1 The Medicaid system was established in 1965 as a safety net for our nation’s most vulnerable citizens. Today, Medicaid covers nearly 60 million Americans at an annual cost of over $400 billion, and is undergoing the single largest expansion in its history as a result of the Patient Protection and Affordable Care Act (PPACA). 1 Projected Medicaid growth over the next decade is staggering. By 2022, 1 in 4 Americans is expected to enter the Medicaid system 2 , adding as many as 26 million new beneficiaries 3 and doubling annual spending to $800 billion. 1 At the state level, this fiscal impact is potentially crippling. Medicaid currently consumes nearly one-fourth of most state budgets. 4 The financial burden of Medicaid expansion is creating fiscal crises for the majority of states.1 Without significant reform, the growth trajectory of Medicaid is unsustainable. In order to establish meaningful reform, new approaches are required to ensure quality, while controlling budget growth, for a Medicaid population that is rapidly expanding. This white paper explores specific and actionable concepts around how community pharmacy can improve health, enhance quality of care, and positively impact Medicaid costs. Community Pharmacy is a logical and integral component to the design of a new system of care for Medicaid—one that makes a very tangible, positive difference in the lives of its beneficiaries. Omnicell, Inc. | Medicaid Reform: Quality Improvement and Cost Reduction through Community Pharmacy-Delivered MTM and Chronic Health Condition Management WHITEPAPER No issue is more important to fixing our nation’s healthcare system than improving Medicaid. 2011 RGA Medicaid Reform Principles, signed by Governors of 29 states 5
Transcript
1
The Medicaid system was established in 1965 as a safety net for our nation’s most vulnerable citizens. Today, Medicaid covers nearly 60 million Americans at an annual cost of over $400 billion, and is undergoing the single largest expansion in its history as a result of the Patient Protection and Affordable Care Act (PPACA).1 Projected Medicaid growth over the next decade is staggering. By 2022, 1 in 4 Americans is expected to enter the Medicaid system2, adding as many as 26 million new beneficiaries3 and doubling annual spending to $800 billion.1 At the state level, this fiscal impact is potentially crippling. Medicaid currently consumes nearly one-fourth of most state budgets.4 The financial burden of Medicaid expansion is creating fiscal crises for the majority of states.1 Without significant reform, the growth trajectory of Medicaid is unsustainable.
In order to establish meaningful reform, new approaches are required to ensure quality, while controlling budget growth, for a Medicaid population that is rapidly expanding. This white paper explores specific and actionable concepts around how community pharmacy can improve health, enhance quality of care, and positively impact Medicaid costs. Community Pharmacy is a logical and integral component to the design of a new system of care for Medicaid—one that makes a very tangible, positive difference in the lives of its beneficiaries.
Omnicell, Inc. |
Medicaid Reform:Quality Improvement and Cost Reduction through Community Pharmacy-Delivered MTM and Chronic Health Condition Management
WHITEPAPER
No issue is more important to fixing our nation’s healthcare
REFERENCES1. Office of the Actuary, CMS. “2012 Actuarial Report on the Financial Outlook for Medicaid.” March 2012. http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Downloads/medicaid-actuarial-report-2012.pdf Accessed May 15, 2014
2. Upton F. Time to save Medicaid, costly waste makes program’s path unsustainable. The Washington Times. http://www.washingtontimes.com/news/2013/feb/7 /time-to-save medicaid/#ixzz2LfnKxxOC. Accessed May 15, 2014
3. http://gingrey.house.gov/uploadedfiles/medicaid_six_major_reasons_for_refor m_final_march_18_2012.pdf Accessed May 15, 2014
4. National Association of State Budget Officers (NASBO) NASBO State Expenditure Report December 20, 2012 http://wwwnasbo.org/sites/default/files/Summary%20-%20State%20Expenditure%20Report_0.pdf. Accessed May 15, 2014
5. Republican Governors Association. Letter to Chairman Upton and Senator Hatch. “GOP Govs Unveil Medicaid Reform Principles.” June 13, 2011. Available online at http://www.rga.org/homepage/gop-govs-unveil-medicaid-reform-principles/
6. Schlaifer M, Albanese N. Scope of contemporary pharmacy practice: Roles, responsibilities, and functions of pharmacists and pharmacy technicians. J Am Pharm Assoc (2003) 2010;50:e35-369. doi:10.1331/JAPhA.2010.10510. http://japha.org/article.aspx?articleid=1043725
7. http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx. Accessed May 21, 2014
8. http://lab.express-scripts.com/insights/government-programs/asthma-hits-medicaid-hardest/ Accessed May 15, 2014
9. Medication adherence 2013: A closer look at compliance during care transition. Health Intelligence Network. February 2013. http://www.hin.com. Accessed May 15, 2014
10. ISMP Medication Safety Alert. Institute for Safe Medication Practices. 2012.http://www.ismp.org/newsletters/acutecare/issues/20121115.pdf. Accessed May 15, 2014
12. http://news.walgreens.com/article_display.cfm?article_id=5861 Accessed May 15, 2014
13. http://www.ashpmedia.org/ppmi/surveys.html Accessed May 15, 2014
14. Health Intelligence Network (2013, February). Medication Adherence 2013: A Closer Look at Compliance During Care Transition. Healthcare Intelligence Report. http://www.hin.com
15. Medication management in care transitions best practices. American Society of Health-System Pharmacists-American Pharmacists. February 2013
16. Sommers A, Cohen M. Medicaid’s high-cost enrollees: how much do they drive program spending? Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org/medicaid/7490.cfm. March 2006. Accessed May 15, 2014
17. Osterberg, Blaschke L, Blaschke T. Adherence to medication. New England Journal of Medicine. 2005;353:487-497
18. Source: Virginia Commonwealth University-ABM Study
19. The Role of Medicaid for People with Behavioral Health Conditions, Kaiser Commission on Key Facts, November 2012. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8383_bhc.pdf. Accessed May 21, 2014
20. Pyenson B, Goldberg S, Iwasaki K, Boyarsky V, Dirani R. A Medicaid and commercial insured claims-based study to estimate improved antipsychotic medication adherence among patients with schizophrenia. Journal of Behavioral Health Services & Research. April 2013;40(2):222-233. doi: 10.1007/s11414-012-9316-9
Omnicell believes that pharmacy is the future of healthcare…and it shows.
TIME MY MEDS MEDICATION SYNCHRONIZATION ADHERENCE SOLUTION DRIVES NEAR-PERFECT ADHERENCE ACROSS THERAPEUTIC CATEGORIES
This Medicaid White Paper represents the views of the author, not America’s Health Insurance Plans (AHIP). The publication, distribution or posting of this Medicaid White Paper by AHIP does not constitute a guaranty of any product or service by AHIP.
