June 6, 2005

The Michigan Department of Community Health (MDCH) has launched an innovative educational program that strives to improve the quality of care for Medicaid patients with mental illness.

The Michigan Pharmacy Quality Improvement Project (PQIP) which began in May, is a two-year educational program that will analyze the prescribing of mental health medications for Medicaid members and identify prescribing patterns inconsistent with evidence-based guidelines. When needed, physicians will be provided with educational materials and client survey information as well as peer-to-peer consultation.

The Michigan PQIP Project is a collaborative effort that involves MDCH’s Mental Health and Substance Abuse Administration and its Medical Services Administration and Comprehensive NeuroScience, Inc. (CNS), of White Plains, N.Y. Eli Lilly and Company is providing funding in support of the independent program. The MDCH Mental Health Advisory Committee, composed of medical directors from the Medicaid Health Plans and the Prepaid Inpatient Health Plans, will serve as an advisor to the project.

“We know that most Michigan doctors follow recommended guidelines when prescribing mental health medications to their patients, but there is always room for improvement,” said Janet Olszewski, MDCH Director. “This innovative new project will help us identify those physicians and provide educational materials to them that will ultimately benefit thousands of Michigan residents who use medications to improve their overall mental health.”

Olszewski said she expects the CNS review of prescribing practices to identify a small group of doctors who regularly fall outside of guidelines. These physicians will receive educational materials promoting adherence to the best practices guidelines. In addition, CNS will continue to monitor physicians for the duration of the program to determine whether prescribing problems improve.

According to the President’s New Freedom Commission on Mental Health, Michigan likely has between 450,000 and 650,000 adults and minors experiencing serious mental illness or serious emotional disturbance. MDCH projects that over 200,000 of these are adults with “serious and persistent mental illness.

Improper prescribing or use of medications can have many negative consequences, including:

• Interference with treatment goals
• Increased risk of medical complications. Although there are times when multiple prescriptions are necessary, some drug interactions may lead to increased hospitalization. Most evidence does not support the use of multiple mental health medications from the same class to treat the same condition.

“This is a program that should be a ‘win-win’ for all interests, including those who administer and rely upon the Medicaid program as well as proponents of evidence-based practices in health care,” said Mark Reinstein, President and CEO, Mental Health Association in Michigan. “We know that other states have had very promising results when implementing similar programs.”

The PQIP process begins with a review by CNS of Medicaid patient pharmacy claims data to identify prescribing and utilization trends for mental health and psychotropic medications. The researchers will look at such categories as multiple medication prescribing 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. Prescriptions that fall within these categories will then be compared with best practices guidelines.

The prescription monitoring program is working in several other states, including Missouri, where an analysis from the program’s first year also shows a 98 percent reduction of patients who are prescribed the same mental health medications from multiple doctors; a 64 percent reduction of patients who are on two or more mental health medications of the same type; a 43 percent reduction of children on three or more psychotropic medications; and, a 40 percent reduction of patients receiving an unusually high dosage of medication.

“We applaud the Michigan Department of Community Health for offering this initiative,” said Susan McParland, Executive Director, Michigan Association for Children with Emotional Disorders. “We believe high quality care is provided when the management of mental health drugs is based on nationally-recognized guidelines as well as individual patient needs.”

The program is entirely voluntary for Michigan doctors. All decisions regarding treatment and medications are made privately between the physician and the patient and are completely individualized. “We are pleased to support this program in Michigan,” said Jack Bailey, Lilly vice president, Business-to-Business.

“We have seen a lot of success with it across the country. We believe Medicaid dollars for mental health drugs can be wisely managed by providing education to increase the quality of prescribing practices rather than limiting access to these vital medications.”