An analysis of the impact on total cost of care within a pharmacist-led comprehensive medication management program

Abstract

Introduction

The rise in health care expenditures continues to pose a significant concern regarding the longevity of the current health care system design. The literature has demonstrated a positive return on investment (ROI) when pharmacists perform medication management services. Building upon positive ROI literature, a clinically integrated network (CIN) in Michigan developed an approach to patient targeting for comprehensive medication management (CMM) services in existing alternative payment model (APM) Medicare Advantage, Medicaid, and Commercial contracts.

Objectives

The primary objective of this study was to examine the real-world impact of an advanced ambulatory care pharmacy model, inclusive of embedded clinic-based ambulatory pharmacists, centralized ambulatory pharmacists, centralized population health pharmacists, and specially trained pharmacy technicians, on the total cost of care (TCOC) within a large integrated health system.

Methods

For CMM dates of service occurring in calendar year 2022, pharmacy and medical claims were evaluated during the 6-month period prior to and following the initial CMM patient encounter. Upon completion of the study period, data were evaluated to assess TCOC and utilization trends for the study population.

Results

Statistically significant differences in median TCOC ($1427.84, p < 0.001), prescription drug costs ($222.82, p < 0.001), and medical costs ($462.26, p < 0.001) were observed between the pre-CMM and post-CMM timeframes for the study population. A 16% reduction in hospital admissions was observed between the pre-CMM and post-CMM timeframes.

Discussion

This study further supports that pharmacist intervention as part of a CMM program can favorably affect health care costs. Criteria such as a population's benchmark costs and utilization, insurance product types, and core conditions present can help determine whether expanding or initiating CMM services could be beneficial in improving care and health care costs.