Integration of a clinical pharmacy team into the patient centered medical home to improve transitions of care for Missouri Medicaid patients

Introduction: A Centers for Medicare and Medicaid Services study found pharmacy services are an added value providing improved clinical outcomes, enhanced patient compliance, and reduced healthcare costs associated with medications. This study focuses on pharmacy-provided education services to assist Missouri Medicaid patients transitioning from inpatient to ambulatory care.  

Objectives: Primary objective is to improve medication compliance rates (medication possession ratio (MPR)) through pharmacy-provided education for Medicaid patients with polypharmacy. Secondary objectives are to reduce 30-day hospital readmission rates, reduce number of emergency room visits, decrease medication discrepancies, report interventions, track the number of contacts per patient for compliance correlation, and address revenue generated by completion of interventions. 

Study Design: Minimal risk, cohort study seeking to compare patient medication compliance rates pre- and post-pharmacy service implementation. 

Methods: Adults 18 years of age or older with an inpatient admission on the interprofessional team, Medicaid as the primary payer source, and polypharmacy will be included. Patients who meet inclusion criteria during hospitalization will be reviewed by the pharmacist for medication related problems and provided pre-discharge education. Post- discharge, billable interventions identified through the Missouri Medicaid MOHealthnet database, including recognized non-compliance, will be addressed by the ambulatory care pharmacy team face-to-face during patient follow-up primary care visits. Interventions will be documented in the medical record and the Medicaid database as appropriate.  

Results:  The average 90 day MPR for the currently enrolled study patients is 71.9% (range: 49-100%) pre-pharmacy service implementation. Current readmission rates for November 2015 extrapolated to a total of approximately 1700 Missouri Medicaid patients were 576 readmissions and 1824 emergency room visits annually, which totals $4,704,000 in healthcare costs. Pre- and post-data will be compared at completion.

Conclusions: Expected completion May 1, 2016.