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Laine statewide dd meeting bpm mailings 4 13

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Mental health professionals discuss best practices for treating patients who need medication.

Mental health professionals discuss best practices for treating patients who need medication.


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  • 1. Missouri-Behavioral Pharmacy Management Program Laine Young-Walker, M.D. Associate Medical Director Department of Mental Health
  • 2. Missouri-BPM Mailings
    • Collaboration with
      • DMH
      • Mo Health Net
      • CMT (Care Management Technologies)
    • Utilizes Medicaid Claims Data
    • Each mailing is for 90 days of claims
  • 3. Missouri-BPM Mailings
    • Data from October 2007 to Present
    • Initially both Adult and Children were followed
    • Mailings are sent to Superintendents of the Habilitation Centers
    • All HAB Center Report and each Individual HAB Center reports
  • 4. Missouri-BPM Mailings
    • Mailings list numbers of patients on various drug classes
    • Identifies various quality indicators and the numbers of patients hitting a QI
    • Identifies number of claims, amount of money paid on the claims and PUPM cost
  • 5. Missouri-BPM Mailings
    • QI’s are placed in various categories
      • High Risk (5 or more psychotropics)
      • Redundancy (2 or more SSRI’s at higher than recommended dose for more than 60 days)
      • Continuity and Coordination of Care (Failure to refill an antipsychotic within 30 days of prescription ending; Multiple prescribers of any antipsychotic for 45 days or more)
  • 6. Missouri-BPM Mailings
    • QI’s are placed in various categories (cont)
      • Bipolar (Use of 5 or more drugs for bipolar disorder for 60 days or more)
      • Antipsychotics ( Use of 2 or more antipsychotics for 60 days or more; Use of 2 or more atypical antipsychotics for 60 days or more)
  • 7. Missouri-BPM Mailings
    • Example of most recent All Hab Center Mailing
  • 8. Missouri-BPM Mailings
    • Also gives a Benchmark Report
      • Number of Outlier prescriptions
      • Total Behavioral Pharmacy Prescriptions
      • % Outlier Prescriptions
  • 9. Missouri-BPM Mailings
    • QI indicates a prescribing pattern that is outside the best practice standard
    • Included in the mailing is some information regarding the QI
      • Why it is a clinical issue
      • What are some clinical considerations
      • References to look up regarding this QI
  • 10. Missouri-BPM Mailings
    • Example of information sheets
  • 11.  
  • 12.  
  • 13.  
  • 14. Missouri-BPM Mailings
    • Review of Cases by Consultant in 2007 and 2008
    • Consumers on 5 or more psychotropics and 2 or more antipsychotics were reviewed
    • Dr. Hogan came to each Habilitation Center and reviewed records/met consumers
  • 15. Missouri-BPM Mailings
    • Recommendations were made regarding frequency of follow-up (appointments/labs) and potential tapering of medications
    • Discussion of recommendations with some physicians
  • 16. Missouri-BPM Mailings June 2009 to February 2010 Quality Indicator 6/1/09 to 8/31/09 10/1/09 to 12/31/09 12/1/09 to 2/28/10 Adult use of 5 or more Psychotropic Meds for 60 days or more 29 26 34 % Hab Center Adult use of 5 or more Psychotropic Meds for 60 or more days 5.51% 5.22% 6.49% Adult use of 2 or more Antipsychotic Meds for 60 days or more 63 63 63 % Hab Center Adult use of 2 or more Antipsychotic Meds for 60 days or more 11.98% 12.65% 12.02% Adult Use of Benzodiazepines at higher than recommended dose for 60 days or more 19 19 19 % Hab Center Adult use Benzodiazepines at higher than recommended dose for 60 days or more 3.61% 3.82% 3.63% Habilitation Center Adults with MHN Behavioral Medication Claims 526 498 524
  • 17. Missouri-BPM Mailings June 2009 to February 2010
  • 18. Missouri-BPM Mailings October 2007 to August 2008 Quality Indicator 6/1/08 to 8/31/08 3/1/08 to 5/31/08 12/1/07 to 2/28/08 10/1/07 to 12/31/07 Adult use of 5 or more Psychotropic Meds for 60 days or more 23 18 10 12 % Hab Center Adult use of 5 or more Psychotropic Meds for 60 or more days 3.91% 2.96% 1.81% 2.38% Adult use of 2 or more Antipsychotic Meds for 60 days or more 66 45 38 43 % Hab Center Adult use of 2 or more Antipsychotic Meds for 60 days or more 11.22% 7.40% 6.87% 8.51% Adult Use of Benzodiazepines at higher than recommended dose for 60 days or more 25 24 24 26 % Hab Center Adult use Benzodiazepines at higher than recommended dose or 60 days or more 4.25 3.95% 4.34% 5.15% Habilitation Center Adults with MHN Behavioral Medication Claims 588 608 553 505
  • 19. Missouri-BPM Mailings October 2007 to August 2008
  • 20. Missouri-BPM Mailings Comparison of Initial and Present Data
  • 21. Missouri-BPM Mailings Benchmark for Most Recent Mailing December 2009 to February 2010 Hab Center Census Total Scripts Scripts/Resident % Outlier SEMORS 77 549 7.26 36.25% Marshall 197 883 4.48 32.39% Nevada 117 910 7.78 30.22% Higginsville 143 1742 12.18 24.86% DDTC 188 1700 9.04 17.65% Bellefountaine 145 278 1.92 16.55%
  • 22.  
  • 23.  
  • 24. Missouri-BPM Mailings Benchmark for Most Recent Mailing October 2007 to December 2007 Hab Center Census Total Scripts Scripts/Resident % Outlier SEMORS 75 570 7.60 30.0% Marshall 206 847 4.11 33.7% Nevada 140 1181 8.44 22.1% Higginsville 110 763 6.94 16.5% DDTC 220 900 4.09 6.8% Bellefountaine 161 343 2.13 8.2%
  • 25. Missouri-BPM Mailings Comparison of 10/07 and 12/09 Benchmark Report
  • 26. Missouri-BPM Mailings Comparison of 10/07 and 12/09 Benchmark Report
  • 27. Missouri-BPM Mailings Comparison of 10/07 and 12/09 Benchmark Report
  • 28. Missouri-BPM Mailings
    • Mailings have provided data regarding prescribing practices
    • Ability to look at changes over time
    • There are many more quality indicators
  • 29. Missouri-BPM Mailings
    • The numbers of consumers on 5 or more than psychotropic medications has increased
    • The numbers of consumers on 2 or more antipsychotics has increased

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