Clinical Innovations

Title: Maryland P3 ( Patients, Pharmacists, Partnerships) Program

Organization: University of Maryland School of Pharmacy in collaboration with the Maryland Pharmacists Association and Department of Health and Mental Hygiene, Office of Chronic Diseases

Innovation Type: Community based Disease Management Program

What They’re Doing: Specially trained clinical pharmacists work with patients with diabetes, hypertension and hyperlipidemia to provide step-by-step guidance in medication adherence, lifestyle changes, and self-care skills.

Clinical Innovation: When a participant with diabetes, hypertension and hyperlipidemia is enrolled into the program, he/she is assigned to a trained Maryland P ³(Patients, Pharmacists, Partnerships) pharmacist who helps him/her understand and implement his/her individualized Medication Action Plan developed in conjunction with his/her primary care physician. P ³p harmacists meet regularly face to face (5-7 times per year) with each of their patients to:

assess the patient’s knowledge and understanding of his or her medication regimen and chronic disease;
coach the patient in setting measurable self-management goals; and
At the completion of each visit,” and replace with “At the completion of each visit, the P ³ pharmacists communicate either in writing or verbally with their patients’ primary health care providers to ensure coordination and the optimization of the patient care strategy

Evaluation Type: Quasi-experimental

Evaluation Plan: Examine clinical and cost data for individuals pre and post enrollment in the program. Compare clinical outcomes and cost to other commercial plans.

Patient Health and Cost Outcomes:

Better Blood glucose control: After 12 months in the program, 55.6 percent of participants had good blood glucose control (with a hemoglobin A1c level of 7.0 percent or below), significantly above the level of control reported by commercial insurance plans about their patients. Moreover, 42 percent of participants achieved the best possible therapeutic goal (with hemoglobin A1c level of 6.5 percent or less). Moderately good blood glucose control (with a hemoglobin A1c level between 7.1 and 8.0 percent) was achieved in 83 percent of the participants, again significantly above the rate of 62 percent reported by commercial plans in 2011. Finally, only 7.3 percent of participants had poor blood glucose control (with hemoglobin A1c levels over 9.0 percent), well below the 27.3 percent rate for commercially insured diabetes patients nationally.
Better blood pressure control: After 12 months, 82 percent of participants had good blood pressure control (less than 140/90 mm Hg), compared with only 65.1 percent of national commercial plan enrollees with diabetes. In addition, 53 percent of participants reached the therapeutic goal for blood pressure (less than 130/80 mm Hg), compared with just 33.9 percent of commercial plan enrollees with diabetes nationally.
More likely to get recommended services: The majority of program participants received recommended services, including influenza vaccinations (67 percent), eye examinations (73 percent), and foot examinations (67 percent). These adherence rates exceed those in most populations of commercial enrollees with diabetes.
Lower overall costs: Total actual cost savings averaged $3,281 per patient for one employer and $495 for a second employer after 1 year of participation in the program. The cost savings compared with projected health care costs averaged $5,343 and $1,508, respectively. Average cost savings per patient aree estimated at $900 per patient per year pre and post program implementation. Cost savings reported are net of Maryland P ³ program costs.