PharmaCare & Polk County Board of County Commissioners

2007 Rx Benefit Innovation Award

Problem Identification

The Polk County Government in Bartow, Fla., is a self-insured entity that provides medical and pharmacy services to 8,300 members, including employees and retirees. The County boasts a low employee turnover rate so it has a high number of retirees retaining benefits. Polk County’s risk manager became concerned about escalating trends in health care expenses and approached PharmaCare, the County’s pharmacy benefits manager, for a creative strategy to contain health care costs in the long term.

Target Audience

Diabetic and hypertensive employees, dependents and retirees covered under the Polk County Prescription Drug Plan were the targeted populations. Analysis of historical account utilization reports indicated that these populations accounted for the majority of the County’s medical costs.

Objectives

The PharmaCare/Polk County initiative sought to:

• Provide the necessary resources for clinical management of diabetes and hypertension in the Polk County Government’s insured population,
• Improve the health status of beneficiaries with diabetes and hypertension, and
• Decrease the County Government’s overall medical and pharmaceutical costs.

Solution

Building on Polk County’s established preventive care programs, PharmaCare helped its client develop an employer-based, pharmacist-coordinated disease management program for diabetes and hypertension. The diabetes program was initiated in February 2005 and the hypertension program began in November 2005. Insurance-eligible employees, dependents and retirees of Polk County Government were invited to enroll in the program.

Key elements of the program include:

• PharmaCare’s placement of a full-time clinical pharmacist onsite in the County’s existing employee health clinic.
• Consent from the clinic’s attending physician to allow the pharmacist to perform physical assessments, order and
  obtain lab work, and refer patients to other providers as needed.
• Database for patient management and data analysis.
• Waiver of copayments for hypertension and diabetes medications and supplies for program participants.
• A Contract for Care that enrollees must sign, agreeing to rules of participation including attendance at required
  appointments with the pharmacist and compliance with treatment.
• Patient accountability. Participants who miss appointments or fail to meet other terms of their contract may be
  disenrolled.
• Comprehensive assessment of each patient’s medical condition, medications, and disease state knowledge.
• Individualized plans of care and education that help patients increase their success in managing diabetes and/or
  hypertension.
• Monitoring to ensure that the desired outcome of drug therapy is achieved.

Program participants are placed in one of three color-coded categories based on severity of disease state as determined by clinical signs and symptoms and the presence of secondary disease complications. The purpose of this classification is to identify patients who require the most time, resources, and interventions to achieve desired outcomes. As an incentive, the number of appointments and follow-ups is reduced for patients who improve their classification.

Results

As of December 2006, more than 700 diabetic or hypertensive patients were enrolled in the Polk County Government disease management programs. Clinical improvement in health status had been achieved in both disease populations. The improvements were most significant in the diabetes program (the longest running) where half of the patients classified in the Red category improved enough to be classified in the Yellow category. Both programs also resulted in significant average reductions per patient in HgbA1c and blood pressure values as shown in the table below.

Polk County Government is now in the process of obtaining pre- and post-program pharmaceutical and medical cost data to evaluate financial results.

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