What WPQC Can Do for Your Members

WPQC, an initiative of the Pharmacy Society of Wisconsin, was created by aligning incentives for pharmacies and health plans. The WPQC program focuses on chronic disease states, use of evidence-based medicines, facilitates patient engagement and works to control health care costs for the payer and the patient. In order to provide this high-quality pharmaceutical care, WPQC has established an accreditation process and uniform set of pharmacist-provided medication therapy management services for participating Wisconsin community pharmacy providers.

The Cost of Prescription Non-Adherence

Patient non-adherence to prescribed medications is associated with poor therapeutic outcomes, progression of disease, and an estimated $290 billion nationwide in avoidable health care costs.^1-3 Via the WPQC pharmacy network, MTM services are being provided to patients across the entire state of Wisconsin. This innovative program improves health outcomes and reduces health care costs.

Return on Investment

Participating insurance payers have recognized the financial value of adding this benefit to their prescription drug insurance.⁴ Results from the pilot phase of WPQC (2008-2010) which included Unity Health Insurance and Group Health Cooperative of South Central Wisconsin showed:

10:1 Return on Investment (ROI) for services which directly impacted medication cost.
Patients who received the services saved on average $25.34 per prescription.
Overall, ROI was maintained at 2.5:1 when combining services which directly impacted medication cost and comprehensive medication reviews. The analysis assumed no cost savings from the comprehensive medication reviews performed and reimbursed.
Facilitating the use of health plan formularies to ensure the least expensive equivalent medication, pharmacists can save payers and patients 3-4 times the cost of medications.

Pharmacist services contributed to a positive ROI via:

Adherence to payer medication formularies when clinically appropriate
Patient access to medications with decreased out-of-pocket costs contributing to increased adherence
Proper use of medication devices, such as inhalers.
Avoidance of inappropriate medication regimens, reducing adverse effects and hospitalizations, while increasing adherence

For more information, please review:

Return on Investment Evaluation of Cost-Effectiveness Interventions Within a Quality-Based Medication Therapy Management Pilot Program

The Cost Associated with Hospital Readmissions

Common chronic disease states such as heart failure, diabetes, and asthma often lead to hospitalizations and re-admissions. The Institute of Medicine estimates Medicare spends over $15 billion annually on readmissions, with approximately 16% of Wisconsin patients being readmitted in this population set (18.6% nationally).^5,6

The WPQC model can help prevent some of the most common barriers to successful patient care transitions post-hospitalization such as: lack of standardization and time, patient confusion about current medications, missing information, and primary care providers unaware of hospitalizations or medication changes. A 2003 study found that post-discharge medication assessment decreased readmission rates in a group of 494 patients, saving the health plan $35,000 per 100 patients annually.⁷

The WPQC program allows pharmacists to perform a comprehensive medication review on high risk patients such as those that have been discharged from the hospital or LTC setting within the last 14 days. These CMR/As will lead to:

Optimization of patients’ medication regimens
Better patient understanding of their medications and the importance of each
Improved medication adherence
Fewer adverse drug reactions
Improved attainment of clinical goals / outcomes
Decreased utilization of unnecessary health care resources

Joining WPQC is easy!

Simply email Kari Trapskin expressing your interest in participation. She will guide you through the rest of the details.

References:

1. Network for Excellence in Health Innovation. Thinking outside the pillbox: A system-wide approach to improving patient medication adherence for chronic disease. 2009. Available at http://www.nehi.net/publications/17-thinking-outside-the-pillbox-a-system-wide-approach-to-improving-patient-medication-adherence-for-chronic-disease/view. Accessed March 25, 2014.

2. DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care 2004;42(3):200-209.

3. IMS Institute for Healthcare Informatics. Avoidable costs in US health care. 2013. Available at http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Institute/RUOM-2013/IHII_Responsible_Use_Medicines_2013.pdf. Accessed March 25, 2014.

4. Evans M, Mott D, Cory P, et al. Return on investment evaluation of cost-effectiveness interventions within a quality-based medication therapy management pilot program. Available at http://www.www.pswi.org/associations/13015/files/WPQC%Pilot%20ROIPoster.pdf. Accessed March 25, 2014.

5. Institute of Medicine. New data on geographic variation. Available at http://iom.edu/Activites/HealthServices/GeographicVariation/Data-Resources.aspx. Accessed April 16, 2014.

6. Baier RR, Gardner RL, Coleman EA, et al. Shifting the dialogue from hospital readmissions to unplanned care. Am J Manag Care. 2013;19(6):450-453.

7. Kilcup M, Schultz D, Carlson J, Wilson B. Postdischarge pharmacist medication reconciliation: impact on readmission rates and financial savings. J Am Pharm Assoc. 2013;53:78-84.

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