Webinar offers tools to improve prescribing

Download the slides and watch the webinar recording

Connecticut, like other states, are struggling to improve appropriate prescribing while lowering costs. In Friday’s webinar, Greg Low, RPh, PhD, offered Mass General’s experience of what works to improve physician prescribing at their ACO. Greg is the Manager for Pharmacy Operations at Mass General Brigham Health Plan. Previously he spent sixteen years as the Director for the Massachusetts General Physicians Organization’s (MGPO) Pharmacy Quality and Utilization Program at Massachusetts General Hospital (MGH), Boston, MA. He worked with clinical leadership to develop, implement, and evaluate ambulatory pharmacy programs. His efforts addressed pharmacy’s contribution to total medical expense, physician variation reporting, ACO reporting, and academic detailing. During his tenure, the organization substantially improved their quality and efficiency metrics.

MGH’s goals for the program include maximizing generic drug use, lowering costs, and improving quality, e.g. percent with blood pressure control, HbA1c levels for people with diabetes, opioid prescribing.

Tools include academic detailing, guidelines for new drugs, decision support, therapeutic substitution, and prescriber feedback reports. MGH’s program continues to evolve and improve.

Highlights from the webinar include:

• Physicians are more accepting of performance goals and minimum standards developed by clinical leadership in their own organization. There is often more confidence in internal reports.
• Physicians agreed to share their performance, and comparisons, with other physicians in their unit.
• Ensure that small, insignificant differences from the averages or from standards are clear in physician reporting.
• ACO and system level reporting offers better feedback. Individual payers and programs often do not have the numbers to support meaningful analysis. Systems have access to clinical records offering more information than claims alone. As provider risk at the system level grows, so does their responsibility to track and improve quality and costs.
• Both in-person and virtual report delivery can be effective. Group meetings to discuss performance were more effective than individual meetings with physicians.
• Challenges to reporting include attribution, appropriate comparisons, and that utilization management does not influence drug prices – a significant driver of rising healthcare costs.
• There is a “Goldilocks” reporting frequency to ensure enough numbers to be meaningful and often enough to be opened and used.
• MGH offered very modest physician incentives to open reports and for improved quality. Despite the low levels, the reports and detailing have been very successful.
• An effective program requires resources and a strong commitment by the ACO.