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1.
J Manag Care Spec Pharm ; 25(5): 538-543, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039066

RESUMO

Managed care organizations are growing more sophisticated in their ability to analyze data. There are increasing numbers of data analysts at managed care organizations, as well as more types of real-time, or "live," data available. These data range from pharmacy claims and enrollment files to medical claims, medical records, and linkages to external data. Moreover, the data are often curated in a way that allows for easier data analysis. Using these data, managed care residents are often required to perform a project to evaluate a utilization management policy or clinical program. Yet, there is a lack of guidance specific to managed care organizations on how to conduct such a research study using "live" claims data. This Viewpoint article provides a primer for managed care residents and other managed care professionals who are seeking to use data to help inform decisions on how to manage their beneficiaries' health and costs. DISCLOSURES: There was no funding source for this manuscript. Hung reports a grant from the Agency for Healthcare Research and Quality and personal fees from Blue Cross Blue Shield Association, outside the submitted work. Gedey, Groeneweg, and Jay have nothing to disclose.


Assuntos
Revisão da Utilização de Seguros/normas , Programas de Assistência Gerenciada/organização & administração , Assistência Farmacêutica/organização & administração , Pesquisa em Farmácia/métodos , Projetos de Pesquisa , Interpretação Estatística de Dados , Humanos , Internato e Residência , Programas de Assistência Gerenciada/economia , Assistência Farmacêutica/economia , Pesquisa em Farmácia/normas , Estados Unidos
2.
J Manag Care Spec Pharm ; 24(5): 458-463, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29694287

RESUMO

BACKGROUND: Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatments. Disease management programs are hypothesized to improve medication adherence thereby improving clinical and economic outcomes. OBJECTIVE: To evaluate the clinical and economic effects of a specialty pharmacy and chronic disease management program for patients with MS from a health plan perspective. METHODS: This study was a retrospective analysis using prescription drug claims, medical claims, and electronic medical record information (2013-2015) 1 year before and after enrollment in the disease management program for members with 24 months of continuous health plan coverage. Medication adherence was calculated using proportion of days covered (PDC). Relapse rate was defined as an MS outpatient visit associated with a corticosteroid dispense within 7 days of the visit or an MS hospitalization. Disease progression was assessed using the Modified Expanded Disability Status Scale (mEDSS). Resource use included outpatient visits, ED visits, and hospitalizations. Cost information was collected as health plan-paid amount and was reported in 2013 U.S. dollars. RESULTS: The analysis included 377 patients (mean age 55 years, 76.4% female). After enrollment in the program, 78.7% of the study group had a PDC of ≥ 0.80 compared with 70.0% before enrollment (P < 0.001). There was no difference in MS relapse rate (0.25 after vs. 0.45 before, P = 0.11) or mEDSS score (3.77 after vs. 3.76 before, P = 0.19). Health care resource utilization was minimal and did not change significantly throughout the study period: mean outpatient visits (13.09 after vs. 13.78 before, P = 0.69); mean ED visits (0.18 after vs. 0.16 before, P = 0.60); and mean hospitalizations (0.12 after vs. 0.12 before, P = 1.00). This nonsignificant finding remained when the analysis was limited to MS-related visits only. Average annual health plan spend per patient on MS medications significantly increased ($55,835 after vs. $40,883 before, P < 0.001). CONCLUSIONS: Specialty pharmacy and chronic disease management for patients with MS can increase the proportion of patients adherent to medication. The increase in health plan spend on MS medications is not offset by savings in health care resource utilization. DISCLOSURES: This study was funded by Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington Pharmacy Administration. The authors have no disclosures to report.


Assuntos
Imunossupressores/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/economia , Esclerose Múltipla/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde/economia , Adulto , Idoso , Doença Crônica/tratamento farmacológico , Doença Crônica/economia , Avaliação da Deficiência , Progressão da Doença , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Imunossupressores/economia , Masculino , Conduta do Tratamento Medicamentoso/organização & administração , Pessoa de Meia-Idade , Esclerose Múltipla/economia , Noroeste dos Estados Unidos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
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