Strengthening value-based medication management in a free clinic for the uninsured: Quality interventions aimed at reducing costs and enhancing adherence. Issue 2 (31st October 2017)

• Record Type: Journal Article
• Authors: Arao, Robert K; O'Connor, Michelle Y; Barrett, Thomas; Chockalingam, Leela; Khan, Farrah; Kumar, Anirudh; Leader, Andrew; Leven, Emily; Power, John R; Shuham, Benjamin; Rifkin, Robert; Thomas, David; Meah, Yasmin; Shah, Brijen J
• Is Part Of: BMJ open quality. Volume 6:Issue 2(2017)
• Publication Date: 2017-10-31
• Subjects: quality improvement -- cost-effectiveness -- compliance -- medical education; Medical care -- Quality control -- Periodicals; 362.106805
• DOI: 10.1136/bmjoq-2017-000069
• Languages: English
• ISSNs: 2399-6641

Abstract

Abstract : Skyrocketing costs of prescription medications in the USA pose a significant threat to the financial viability of safety net clinics that opt to supply medications at low to no out-of-pocket costs to patients. At the East Harlem Health Outreach Partnership clinic of the Icahn School of Medicine at Mount Sinai, a physician-directed student-run comprehensive primary care clinic for uninsured adults of East Harlem, expenditures on pharmaceuticals represent nearly two-thirds of annual costs. The practice of minimising costs while maintaining quality, referred to as high-value care, represents a critical cost-saving opportunity for safety net clinics as well as for more economical healthcare in general. In this paper, we discuss a series of quality improvement initiatives aimed at reducing pharmacy-related expenditures through two distinct yet related mechanisms: (A) promoting value-conscious prescribing by providers and (B) improving patient adherence to medication regimens. Interventions aimed at promoting value-conscious prescribing behaviour included blacklisting a costly medication on our clinic's formulary and adding a decision tree in our mobile clinician reference application to promote value-conscious prescribing. Interventions targeted to improving patient adherence involved an automated text messaging system with English and Spanish refill reminders to encourage timely pick-up of medication refills. As a result of these processes, the free clinic experienced a 7.3%, or $3768, reduction in annual pharmacy costs. Additionally, medication adherence in patients with diabetes on oral antihyperglycaemic medications increased from 55% to 67%. Simultaneous patient-based and provider-based interventions may be broadly applicable to addressing rising pharmacy costs in healthcare across the USA.