OPTIMIZING DRUG USE MANAGEMENT
KAISER PERMANENTE
NORTHERN CALIFORNIA
Sharon Levine, MD
January 16, 2002
THE ORGANIZATION
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GROUP MODEL HMO, PREPAID GROUP PRACTICE
INTEGRATED DELIVERY SYSTEM
(Medical Groups, Hospitals, Health Plan)
MUTUAL EXCLUSIVITY
LARGE, STABLE POPULATION
LONG HISTORY OF INTEGRATED PHARMACEUTICAL MANAGEMENT ¾
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245 Pharmacies 1800 Pharmacist FTEís $1.6 Billion Drug Spend
21800
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DO „
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Generic Substitution
Therapeutic Conversion (physician-directed)
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Formulary Exception Process
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Physician/Patient Education
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Retrospective Review of Prescribing Practices
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Peer Feedback
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Academic Detailing
DONíT DO
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Prospective UR/Prior Authorization
Pharmacy Risk Shifted to Medical Group
Financial Incentives for Physicians (e.g. bonuses tied to generic use, formulary compliance)
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MEDICAL GROUP CULTURE AND FORMAL ORGANIZATION (SYSTEMS, STRUCTURES, PROCESSES) ENABLE PHYSICIANS TO DO THE RIGHT THING
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FULL PARTICIPATION/ENGAGEMENT IN THE PHARMACY AND THERAPEUTICS PROCESS
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Every Department
Every Medical Center
Each Region (Northern and Southern California)
Full Partnership with Pharmacy
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OWNERSHIP OF THE PROCESS COMMITMENT TO THE OUTCOMES CLINICAL DISCIPLINE
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Industry leading use of generics
(98% generic use when generics available)
Industry leading formulary compliance
(97% formulary prescribing)
Formulary exceptions without pre-authorization
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INTEGRATION OF PHARMACEUTICAL THERAPY WITH CLINICAL CARE; CHRONIC CONDITION MANAGEMENT
DATA SYSTEMS: Patient Safety; Utilization Management; Peer Feedback
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PIMS
PharmaFax
TRACRx
POINT
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AGGRESSIVE MANAGEMENT OF PHARMACEUTICAL COMPANY ACCESS TO PRESCRIBERS
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Pharma Rep Visitation Policy
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Non-Detailable Drugs
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Sanctions Imposed on the Company for Violations of the Policy
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COMPREHENSIVE AND PERVASIVE PHYSICIAN EDUCATION
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ì Cost Effective Prescribing is Quality Careî
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CME Programs; Leadership training; ClinicianPatient Communication training; „
Region-wide Educational video-conferencing:
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ì Solutions to Rhinitisî
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Antibiotics and Respiratory Infections
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Cox II Inhibitors
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Physicians and the Pharmaceutical Industry
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Drug Education Coordinators
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Member and Patient Education
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Prescription drug stories in all member communication vehicles
SPOTLIGHT newsletter in Pharmacies and Waiting Rooms
Video clips in Waiting Areas
Targeted, condition-specific member communication
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Results
New Rxís market share: 2001
100%
6%
80%
60%
40%
44%
94%
56%
20%
0%
K-P
Other NSAIDs
Retail
CelebrexÆ/Vioxx
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Results
Ulcer Medication Market Share
KP maintains use of generic H2 antagonists which have eroded in the U.S.
100%
90%
80%
70%
60%
Generic
50%
40%
30%
Generic
20%
10%
0%
KP CA
Tagamet
U.S.
Zantac
Prilosec
Prevacid
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Results
Cholesterol Medication Market Share
KP uses almost 100% of our preferred products for cholesterol
100%
90%
80%
KP Preferred
70%
60%
50%
40%
30%
KP Preferred
20%
10%
0%
KP CA
A
U.S.
B
C
D
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RESULTS
QUALITY CAMPAIGN TO DRIVE APPROPRIATE USE OF ANTIBIOTICS IN OUTPATIENT RESPIRATORY INFECTIONS
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13% Overall Decrease in Utilization of Antibiotics
No Increase in Outpatient Visits
No Increase in Hospitalization Rates
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