OKLAHOMA CITY, July 21 Over the past three years, Oklahoma has risen from a "D" to a "B" grade in the 2009 National Alliance on Mental Illness' Grading the States Report -- a state-by-state assessment of the nation's public mental health care system.(1) Oklahoma showed the greatest improvement in the nation and is heads above the national average grade of "D."(1)
Oklahoma's report card featured several of the state's innovations in mental health services, including SoonerPSYCH (Sooner Prescription Solutions for Your Cognitive Health) - a Medicaid prescription management program.(1) An analysis of 2007 data from SoonerPSYCH shows the program has helped increase the quality of care for Oklahoma residents with severe mental illness while helping lower health care costs.(2)
SoonerPSYCH was developed by the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) and Oklahoma Health Care Authority (OHCA) in collaboration with clinical research firm Comprehensive NeuroScience, Inc. Lilly, an Indianapolis-based pharmaceutical company, provides funding for this program to promote excellence in patient care. Operation and implementation of the program is done solely by the states and Comprehensive NeuroScience, Inc.
Improving Quality of Care
The four goals of SoonerPSYCH are to improve continuity of patient care, eliminate redundant treatments, coordinate care among health care providers, and decrease risks associated with inappropriate medication use. An analysis(2) of the program's provider outreach in 2007 showed a:
The same analysis showed that, between August 2004 and December 2007, Oklahoma may have avoided $12.3 million in behavioral health pharmacy costs that would have been incurred had the state not intervened.(2)
"OHCA is pleased that the SoonerPSYCH collaboration with ODMHSAS was specifically cited in the NAMI report card. Our ongoing partnership continues to result in positive outcomes for our members," said Dr. Lynn Mitchell, Oklahoma Medicaid director.
How the Program Works
First launched in 2004, the SoonerPSYCH program evaluates Medicaid pharmacy claims on more than 400 mental health medications. It identifies prescribing patterns that are inconsistent with national, evidence-based best practice guidelines, including those published in peer-reviewed medical journals. When there is an inconsistency with what is considered best prescribing practice, SoonerPSYCH sends an educational mailing that highlights the research and best practice information in a concise document for the physician's review and consideration at the next visit with the patient.
Some of the inconsistent patterns the program has identified include premature discontinuation of a medication, rapid switching from one medication to another, prescribing above or below recommended dosing levels, and prescribing multiple medications from the same therapeutic class.
SoonerPSYCH also alerts physicians when patients receive the same medication from two different doctors, and informs physicians when their patients have not refilled their prescriptions. This is a health care concern because poor compliance or non-compliance with medication treatment is strongly linked to relapse, rehospitalization, poor outcomes, and high economic costs.(3)
SoonerPSYCH is entirely voluntary for doctors. All decisions regarding treatment and medications are made privately between the physician and the patient and are completely individualized.
"Physicians will change their prescribing practice patterns to be in keeping with best practice, when they know what the best practice is. They use the educational information from the program's mailings and, when they do, the overall care of the patient is improved, and we see overall reduction in health care costs," said Carol D. Clayton, Ph.D., vice president, Operations, Comprehensive NeuroScience, Inc.
National Results and Awards
Twenty-seven other states have run similar programs, based in part on the increasing awareness that disease management and coordination of care programs are effective health care reform solutions.
Nationwide, these programs have resulted in 2 million patient care improvement interventions.(4) On average, states that have run the program have seen a behavioral health pharmacy cost avoidance of almost $800 each year per patient whose physician received an educational mailing compared with those patients whose physician has not yet received an educational mailing.(5)
"We're pleased to see how this program is helping improve care for Oklahoma Medicaid patients with mental illness, who represent some of our most vulnerable citizens,'' said Alex M. Azar II, vice president of business-to-business, LillyUSA. "We congratulate the state on the success of this program and its dedication to delivering high quality health care to patients."
Because of its success, the program has been highlighted by leading organizations and received several national awards, including:
About Oklahoma Department of Mental Health and Substance Abuse Services
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is responsible for providing appropriate care to Oklahomans who are affected by mental illness and substance abuse. Through the use of evidence-based practices and delivery of treatment and preventative services across the lifespan, the department continues to increase the effectiveness and efficiency of the state's service delivery system. Advances in health care, along with targeted prevention and early intervention efforts, have made recovery a reality for thousands of Oklahomans. Continuation and expansion of these efforts will save thousands more. In fact, Oklahoma has become a national leader in several areas of community based services including the implementation of programs for assertive community treatment, alternative criminal justice initiatives such as drug and mental health courts, and comprehensive services for children and families.
About Oklahoma Health Care Authority
The Oklahoma Health Care Authority (OHCA) operates the state's SoonerCare (Medicaid) and Insure Oklahoma programs. Through SoonerCare, the agency provides health care for low-income children, pregnant women and some individuals categorized as aged, blind and disabled. Specialized programs provide services for uninsured women with breast and cervical cancer, family planning services for low-income Oklahomans and health care services for children with disabilities who don't normally qualify for regular SoonerCare. The Insure Oklahoma program provides assistance paying health insurance premiums for lower-income employees of small businesses in the state and some qualifying individuals who are self-employed, temporarily unemployed or college students.
About Eli Lilly and Company
Lilly, a leading innovation-driven corporation, is developing a growing portfolio of pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers -- through medicines and information -- for some of the world's most urgent medical needs. For more information about Lilly programs that help improve patient care, visit www.lillyforbetterhealth.com.
About Comprehensive NeuroScience, Inc.
Comprehensive NeuroScience, Inc., is a privately-held company, specializing in research, care management and education related to central nervous system disorders. Comprehensive NeuroScience, Inc actively invites collaboration and contact across multiple spheres, including academia, government agencies, and with members of the biopharmaceutical and commercial health care industries, as well as financial and investment communities.
(1) Aron L, Honberg R, Duckworth K et al. Grading the States 2009: A Report on America's Health Care System for Adults with Serious Mental Illness, Arlington, VA: National Alliance on Mental Illness. Available at: http://www.nami.org/gtsTemplate09.cfm?Section=Overview1&Template=/ContentManagement/ContentDisplay.cfm&ContentID=75090. Accessed on April 13, 2009.
(2) Data provided by Comprehensive NeuroScience Inc.
(3) Perkins DO. Predictors of noncompliance in patients with schizophrenia. J Clin Psychiatry. December 2002; 63(12):1121-1128.
(4) Data provided by Comprehensive NeuroScience Inc.
(5) Data provided by Comprehensive NeuroScience Inc.
-- 72 percent decrease in the number of patients who were prescribed the same mental health medications from multiple doctors; -- 61 percent decrease in the number of patients who were on two or more antipsychotics for 45 or more days; and -- 52 percent decrease in the number of multiple prescribers of any psychotropic for 45 or more days.
SOURCE Eli Lilly and Company