PQIP Improves Medicaid Quality of Care for Individuals with Mental Illness

Armen Hareyan's picture
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The Michigan Department of Community Health (MDCH) has announced marked improvements in the quality of care provided to Medicaid patients with mental illness through the Pharmacy Quality Improvement Project (PQIP).

"We know that educating physicians on prescribing patterns for drugs that treat mental illness is an excellent way to improve the overall quality of mental health treatment within our Medicaid program," said Janet Olszewski, MDCH Director. "Through this project, many opportunities for coordination of care have been identified, resulting in improved quality of care and enhanced quality of life for persons with mental illness."

The PQIP-first launched in May 2005-is a three-year educational program that analyzes the prescribing of mental health medications for Medicaid adult and child members and identifies prescribing patterns that do not follow accepted evidence-based treatment guidelines.

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An impact analysis was performed comparing claims cost before and after a PQIP intervention between May 2005 and January 2006. The results showed a 22 percent reduction in claims and a 21 percent reduction in costs were both realized during the time period.

In the PQIP, physicians are provided with educational materials as well as opportunities for peer-to-peer consultations. Goals identified for the project include improving continuity of care, eliminating redundant treatments, coordinating care among providers, and decreasing risks associated with inappropriate use of prescription drugs.

The project is a collaborative effort involving the MDCH Mental Health and Substance Abuse Administration and the Medical Services Administration, in partnership with Comprehensive NeuroScience, Inc. (CNS) of White Plains, N.Y. Eli Lilly and Company is providing funding in support of this independent program. The MDCH Mental Health Advisory Committee, composed of medical directors from the Medicaid Health Plans and the Prepaid Inpatient Health Plans, serves as an advisor to the project.

The PQIP process includes a monthly review by CNS of Medicaid patient pharmacy claims data to identify prescribing and utilization trends for mental health and opiate medications. Researchers look at categories such as multiple medications being prescribed in the same therapeutic class, prescribing above or below FDA-recommended dosing levels, failure of patients to fill their prescription in a timely fashion, and patients with two or more physicians prescribing the same medications during the same time period.

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