Specialty pharmacy wins spot in Medicare program

A Philadelphia specialty pharmacy known for its hospice care has been selected to participate in one of nine contracts awarded through Medicare's new Chronic Care Improvement Program (CCIP) for fee-for-service beneficiaries.

The prospective medication therapy management expertise honed in hospice care is what won excelleRx a subcontract to serve about 20,000 beneficiaries with complex diabetes and congestive heart failure living in Maryland and the District of Columbia. The firm ( http://www.excelleRx.com/) will be analyzing patient medication data for American Healthways, a leading provider of specialized disease management for more than 1.4 million lives nationwide.

"We'll be like the Intel inside the Dell computer," said Brian Esterly, excelleRx senior VP-corporate development. "We will receive information on Medicare-enrolled patients in American Healthways' program and run it through our automated process to identify potential medication-related problems. If warranted, our clinical pharmacists will contact the physician. Unlike our work with hospices where we provide pharmaceutical care, this is more case management that's removed from actually delivering care."

Enrollment will begin in the second half of the year after an outreach phase to persuade beneficiaries to join the volunteer program scheduled to run for three years. When the program has run its course, the secretary of Health & Human Services will evaluate outcomes. If results are clinically and financially positive, the program will be expanded to more Medicare members.

"HHS is seeking a 5% reduction in overall healthcare costs compared with control groups," Esterly said. "Both American Healthways and excelleRx are at risk if we don't achieve the 5% reduction."

There may be financial risks in the CCIP model, but excelleRx has worked hard to minimize its exposure, said chairman/CEO Calvin Knowlton, R.Ph., Ph.D. Despite the risks, the contract "is a tremendous opportunity to expand our evidence-based platform beyond the hospice market," he added. "This is a significant step forward for us and the value we offer the healthcare industry. We aim to transform the way prescribing decisions are made and improve patient care. This is a chance to see what happens with chronic care patients. The program is akin to what the government did 25 years ago to seed health maintenance organizations. This is the same type of threat. We need to figure out what to do, and pharmacy must be part of it."