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Think Beyond the Mail

Les Masterson, for Health Plan Insider, April 16, 2008

Simply sending physicians newsletters, clinical guidelines, and audiovisual materials is easy, but don’t expect it to improve medication use or reduce drug costs. It’s just not effective.

Physicians are already stretched for time and there is a good chance your communication won’t reach their desks. And even if it gets there, they probably won’t read it. That logic seems simple, but managed care companies commonly use educational material dissemination as a stand-alone intervention. A new study suggests managed care try something else.

"Interventions designed to improve the quality and efficiency of medication use in managed care: a critical review of the literature—2001-2007" reviewed papers published during those years to gauge the effectiveness of strategies geared toward cutting costs and improving quality of medication use.

The predominant strategies featured were education interventions, monitoring and feedback, formulary interventions, collaborative care involving pharmacists, and disease management with pharmacotherapy as a primary focus.

The review found that all of these interventions are valuable if part of a larger program. Otherwise, they are a waste. For instance, disseminating educational materials alone "had little or no impact, while the impact of group education was inconclusive," according to the study.

Instead, a system in which educational materials serve as a piece of the program that is buffered by lowering or tiering copays, group education, disease management, and computerized real-time alerts is most effective.

One of the study’s authors, Sallie-Anne Pearson, who is on the faculty of medicine at University of New South Wales and Clinical School’s Prince of Wales Hospital in Sydney, Australia, says a managed care company must understand and address the issues preventing practice change.

"It might seem like a very obvious statement, but a multi-faceted intervention will not necessarily work unless it is targeted to the specific issues within the environment—effectively I am saying one size does not fit all," Pearson says.

The study found that there is simply not enough analysis done on the interventions’ impact on quality, efficiency, and costs. Here are four future directions the researchers suggest for managed care:

  • Review study interventions done in "more lightly managed settings," such as PPOs. There has been a mere handful of intervention studies conducted in PPOs, though they comprise the largest percentage of health plans (61%).
  • The researchers suggest that cost-effectiveness data are needed so companies can have enough information to know which interventions to choose. Few studies have looked into reported "medication adherence or patient-relevant outcomes."
  • Though formulary changes and financial incentives are most commonly used to influence medication use, there isn’t much "high quality evidence" analyzing the impacts of the interventions.
  • Future studies must take a longer-range view of the interventions. Few studies extended beyond two years follow-up and many were even shorter.

"It was great to see a significant increase in the number of studies published in the area, but it is a shame that so many resources are spent on studies where you can’t really make any firm conclusions about the outcomes," says Pearson.

This study is the latest example of researchers questioning the amount of review done on managed care’s programs and services. In recent months, RAND questioned disease management’s effectiveness in containing costs and whether DM is a good investment. The DM industry did not refute RAND’s conclusion that DM has not received many third-party evaluations, but stands by its claims that DM is a valuable component that can improve outcomes and reduce costs in some chronic disease states.

As the RAND and medication use study show, the industry has plenty of work ahead to both find the most effective programs and to silence doubting Thomases.

For those working in the managed care trenches, there is one important take-away point from the medication use study. Don’t rely on the postal service or e-mail provider to improve medication compliance and lower costs. Sending newsletters is easy, but it’s not effective. Instead, create a multi-tiered program that reaches out to the physicians and members.


Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.

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