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Coal/Energy Coalition
and Pro Pharma Pharmaceutical Consultants, Inc.
Quality Initiative to Improve Physician Prescribing
Problem Identification
Continuing increases in pharmacy benefit cost occur even while generic use increases as a percent of total medications dispensed. Movement of office injectables from the medical benefit to the pharmacy benefit has highlighted the run-away inflation for such medications. For six member companies of the Coal/Energy Coalition, traditional interventions were not curbing escalation in costs. Exasperated with a trend that significantly exceeded the national average every year, the Coalition companies came together in 2003 to try an innovative approach to improving quality of care and managing benefit costs.
Objectives
Responding to an RFP, Pro Pharma Pharmaceutical Consultants, Inc. (Pro Pharma) proposed a program that would engage physicians in improving the clinical quality of pharmaceutical care for their patients, and at the same time lower costs. The objective is to decrease the quality gap between actual prescribing experience and national standards of care for applicable diagnosis and move the mean toward lower trends.
Target Audience
Coal/Energy Coalition companies designated primary care and medical practitioners with sufficient patient volumes in seven states -- West Virginia, Virginia, Kentucky, Wyoming, Illinois, Indiana, and South Dakota -- as the target audience. These states are among the highest utilizers of both medical services and prescription drugs.
Solution
Pro Pharma developed and executed a multi-faceted prescriber intervention program focused on quality management. It combines compelling, patient-focused clinical information, clinical problem solving, relationship building with physicians and their office staffs, and continuous prescriber feedback for ongoing success. Interventional efforts are implemented with each Coalition member company’s benefit design, formulary, cost share definitions, and PBM programming.
Critical success factors include:
- Bi-weekly confidential communication to physicians with clinically compelling information on patient-specific opportunities to improve pharmaceutical care.
- Coal/Energy Coalition Prescribing Guide with medications that can be found on all Coalition company formularies.
- Clinical educational materials sent weekly to prescribers, plus Continuing Education (CE) programs.
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Frequent feedback to individual prescribers with comparative information on generics use, average number of medications per patient, and average cost per prescription.
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Annual Best-in-Class practitioner award program.
Results
Three-year results demonstrate that quality does lead to lower costs. Among the results:
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The 2007 all-Coalition drug trend was -3% compared to 8.3% national trend and 16% for the coal/energy industry.
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Trend was based on improving the performance of the mean for the targeted physicians who controlled 85% of drug spend. (See graph below.)
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Pharmacy cost of Best-in-Class physicians is approximately 1/5 that of other physicians, and Best-in-Class physicians use half as many prescriptions.
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Physician practices that use the Coal/Energy Coalition Prescribing Guide report a reduction of approximately 50% of pharmacy callbacks, thus reducing unreimbursed overhead within the practice.
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Source: Pro Pharma Pharmaceutical Consultants, Inc. |
This graph demonstrates the variance between the overall drug cost of the Top 100 Primary Care Physicians (PCPs) targeted for intervention, as compared to the Ingredient Cost of Physicians treating similar patients, in the same geographic areas who were not in the targeted intervention group.
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