Evaluation of an Educational Program on Deciphering Heterogeneity for Medical Coverage Decisions

AUTHORS: Terri L. Warholak, Jianhua W. Hilgaertner, Joni L. Dean, Ann M. Taylor, Lisa E. Hines, Jason Hurwitz, Mary Brown, Daniel C. Malone

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SUMMARY:

BACKGROUND: It is increasingly important for decision makers, such as medical and pharmacy managers (or pharmacy & therapeutics committee members and staff), to understand the variation and diversity in treatment response as decisions shift from an individual patient perspective to optimizing care for populations of patients. 

OBJECTIVE: To assess the effectiveness of an instructional program on heterogeneity designed for medical and pharmacy managers. 

METHODS: A live educational program was offered to members of the Academy of Managed Care Pharmacy at the fall 2012 educational meeting and also to medical directors and managers attending a national payer roundtable meeting in October 2012. Participants completed a retrospective pretest-posttest assessment of their knowledge, attitudes, and self-efficacy immediately following the program. Participants were offered the opportunity to participate in a follow-up assessment 6 months later. Willing participants for the follow-up assessment were contacted via e-mail and telephone. Rasch rating scale models were used to compare pre- and postscores measuring participants’ knowledge about and attitude towards heterogeneity. 

RESULTS: A total of 49 individuals completed the retrospective pretest-posttest assessment and agreed to be a part of the program evaluation. Fifty percent (n = 25) of participants had heard of the phrase “heterogeneity of treatment effect,” and 36 (72%) were familiar with the phrase “individualized treatment effect” prior to the live program. Participants reported a significant improvement in knowledge of heterogeneity (P < 0.01) and attitudes about heterogeneity (P < 0.01) immediately after attending the program. At the time of the educational program, participants had either never considered heterogeneity (26%) or reported not knowing (28%) whether their organizations considered it when determining basic coverage. Participants were more likely to report “sometimes” considering heterogeneity for determining necessity for individual appeals, prior authorization, tier placement for pharmaceutical therapies, and other types of medical management. At the 6-month follow-up, 21 of the 49 willing participants (43% response rate) completed the evaluation; participants continued to have a good understanding of heterogeneity, but there was no significant difference in attitudes towards heterogeneity between pre- and 6-month follow-up. 

CONCLUSION: A live educational program was effective in improving participants’ immediate knowledge and attitudes regarding the topic of heterogeneity. Participating managed care pharmacists and medical managers indicated that heterogeneity of treatment effect was likely to be used in determining prior authorizations and determining necessity.

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