Case Study 4: Over-utilization of Expensive Drugs

Challenge:
In many hospitals and health systems, drug costs now exceed the cost of all hospitalizations for a given cohort of commercial patients. The never-ending rise in the cost and volume of specialty/biotechnology drugs for conditions such as rheumatoid arthritis, multiple sclerosis, hepatitis C and HIV, are just a few that threaten to upend the successful transition from fee-for-service to global payment budgets. In addition, the frequent use of brand name drugs in categories where generic versions are available and deemed to be equally effective, continues to add unnecessary cost with little if any proven, added value.

Actions Taken/Approach to Solutions:
Powerful health information technology applications were used to analyze physician prescribing patterns. Clinical pharmacists worked directly with providers to change their prescribing patterns while educating them about how those decisions affected the global payment budgets. In one case, we focused on anti-hyperlipidemia medications, anti-depressants, antibiotics and anti-hypertensive agents. Medication compliance and adherence issues were identified in patients suffering with asthma and depression and appropriate interventions were undertaken by pharmacists.

Results:
These efforts resulted in increased quality, decreased cost of care and improved financial performance in the Global Budgets. (Actual numbers for these changes are proprietary; therefore, are not provided.)

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