The State of Florida and Pfizer Inc. announced in November they have contacted nearly 150,000 Medicaid beneficiaries with serious medical conditions and worked to monitor and improve their health through the Florida: A Healthy State program. When the program was launched in 2001, it was expected to reach just 50,000 Medicaid beneficiaries.
The program provides innovative patient education and nursing care to high-risk, targeted Medicaid patients through a statewide network of community hospitals, civic organizations, and patients’ advocate groups. It cut the growth in Florida’s medical costs by $41.9 million during a 27-month period ending in September 2003, according to Medical Scientists Inc., an independent organization that examined the results of the program. The firm’s report was released November 9.
In addition, the state government received about $19.2 million in Pfizer investments and medicines donated by the firm. In all, the program generated $2.18 of medical claims reductions for each dollar invested in the program, according to the Medical Scientists report.
Real Patients Report Benefits
“At a time several years ago when Florida was looking to be a pioneer in developing meaningful strategies to reduce the growth in costs and improve health outcomes, Pfizer offered an innovative solution [that is] today delivering positive, measurable results well above our original objectives,” said Alan Levine, secretary of Florida’s Agency for Health Care Administration.
“The stories real patients are telling about this program are powerful reminders of the purpose behind Florida: A Health State,” added Levine. “While cost avoidance is measurable and important, it is equally critical we improve lives and reduce dependency on sophisticated medical interventions in those cases where simply engaging the patient can make all the difference. Partnerships like this one … are good benchmarks for states to use as they, like Florida, struggle with the difficult balance between cost and outcomes.”
“I personally see the impact this program continues to have on the lives of real people in our community every day,” said Michael L. Howell, MD, MBA, medical director of Florida: A Healthy State. “Patients are able to learn the tools necessary to adequately manage their chronic illnesses in ways that emergency rooms and acute inpatient hospital stays can never achieve. And it is because of the personal level of the training and the learning processes that this program is able to succeed.”
The community-based health network created through the Healthy State links 10 of the state’s “safety-net” hospitals with dedicated care managers who provide individualized care to low-income patients with serious medical conditions.
In addition to care support, education, and immunizations, the program has distributed more than 30,000 home health aids such as blood pressure cuffs, weight scales, and peak flow meters for asthma sufferers to measure breathing difficulty.
The Medical Scientists’ study indicates Florida: A Healthy State educated many patients about their diseases and health care, increased their ability to monitor their own conditions, changed health-related behaviors, slowed the progression of chronic diseases, and, as a result, reduced utilization of high-cost health services. Clinical and behavioral outcomes include:
- 52 percent of patients showed improvement in their physical health score, the medically accepted measure of a patient’s overall health, as calculated by the SF-12, a single-page scannable survey to assess physical and mental health, between baseline and most recent follow-up.
- 53 percent of patients improved their mental health score, as measured by the SF-12, between baseline and most recent follow-up.
- 39 percent of patients improved their medication compliance score, as measured by the Morisky Medication Compliance Scale.
- 42 percent of heart failure patients improved their heart function after one year of care management, as indicated by an improvement in New York Heart Association classification.
- Diabetics increased their home monitoring of blood glucose, which contributed to an improvement in the patients’ average blood glucose level.
- 50 percent of diabetic patients lowered their Hemoglobin A1c level, a measure of diabetes severity, after three months.
- The percentage of asthmatics who measured their peak flow at home doubled to 64 percent, while the number of severe asthmatics dropped by 24.7 percent, between baseline and most recent follow-up.
- 40 percent of asthmatics improved their National Heart Lung Blood Institute classification over a period of one year under management.
- The number of asthmatic patients reporting no symptoms increased by 45 percent.
Improves Patients’ Use of Physician Care
The study noted changes in patient health knowledge and behavior, coupled with the support of the care managers in helping patients find a medical home–consistent physician care–have been reflected in more-appropriate utilization of health care services:
- Physician visits for patients with heart failure increased by 13 percent, and patients reduced their emergency department (ED) visits by 19 percent and their inpatient visits by 7 percent.
- Diabetics increased their number of physician visits by 2 percent while reducing ED visits by 5 percent and reducing inpatient visits by 17 percent.
- Hypertensive patients increased physician visits by 7 percent, reduced ED visits by 8 percent, and reduced inpatient visits by 4 percent.
“We are gratified by these results, which show very clearly that this innovative public-private partnership that modifies the health care system and engages patients actively in their own care decisions is delivering exactly what it promised three years ago: a practical, patient-centered solution that combines better medicine with better outcomes all at less cost,” said Hank McKinnell, chairman and chief executive officer of Pfizer.
“We look forward to continuing to improve patient health and providing low-income Floridians with access to the best that modern medicine has to offer,” McKinnell concluded. “The lessons we have learned … have important implications as both federal and state governments look for new ways to deliver better health care to patients with chronic diseases.”
Susan Konig ([email protected]) is managing editor of Health Care News.