July 20, 2020— A decade-and-a-half ago, Chicago patient Hanan Tadros was feeling overwhelmed. She was struggling to manage her multiple chronic health conditions and juggle her more than 10 prescription medications for diabetes, depression, and more. That’s when a hospital participating in the 340B drug pricing program intervened to help change her life for the better.
Hanan’s physicians at the University of Illinois Hospital and Health Sciences System knew she would benefit from UI Health’s Medication Therapy Management Clinic (MTMC), so they referred her to the pharmacy team that ran the clinic. This was the start of what has become a more than 15-year essential service for her.
Every two weeks, Hanan comes to UI Health and meets with a pharmacist to have her blood pressure taken and discuss any side effects she might be experiencing from her different medications. Before she leaves, she receives a two-week supply of all her drugs organized in a pill box. This is critical to her comfort level and her ability to adhere to her medication regimen.
“It’s safer for me because so many medications get me confused,” she says.
Hanan is the newest patient profile in our Faces of 340B series. None of the services Hanan receives from UI Health’s MTMC result in any compensation for the clinic, yet the system provides them to her free of charge. This is possible because the 340B program is helping to pay the costs of delivering this care to her and many other UI Health patients who also are living with multiple chronic diseases.
Taking the Time to Listen
UI Health has a disproportionate share (DSH) percentage of greater than 40%. This means it serves many patients in the Chicago area with low incomes, including patients who are uninsured or are on Medicaid. According to MTMC Clinical Coordinator Jessica Tilton, the health system prides itself on improving the health outcomes and quality of life for patients in groups that typically have been underserved.
Jessica is the newest provider profile in our Faces of 340B series. She says 340B savings are what are behind the ability of the MTMC to operate a robust, uncompensated service that is staffed by six pharmacists and one dedicated pharmacy technician. The MTMC is a stellar example of how hospitals and health systems such as UI Health use their 340B savings to stretch resources and provide comprehensive services that they otherwise could not afford to offer.
A primary care physician or specialist typically will refer someone to the clinic when the patient has an unmet care need. Frequently, the patients have multiple chronic conditions and are at the highest risk for medical complications. When patients first come to the MTMC, the clinic’s pharmacists work to assess the primary challenge a patient is having, which often involves nonadherence with their medication regimens.
“Many times, people think nonadherence is just that somebody forgot a medication, but that’s not necessarily the case,” Jessica said. “The reasons for nonadherence can run the gamut, so we are really investigating and evaluating what the core issue of their nonadherence is and then fully addressing it.”
Once the patient’s core challenges have been addressed, the MTMC focuses on what is known as disease-state management. The clinic’s pharmacy team works with the patient to ensure their medications are the most appropriate for them and that they are not over-prescribing or under-prescribing. Each prescribing decision is intended to reduce hospitalizations and improve health outcomes and quality of life. Jessica says a key factor in these decisions is making sure that the medication regimen actually works for the patient, rather than “what we think works.”
Jessica recalls many stories of patients who have benefited from 340B because of the impact the MTMC has had on their lives. She had one patient who appeared to have optimized vital signs, but the patient’s quality of life still was not ideal. He was unable to complete daily tasks such as washing dishes without experiencing dizziness.
“No one had the time to sit down and listen to his symptoms,” Jessica said. “After I listened and digested and looked at his regimen, I started peeling back some of his medications in collaboration with his physician.”
Jessica had discovered that the patient’s drug regimen was resulting in lowered blood pressure. Once he started taking fewer medications, he experienced fewer side effects and now enjoys an improved quality of life.
Documenting the Successes
UI Health has conducted rigorous research to measure how the MTMC has directly impacted its patients’ health outcomes. The findings have demonstrated that patients across various disease groups have achieved measurably improved health.
For example, clinic patients with diabetes saw a reduction in hemoglobin A1C levels of 0.63%, lowering their risk for medical complications such as cardiac issues, stroke, and vision problems. Jessica and her colleagues also found that MTMC patients had a reduction in systolic blood pressure of 8.2 mm Hg, reducing their cardiovascular health risks. Research modeling on 200 such patients concluded that over a 10-year period, the cohort could expect cardiovascular events reduced by a factor of 10, direct medical costs reduced by at least $500,000, and patient life years increased by 4.5.
All these measurable improvements in patient health can be traced back to the financial support that 340B provides the MTMC, Jessica notes. “Without 340B savings, the medication therapy management clinic would not be the clinic that it is today.”
Hanan’s health has improved significantly since she started coming to the MTMC. She has avoided hospital admissions, and the clinic has taught her how to monitor her A1C levels and manage her health through teaching her healthy habits. As a result, her diabetes is now under control.
“It’s been seven years since I’ve had one insulin shot,” she says.
The MTMC also has helped Hanan access the medications she needs. Her insurance coverage at times has taken up to a year to determine that it will cover one of her prescribed medications. The clinic has provided her those drugs at no cost so she could stick to her medication regimens during the insurance approval process.
“If there is no medication therapy management clinic, I don’t know what I’d do,” she says. “They saved my life. If there is no program, I’m not here.”