The P3 Program – Patients, Pharmacists, Partnerships

Submission Date: January 2013

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Maryland

States/Territories Involved: Maryland

Domain Addressed:

Community-Clinical Linkages

Public Health Issue:

• People with diabetes can develop costly and serious disease complications such as heart attack and blindness that greatly affect their quality of life.
• Pharmacists working cooperatively with health care providers can educate people about their diabetes, help them achieve care management goals and improve delivery of recommended care – reducing development of the complications of diabetes and potentially reducing health care costs.

Project Objectives:

The Maryland P³ Program trained pharmacists to assist patients with medication therapy management, adherence to therapy, and chronic disease self-management. It was offered as a voluntary “opt-in” health benefit for the covered employees and dependents of self-insured employers. The target population is adult patients with hypertension, hyperlipidemia and diabetes.

TheProgram implements Core Diabetes Intervention #2 & Strategies 2.3 & 2.5:

• Increase access to sustainable self-management education and support services for populations with greatest diabetes burden and risk, to improve control of A1C, blood pressure, and cholesterol, and to promote tobacco cessation.
• Implement evidence-based programs and policies within worksites that contribute to improved control of A1C, blood pressure, and cholesterol, and promote tobacco cessation among people with diabetes.
• Expand the role of allied health professionals by replicating and scaling evidence-based programs founded on the principles of the Asheville Project and the Diabetes 10-City Challenge.

Program Action:

• The Maryland Diabetes Prevention and Control and Heart Disease and Stroke Prevention programs partners with the University of Maryland School of Pharmacy on statewide implementation of the Patients, Pharmacists and Partnerships Program™ – the P³ Program.
• The P³ program uses trained pharmacists to assist patients with medication therapy management, adherence to therapy, and chronic disease self-management. The program is offered by self-insured employers as a voluntary “opt-in” health benefit for their covered employees and dependents with diabetes, hypertension, and/or hyperlipidemia.
• Pharmacists receive specialized training in comprehensive medication therapy management, diabetes chronic disease management, and motivational interviewing and then deliver comprehensive medication therapy management and counsel patients about lifestyle changes, sharing results with participants’ primary care providers.

Data/Other Information Collected:

The Program examines clinical and cost data for individuals pre- and post-enrollment in the program, comparing clinical outcomes and cost to other commercial plans.

Impact/Accomplishments:

Participant impact of P³over several years includes:

• Hospitalizations & emergency department visits decreased 33%
• 64% of participants were proficient or advanced in performance of self-care tasks
• 79% of participants had A1C less than 8% compared to only 64% for Maryland commercial health plans (A1c is a measure of blood sugar control)
• 84% of participants had improved LDL cholesterol compared to only 46% for Maryland commercial health plans
• 84% of participants had good blood pressure (SBP ≤ 140/90 mmHg) control compared to only 64% of national commercial plan enrollees with diabetes
• Average cost savings per patient per year was an estimated $1,599

Challenges/Lessons Learned:

• Substantial time and effort were needed to recruit businesses into the program.
• Working with smaller selfinsured businesses that were not part of a larger network. A large employer or multiple small employers could have advocated for inclusion of the P3 Program in benefits packages and gotten payers on board.

Program Areas:

Diabetes, Heart Disease and Stroke

State Contact Information:

MD
Adelline Ntatin, MPH, MBIM, MA
Maryland Department of Health & Mental Hygiene
410-767-2623
adelline.ntatin@maryland.gov

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