Clinical and economic outcomes of medication therapy management services: the Minnesota experience.
OBJECTIVE
To (1) provide medication therapy management (MTM) services to patients, (2) measure the clinical effects associated with the provision of MTM services, (3) measure the percent of patients achieving Healthcare Effectiveness Data and Information Set (HEDIS) goals for hypertension and hyperlipidemia in the MTM services intervention group in relationship to a comparison group who did not receive MTM services, and (4) compare patients' total health expenditures for the year before and after receiving MTM services.


METHODS
Prospective study.


METHODS
Six ambulatory clinics in Minnesota from August 1, 2001, to July 31, 2002.


METHODS
285 intervention group patients with at least 1 of 12 medical conditions using prestudy health claims; 126 comparison group patients with hypertension and 126 patients with hyperlipidemia were selected among 9 clinics without MTM services for HEDIS analysis.


METHODS
MTM services provided by pharmacists to BlueCross BlueShield health plan beneficiaries in collaboration with primary care providers.


METHODS
Drug therapy problems resolved; percentage of patients' goals of therapy achieved and meeting HEDIS measures for hypertension and hypercholesterolemia. Total health expenditures per person were measured for a 1-year period before and after enrolling patients in MTM services.


RESULTS
637 drug therapy problems were resolved among 285 intervention patients, and the percentage of patients' goals of therapy achieved increased from 76% to 90%. HEDIS measures improved in the intervention group compared with the comparison group for hypertension (71% versus 59%) and cholesterol management (52% versus 30%). Total health expenditures decreased from $11,965 to $8,197 per person (n = 186, P < 0.0001). The reduction in total annual health expenditures exceeded the cost of providing MTM services by more than 12 to 1.


CONCLUSIONS
Patients receiving face-to-face MTM services provided by pharmacists in collaboration with prescribers experienced improved clinical outcomes and lower total health expenditures. Clinical outcomes of MTM services have chronic care improvement and value-based purchasing implications, and economic outcomes support inclusion of MTM services in health plan design.
Isetts
Brian J
BJ
College of Pharmacy, University of Minnesota, Minneapolis. Electronic address: isett001@umn.edu.
Schondelmeyer
Stephen W
SW
College of Pharmacy, University of Minnesota, Minneapolis.
Artz
Margaret B
MB
VFW Endowed Chair in Pharmacotherapy for the Elderly, College of Pharmacy, University of Minnesota, Minneapolis, at the time of this study; she is currently Senior Pharmacy Analyst, Ingenix, Eden Prairie, Minnesota.
Lenarz
Lois A
LA
Fairview Health Services, Minneapolis.
Heaton
Alan H
AH
Director of Pharmacy, BlueCross BlueShield of Minnesota, Eagan, Minnesota.
Wadd
Wallace B
WB
Clinical Program Director, Prime Therapeutics LLC, Eagan, Minnesota.
Brown
Lawrence M
LM
College of Pharmacy, University of Minnesota, Minneapolis, at the time of this study; he is currently Associate Professor, College of Pharmacy, University of Tennessee Health Science Center, Memphis.
Cipolle
Robert J
RJ
College of Pharmacy, University of Minnesota, Minneapolis.
D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D002908:Chronic Disease; D003157:Community Pharmacy Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D054539:Medication Therapy Management / Q000191:economics; D008875:Middle Aged; D008910:Minnesota; D010595:Pharmacists / Q000458:organization & administration*; D024382:Professional Role; D011446:Prospective Studies