Missouri-BehavioralMissouri-BehavioralPharmacyPharmacy

Management ProgramManagement Program

Laine Young-Walker, M.D.Associate Medical Director

Department of Mental Health

Missouri-BPM MailingsMissouri-BPM MailingsCollaboration with

◦DMH◦Mo Health Net ◦CMT (Care Management Technologies)

Utilizes Medicaid Claims Data

Each mailing is for 90 days of claims

Missouri-BPM MailingsMissouri-BPM MailingsData from October 2007 to Present

Initially both Adult and Children were followed

Mailings are sent to Superintendents of the Habilitation Centers

All HAB Center Report and each Individual HAB Center reports

Missouri-BPM MailingsMissouri-BPM MailingsMailings list numbers of patients on

various drug classes

Identifies various quality indicators and the numbers of patients hitting a QI

Identifies number of claims, amount of money paid on the claims and PUPM cost

Missouri-BPM MailingsMissouri-BPM MailingsQI’s are placed in various categories

◦High Risk (5 or more psychotropics)

◦Redundancy (2 or more SSRI’s at higher than recommended dose for more than 60 days)

◦Continuity and Coordination of Care (Failure to refill an antipsychotic within 30 days of prescription ending; Multiple prescribers of any antipsychotic for 45 days or more)

Missouri-BPM MailingsMissouri-BPM MailingsQI’s are placed in various

categories (cont)◦Bipolar (Use of 5 or more drugs for

bipolar disorder for 60 days or more)

◦Antipsychotics ( Use of 2 or more antipsychotics for 60 days or more; Use of 2 or more atypical antipsychotics for 60 days or more)

Missouri-BPM MailingsMissouri-BPM MailingsExample of most recent All Hab

Center Mailing

Missouri-BPM MailingsMissouri-BPM MailingsAlso gives a Benchmark Report

◦Number of Outlier prescriptions

◦Total Behavioral Pharmacy Prescriptions

◦% Outlier Prescriptions

Missouri-BPM MailingsMissouri-BPM MailingsQI indicates a prescribing pattern

that is outside the best practice standard

Included in the mailing is some information regarding the QI ◦Why it is a clinical issue◦What are some clinical considerations◦References to look up regarding this

QI

Missouri-BPM MailingsMissouri-BPM MailingsExample of information sheets

Missouri-BPM MailingsMissouri-BPM MailingsReview of Cases by Consultant in

2007 and 2008

Consumers on 5 or more psychotropics and 2 or more antipsychotics were reviewed

Dr. Hogan came to each Habilitation Center and reviewed records/met consumers

Missouri-BPM MailingsMissouri-BPM MailingsRecommendations were made

regarding frequency of follow-up (appointments/labs) and potential tapering of medications

Discussion of recommendations with some physicians

Missouri-BPM MailingsMissouri-BPM MailingsJune 2009 to February 2010June 2009 to February 2010

Quality Indicator 6/1/09 to 8/31/09

10/1/09 to 12/31/09

12/1/09 to 2/28/10

Adult use of 5 or more Psychotropic Meds for 60 days or more

29 26 34

% Hab Center Adult use of 5 or more Psychotropic Meds for 60 or more days

5.51% 5.22% 6.49%

Adult use of 2 or more Antipsychotic Meds for 60 days or more

63 63 63

% Hab Center Adult use of 2 or more Antipsychotic Meds for 60 days or more

11.98%

12.65% 12.02%

Adult Use of Benzodiazepines at higher than recommended dose for 60 days or more

19 19 19

% Hab Center Adult use Benzodiazepines at higher than recommended dose for 60 days or more

3.61% 3.82% 3.63%

Habilitation Center Adults with MHN Behavioral Medication Claims

526 498 524

Missouri-BPM MailingsMissouri-BPM MailingsJune 2009 to February 2010June 2009 to February 2010

Missouri-BPM MailingsMissouri-BPM MailingsOctober 2007 to August 2008October 2007 to August 2008

Quality Indicator 6/1/08 to 8/31/08

3/1/08 to 5/31/08

12/1/07 to 2/28/08

10/1/07 to 12/31/07

Adult use of 5 or more Psychotropic Meds for 60 days or more

23 18 10 12

% Hab Center Adult use of 5 or more Psychotropic Meds for 60 or more days

3.91% 2.96% 1.81% 2.38%

Adult use of 2 or more Antipsychotic Meds for 60 days or more

66 45 38 43

% Hab Center Adult use of 2 or more Antipsychotic Meds for 60 days or more

11.22% 7.40% 6.87% 8.51%

Adult Use of Benzodiazepines at higher than recommended dose for 60 days or more

25 24 24 26

% Hab Center Adult use Benzodiazepines at higher than recommended dose or 60 days or more

4.25 3.95% 4.34% 5.15%

Habilitation Center Adults with MHN Behavioral Medication Claims

588 608 553 505

Missouri-BPM MailingsMissouri-BPM MailingsOctober 2007 to August October 2007 to August

20082008

Missouri-BPM MailingsMissouri-BPM MailingsComparison of Initial and Present Comparison of Initial and Present

DataData

Missouri-BPM MailingsMissouri-BPM MailingsBenchmark for Most Recent Benchmark for Most Recent

Mailing Mailing December 2009 to February December 2009 to February

20102010Hab Center

Census Total Scripts

Scripts/Resident

% Outlier

SEMORS 77 549 7.26 36.25%

Marshall 197 883 4.48 32.39%

Nevada 117 910 7.78 30.22%

Higginsville

143 1742 12.18 24.86%

DDTC 188 1700 9.04 17.65%

Bellefountaine

145 278 1.92 16.55%

Missouri-BPM MailingsMissouri-BPM MailingsBenchmark for Most Recent Benchmark for Most Recent

Mailing Mailing October 2007 to December October 2007 to December

20072007Hab Center

Census Total Scripts

Scripts/Resident

% Outlier

SEMORS 75 570 7.60 30.0%

Marshall 206 847 4.11 33.7%

Nevada 140 1181 8.44 22.1%

Higginsville 110 763 6.94 16.5%

DDTC 220 900 4.09 6.8%

Bellefountaine

161 343 2.13 8.2%

Missouri-BPM MailingsMissouri-BPM MailingsComparison of 10/07 and Comparison of 10/07 and

12/0912/09Benchmark ReportBenchmark Report

Missouri-BPM MailingsMissouri-BPM Mailings Comparison of 10/07 and Comparison of 10/07 and

12/0912/09Benchmark Report Benchmark Report

Missouri-BPM MailingsMissouri-BPM Mailings Comparison of 10/07 and Comparison of 10/07 and

12/0912/09Benchmark Report Benchmark Report

Missouri-BPM MailingsMissouri-BPM MailingsMailings have provided data

regarding prescribing practices

Ability to look at changes over time

There are many more quality indicators

Missouri-BPM MailingsMissouri-BPM MailingsThe numbers of consumers on 5

or more than psychotropic medications has increased

The numbers of consumers on 2 or more antipsychotics has increased