A pharmacist-run transition of care program was estimated to save a managed Medicaid plan over $25 million in total health care costs over 2 years compared with usual discharge care.
Does an outpatient pharmacy-based transition of care program reduce health care costs in a high-risk managed Medicaid population after hospitalization?
An outpatient pharmacy-based transition of care program for high-risk Medicaid patients is projected to yield substantial cost savings over 2 years, primarily driven by reduced inpatient costs.
BACKGROUND: Postdischarge medication management services have been shown to reduce the incidence of medication-related problems during the transition from inpatient to outpatient care. A pharmacist-run transition of care (TOC) program has been developed to reduce the unplanned readmissions of a high-risk managed Medicaid population after hospitalization. OBJECTIVE: To estimate the budget impact of adding an outpatient pharmacy-based TOC program to a medical benefit from the payer perspective. METHODS: A budget impact analysis was conducted using a decision-tree model developed in Microsoft Excel. The effect on inpatient and total health care costs from the payer perspective was estimated for the 2-year period following initial hospital discharge. Inputs were based on a total plan population of 240, 000 lives, with a high-risk population of 7. 5%, of whom 37% were hospitalized and potentially qualified for TOC services, resulting in an eligible population of 6, 660 patients. The TOC program was assumed to initially cover 30% of the eligible population, with expansion to 60% over the 2 years. We previously reported that this program reduced the risk of readmission by 32% within 6 months and saved the health plan 2, 139 per patient referred to the program, inclusive of program cost, compared with patients receiving usual discharge care. Sensitivity analyses were performed to test the impact of uncertainty of model inputs on the results, with the cost of TOC services ranging from 99 to 2, 000 per patient referred. RESULTS: The model showed that the TOC program was cost saving at over 3 per member per month in the first 6 months, which translates to over 25 million in total health care cost savings over 2 years. These results were primarily driven by the estimated reduction in inpatient costs associated with the program, which were estimated at 20 million over the 2 years. Sensitivity analyses illustrated that within all the reasonable ranges of model input parameters, including the upper limit of TOC services set to 2, 000 per patient referred, the TOC program resulted in cost savings to the health plan. CONCLUSIONS: The TOC program resulted in potential cost savings of over 25 million to the managed Medicaid plan over a period of 2 years, corresponding to over 4 per member per month. DISCLOSURES: Funding for this study was contributed by the Komoto Family Foundation, which provided fellowships to Ni and McCombs during the time of this study. Colayco is employed by Synergy Pharmacy Solutions and by the Komoto Family Foundation. Hashimoto and Komoto are employed by Synergy Pharmacy Solutions. Gowda and Wearda report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. Study concept and design were contributed by Ni, Colayco, and McCombs, along with the other authors. Hashimoto, Komoto, and Wearda took the lead in data collection, assisted by Ni, Colayco, and Gowda. Data interpretation was performed by Ni, Colayco, and McCombs, along with the other authors. The manuscript was written by Ni and Colayco and revised by Gowda and McCombs, along with the other authors.
Ni et al. (Wed,) conducted a other in High-risk managed Medicaid population after hospitalization (n=240,000). Pharmacist-run transition of care (TOC) program vs. Usual discharge care was evaluated on Budget impact on inpatient and total health care costs. A pharmacist-run transition of care program was estimated to save a managed Medicaid plan over $25 million in total health care costs over 2 years compared with usual discharge care.