Targeting Disease Treatment Could Save States Thousands in
Medicaid Costs and Improve Health Outcomes for Patients with Asthma
Virginia Program Results Could Be
Duplicated Nationwide
WASHINGTON, DC (August 28, 2000) — The Virginia Health Outcomes
Partnership (VHOP), a model disease management program, conducted
in eight Virginia counties and metropolitan Richmond between 1995
and 1997, saved thousands of dollars in Medicaid costs for the treatment
of asthma in fiscal year 1997, according to a peer-reviewed
article appearing today in the economics journal Inquiry.
At the same time, rates of urgent care visits for patients with
asthma in the pilot area were reduced.
The study, the first of its kind in a Medicaid population, estimated
annual savings of over $1 million if the program was implemented
statewide. It further serves as evidence that state Medicaid departments
can improve both patient health outcomes and the state's fiscal
investment through disease management programs. Since the pioneering
initiative in disease management and health outcomes for the fee-for-service
portion of Virginia Medicaid, many other states are adopting programs
as well.
"States are looking for the next tier of best management practices
to apply to their Medicaid programs, after the managed care expansions
of the 1990s," said Louis F. Rossiter, PhD, deputy secretary
for the Virginia Department of Health and Human Resources and the
lead researcher on the VHOP project. "Outcomes measurement
and improvement have to provide some of the answers for states looking
for answers."
The program's goals were to educate physicians to help them improve
their communications skills and their ability to educate patients
on how to manage their asthma. It also provided information about
treatment advances in an attempt to reduce the use of costly emergency
room visits. Additionally, some physicians received feedback reports
on their patients to track their use of asthma-related services
and target those who needed additional information or preventative
treatments. The program was designed to be easily reproduced in
other states, particularly those with primary care case management
programs.
"Program physicians who didn't receive feedback reports had
almost a 25 percent reduction in emergency visits by their patients,
but those who received the feedback reports as well saw reductions
of almost twice that much," said Rossiter. "On average,
the rates of emergency visits for the physicians who received feedback
were 18-31 percent lower than those for physicians who had no training
or feedback at all."
The dispensing of drugs recommended by the guidelines for asthma
also rose significantly during the study period in the intervention
communities. In some cases this increase was as much as 25 percent.
"Asthma drugs can be very effective at keeping people out of
the emergency room when used properly," said Rossiter. "The
VHOP program was designed specifically to help the low-income Medicaid
population and their physicians and pharmacists tap into the potential
cost savings and health benefits of better adherence to treatment
regimens."
Medicaid saved an average of $659 per physician trained, according
to Rossiter, and the incremental cost for the VHOP training was
$235 per physician.
"In essence, each dollar spent training another physician generated
$3 in savings," said Rossiter. "If the same results could
be achieved statewide as for those physicians who received feedback,
each dollar spent would generate $4 in savings."
The VHOP program has expanded since the conclusion of the study
and now incorporates pharmacist training and involves the statewide
point-of-sale prescription drug system.
The VHOP Pilot program was conducted in partnership with the Virginia
Department of Medical Assistance Services, Virginia Commonwealth
University Schools of Medicine and Pharmacy, all Virginia health
professional associations for medicine, pharmacy and nursing, and
was supported with funding from the National Pharmaceutical Council
(NPC).
Since 1953, NPC has sponsored and conducted scientific, evidence-based
analyses of the appropriate use of pharmaceuticals and the clinical
and economic value of pharmaceutical innovation. NPC provides educational
resources to a variety of health care stakeholders, including patients,
clinicians, payers and policy makers. More than 20 research-based
pharmaceutical companies are members of the NPC.
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Please direct all media inquiries to Pat Adams, phone
(703) 620-6390.
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