A penny saved is a penny earned: Pharmacy and behavioral health cost

savings in pediatric IPC clinicsPaul Kettlewell, Ph.D.

Tawnya J. Meadows, Ph.D.Shelley J. Hosterman, Ph.D.Vanessa Pressimone, Ph.D.

Collaborative Family Healthcare Association 16th Annual ConferenceOctober 16-18, 2014 Washington, DC U.S.A.

Session F 1 cFriday October 17, 2014

Faculty Disclosure

• We have not had any relevant financial relationships during the past 12 months.

Learning Objectives

At the conclusion of this session, the participant will be able to:

• Identify data collection procedures to measure outcomes on cost offset.

• Describe pharmacy savings found.

• List two plausible reasons why behavioral health costs were found to be relatively cheaper per member per month in integrated primary care clinics versus standard primary care clinics.

Bibliography / Reference

Cummings, N.A., O'Donohue, W.T., & Cummings, J.L. (2009). The financial dimension of integrated behavioral/primary care. Journal of Clinical Psychology in Medical Settings, 16, 31-39. doi:10.1007/s10880-008-9139-2 Felleman, B.I., Athenour, D.R., Ta, M.T., & Stewart, D.G. (2013). Behavioral health services influence medical treatment utilization among primary care patients with comorbid sustance use and depression. Journal of Clinical Psychology in Medical Settings, 20, 415-426. doi:10.1007/s10880-013-9367-y Monson, S.P., Sheldon, J.C., Ivey, L.C., Kinman, C.R., & Beacham, A.O. (2012). Working toward financial sustainability of integrated behavioral health services in a public health care system. Families, Systems, & Health, 30, 181-186. doi:10.1037/a0028177 Wiley-Exley, E., Domino, M.E., Maxwell, J., & Levkoff, S.E. (2009). Cost-effectiveness of integrated care for elderly depressed patients in the PRISM-E study. Journal of Mental Health Policy & Economics, 12, 205-213.

Thielke, S. (2011). Health psychology in primary care: recent research and future directions. Psychology Research and Behavior Management, 4, 59-68. doi:10.2147/PRBM.S12996

Learning Assessment

• A learning assessment is required for CE credit.

• A question and answer period will be conducted at the end of this presentation.

Pediatric IPCModel & Outcomes

Clinical Model & Services

Three pilot sites• Psychologist (4 days/week)• Postdoc fellows (2-3 days/week)

Behavioral health schedules• 6-7 billable units a day• Family, individual, group• Gaps in schedule for integrated activities• Always available

Clinical Model & Services

• Sites & staff• Problem focused

eval/treatment• Family, individual, &

group therapy• Consults & hand-offs• Crisis appointments• Same day evaluations

• Screening tools• Handouts• Communication• Psychiatry telemedicine• PCP education• Liaison to MH/school• Clinic wide

interventions

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Collaborative Care: Consults & Handoffs Add Value

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200

100

200

300

400

500

600

700

800

Scheduled appointments

Collabora-tions

Total Patient Contacts

Months of Service 09/11 - 04/13

Nu

mb

er o

f C

on

tact

s

Added value: 25.6% of con-tacts

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Reducing Hospitalization & Costs (ED Saves)

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OutpatientWraparoundHospital

n = 6 (6.5%)

n = 85 (91.4%)Data represents a savings of $560K just in hospitalization costs

n = 2 (2.1%)

GHP Data: Bending the Cost Curve

IPC Book

Average Total Behavioral Health Spend 12.0% 22%

UBH Claims5% 18.3%

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• Average length of treatment in IPC (3.7 sessions) as compared to usual care (18.9 sessions). Able to serve more patients

Reduction in PMPM for Medications

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Allo

wed

PM

PM

Time of IPC Implementation

GHP Data: Bending the Cost Curve

IPC Book

Average Total Pharmacy Spend 9.8% 35.5%

BH medication35.6% 55.8%

Non BH medication -19.5% 15.8%

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Reduced Costs: Treatment Costs

• Total revenue generated per session resulted in significant gains for IPC clinic vs. control clinic (*p< .01)

• Possible factors: Less staffing, higher show rates, lower drop out rates, shorter courses of treatment

DBD Anxiety Depression

■ Control■ IPC

Reduced Costs: Medication Utilization

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• Prescription medications/month decreased by 3.25% after integration. Stimulant prescriptions decreased marginally. Levels & trends did not change among the control sites.

Implications

• Value-based payment

Or• Share in cost savings

Or• Payment based upon members

Or• Flat percentage more of payment due to value added

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Session Evaluation

Please complete and return theevaluation form to the classroom

monitor before leaving this session.

Thank you!