UMMS Affiliation

Commonwealth Medicine, Clinical Pharmacy Services

Date

9-17-2012

Document Type

White Paper

Disciplines

Health Services Administration | Health Services Research | Pharmacy and Pharmaceutical Sciences

Abstract

A pharmacist’s medication management skill can enhance health outcomes and quality of life for members of Medicaid, Medicare, and commercial health plans — especially for members who have serious medical conditions or need closely coordinated pharmaceutical care. For this reason, UMass Medical School’s Clinical Pharmacy Services program has developed a specialized medication therapy management program for high-cost populations with complex medical conditions or other issues that put them at risk.

The Clinical Pharmacy Services pharmacists who work within this program have expertise with high-cost, high-risk populations. They also understand coverage limits and can nimbly navigate the health care system. Currently, these pharmacists work as part of care coordination teams for the following populations:

  • Medically fragile children under age 22

  • Adults with multiple chronic, complex conditions, such as acquired brain injury with other co-morbidities

  • Children in the care of social services

  • Children in the care of, or about to enter, the foster care system

  • Members with complex medical needs being discharged from hospitals

While medication management programs for the general population save about $4 for each $1 spent, Clinical Pharmacy Services’ specialized medication management program produces average cost avoidance of $10.64 for each $1 spent to optimize pharmaceutical care for these medically complex populations. That figure is achieved by having dedicated pharmacists — who have expertise with the populations served — manage multiple aspects of members’ pharmaceutical needs, with emphases on procuring medication, resolving clinical and insurance issues, improving care, and enhancing quality of life.

The pharmacists involved in this specialized medication management therapy program are supported by a larger team that includes dozens of pharmacists with board certification in pharmacotherapy and postgraduate training in pharmacy practice specialties. First established in 1999 to provide drug utilization review services for Massachusetts Medicaid, Clinical Pharmacy Services now provides evidence-based clinical and operational support, consulting, and service delivery in areas such as medication management, patient-centered medical homes, prescriber outreach, pharmacoeconomic analysis, clinical guideline development, and formulary management.

Keywords

pharmacy services, pharmacists, medication therapy management, health care, coordination

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