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    Harsha Mistry, IHSE Comprehensive Health Solutions WellPoint, Inc.

    Case Management Success Story

    This last year WellPoint created a pilot program which integrated pharmacists into case management. WellPoint Case Management promotes interventions which focus on member’s self-management skills and improve patient-physician communication, with the expectation that those patients who are engaged in their health care will become better consumers of health care services, thus leading to better outcomes at lower costs.

    Since July 2010, the pharmacists have been supporting collaborative case rounds and case referrals from case managers. The pharmacists were responsible to assess the members medication needs, identify medication related problems, develop a plan of care, and provide follow-up. By the end of October 2010, the pharmacists worked on 400 cases. The pharmacists focused on assisting case managers in effectively communicating and educating members by providing drug information, managing member’s drug therapy, promoting safety, and assisting in pharmacy benefit issues.

    In one case a member requested a pharmacist to review their current medications. In the first interaction, the pharmacist learned the member recently received a pacemaker and was recently placed on warfarin. The member also discussed the use of multiple herbal medications and other prescribed prescription medications. The pharmacist performed a medication review and informed the member of the multiple potential drug-drug and drug-herb interactions with warfarin. In the same conversation the member shared that the use of multiple herbs was in fact due to the cost of a statin medication. Thus, the pharmacist provided formulary statin medications to discuss with their physician. The member notified the pharmacist he removed most of his herbal medications because his physician prescribed him a formulary statin that he could afford. In addition the pharmacist asked about his International Normalized Ratio (INR) score to determine if the warfarin therapy was therapeutic. Unfortunately the member stated his INR was subtherapeutic at 1.2. After a short discussion, the pharmacist determined the member had a rich diet of Vitamin K and provided education about how diet interferes with warfarin therapy. The pharmacist also suggested a dietary consult from a dietician for further dietary warfarin education and the member accepted. This is just one consult where a discussion meant for a medication review actually empowered the member to manage their warfarin drug therapy and potentially prevent drug interactions through simple conversation with a pharmacist.

    The pharmacists also presented a training module to case manager nurses to encourage the importance of discussing medication adherence with members. Poor adherence to treatment regimens is one example of where members have a substantial roadblock to achieving better health outcomes. Data shows that as many as half of all patients do not adhere to their prescription regimens and the result is more than $100 billion is spent each year on avoidable hospitalizations.

    There is clear evidence for pharmacists in collaborative case management. As we continue the program in case management, we will continue to focus on the two core principles of case management: promoting self-management and improving patient-physician communications.

    Nov. 2010
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