70 80 90 100
*Depressed respondents had lowest mean score among all chronic conditions (P<.0001)
†Depressed respondents with another chronic condition had lower mean health scores than
respondents with the chronic condition alone (P<.01)
M e a n H e a lt h S c o re ( 0 -1 0 0 ) N=245,404
Moussavi S, et al. Lancet.2007;370:851-858.
90.6 = No Chronic Condition
One Chronic Condition Depression + One Chronic Condition
1 2 3 4
1 2 3
4 Conditions 1. Asthma 2. Angina 3. Arthritis 4. Diabetes Depression Only * † † † † *P<.0001 †P<.01
“Depression had the largest effect on worsening mean health scores”
0 * * * *
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Solution – Pharmacy Intervention
Protocol (PIP)
• A two-way secure data feed to the pharmacy benefit manager (PBM) to exchange drug and compliance information
• Effective outreach to potential candidates based on filtering of drug data
• Financial incentives involving drug co-pays to encourage participation
• Telephonic screenings to determine candidates for participation • Daily electronic reporting of compliance/noncompliance to the PBM • Outreach and partnering with prescribing physicians to improve
standards of care and treatment outcomes
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Patented process to address the quality of care issues associated with mental health treatment in the general medical setting:
Solution – PIP
(patented)• Ongoing standardized screenings completed with all participants to score and measure change in the severity of their symptoms (frequency based on severity)
• Educational materials provided to participants so they better understand the conditions for which they are being treated, including the need for medication compliance during treatment • Recommendations to treating physicians and participants around
med-management and other treatment modifications based on screening outcomes, drug compliance, and treatment history • Coordination with the EAP for free short-term psychotherapy when
appropriate
• Outcome reporting on quality improvement
• Monitoring of drug compliance through ongoing reviews of drug data
• Results of standardized screenings provided to participants and physicians
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PIP Compliance for Initial Screening
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Several thousand PIP members in data sample
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PIP Outcomes – Global Analysis
Scoring of change in symptoms – segregated by the severity of the initial HAD
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52% 69%
89%
13%
1%
10%
Average Medication Compliance
3643 Members with >1 year of data (22,785 scripts)
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Presented By: Mike Hoffman
Arizona Benefit Plans, Inc.
St. Joseph’s Hospital
and Medical Center, et al.
PIP Outcome Data
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Outcome Data – Hospital System
60.3% of participants scored a reduction in symptoms over 3.75 years of PIP in place
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Outcome Data – Hospital System
Annual EAP Utilization
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Outcome Data – Hospital System
35% pepm reduction in drug spend for target drugs over 3.75 years
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Outcome Data – Hospital System
Rx count for target drugs over 3.75 years (pepm calculation)
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Average Medication Compliance
2802 Plan Members with > 1 year of data (17,017 scripts)
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Outcome Data – Hospital System
Overall medical claims costs comparison for year after PIP intervention vs. prior year for compliant vs. non-compliant members
