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Mental health professionals discuss best practices for treating patients who need medication.
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Missouri-BehavioralMissouri-BehavioralPharmacyPharmacy
Management ProgramManagement Program
Laine Young-Walker, M.D.Associate Medical Director
Department of Mental Health
Missouri-BPM MailingsMissouri-BPM MailingsCollaboration with
◦DMH◦Mo Health Net ◦CMT (Care Management Technologies)
Utilizes Medicaid Claims Data
Each mailing is for 90 days of claims
Missouri-BPM MailingsMissouri-BPM MailingsData 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
Missouri-BPM MailingsMissouri-BPM MailingsMailings 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
Missouri-BPM MailingsMissouri-BPM MailingsQI’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)
Missouri-BPM MailingsMissouri-BPM MailingsQI’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)
Missouri-BPM MailingsMissouri-BPM MailingsExample of most recent All Hab
Center Mailing
Missouri-BPM MailingsMissouri-BPM MailingsAlso gives a Benchmark Report
◦Number of Outlier prescriptions
◦Total Behavioral Pharmacy Prescriptions
◦% Outlier Prescriptions
Missouri-BPM MailingsMissouri-BPM MailingsQI 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
Missouri-BPM MailingsMissouri-BPM MailingsExample of information sheets
Missouri-BPM MailingsMissouri-BPM MailingsReview 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
Missouri-BPM MailingsMissouri-BPM MailingsRecommendations were made
regarding frequency of follow-up (appointments/labs) and potential tapering of medications
Discussion of recommendations with some physicians
Missouri-BPM MailingsMissouri-BPM MailingsJune 2009 to February 2010June 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
Missouri-BPM MailingsMissouri-BPM MailingsJune 2009 to February 2010June 2009 to February 2010
Missouri-BPM MailingsMissouri-BPM MailingsOctober 2007 to August 2008October 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
Missouri-BPM MailingsMissouri-BPM MailingsOctober 2007 to August October 2007 to August
20082008
Missouri-BPM MailingsMissouri-BPM MailingsComparison of Initial and Present Comparison of Initial and Present
DataData
Missouri-BPM MailingsMissouri-BPM MailingsBenchmark for Most Recent Benchmark for Most Recent
Mailing Mailing December 2009 to February December 2009 to February
20102010Hab 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%
Missouri-BPM MailingsMissouri-BPM MailingsBenchmark for Most Recent Benchmark for Most Recent
Mailing Mailing October 2007 to December October 2007 to December
20072007Hab 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%
Missouri-BPM MailingsMissouri-BPM MailingsComparison of 10/07 and Comparison of 10/07 and
12/0912/09Benchmark ReportBenchmark Report
Missouri-BPM MailingsMissouri-BPM Mailings Comparison of 10/07 and Comparison of 10/07 and
12/0912/09Benchmark Report Benchmark Report
Missouri-BPM MailingsMissouri-BPM Mailings Comparison of 10/07 and Comparison of 10/07 and
12/0912/09Benchmark Report Benchmark Report
Missouri-BPM MailingsMissouri-BPM MailingsMailings have provided data
regarding prescribing practices
Ability to look at changes over time
There are many more quality indicators
Missouri-BPM MailingsMissouri-BPM MailingsThe numbers of consumers on 5
or more than psychotropic medications has increased
The numbers of consumers on 2 or more antipsychotics has increased