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Review
. 2018 Apr;11(2):65-73.

Standardized Review and Approval Process for High-Cost Medication Use Promotes Value-Based Care in a Large Academic Medical System

Raghu Durvasula  1 , Janet Kelly  2 , Anneliese Schleyer  3 , Bradley D Anawalt  4 , Shabir Somani  5 , Timothy H Dellit  6
Affiliations
Review

Standardized Review and Approval Process for High-Cost Medication Use Promotes Value-Based Care in a Large Academic Medical System

Raghu Durvasula et al. Am Health Drug Benefits. 2018 Apr.

Abstract

Background: As healthcare costs rise and reimbursements decrease, healthcare organization leadership and clinical providers must collaborate to provide high-value healthcare. Medications are a key driver of the increasing cost of healthcare, largely as a result of the proliferation of expensive specialty drugs, including biologic agents. Such medications contribute significantly to the inpatient diagnosis-related group payment system, often with minimal or unproved benefit over less-expensive therapies.

Objective: To describe a systematic review process to reduce non-evidence-based inpatient use of high-cost medications across a large multihospital academic health system.

Methods: We created a Pharmacy & Therapeutics subcommittee consisting of clinicians, pharmacists, and an ethics representative. This committee developed a standardized process for a timely review (<48 hours) and approval of high-cost medications based on their clinical effectiveness, safety, and appropriateness. The engagement of clinical experts in the development of the consensus-based guidelines for the use of specific medications facilitated the clinicians' acceptance of the review process.

Results: Over a 2-year period, a total of 85 patient-specific requests underwent formal review. All reviews were conducted within 48 hours. This review process has reduced the non-evidence-based use of specialty medications and has resulted in a pharmacy savings of $491,000 in fiscal year 2016, with almost 80% of the savings occurring in the last 2 quarters, because our process has matured.

Conclusion: The creation of a collaborative review process to ensure consistent, evidence-based utilization of high-cost medications provides value-based care, while minimizing unnecessary practice variation and reducing the cost of inpatient care.

Keywords: cost-containment; medication utilization; pharmacy costs; practice transformation; process improvement; specialty medications; standardized review process; stewardship; value-based care.

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Figures

Figure 1
Figure 1. Workflow for Review of High-Cost Medication Requests
Figure 2
Figure 2. Trend of Quarterly Volume of Requests for High-Cost Medications
Figure 3
Figure 3. Quarterly Cost-Savings in 2015 and 2016 Resulting from High-Cost Medication Review Process
None
See this image and copyright information in PMC

References

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