The Multiple Sclerosis Treatment Optimization Program

Abstract Objective To design and implement a health system level intervention to reduce escalating multiple sclerosis (MS) disease modifying treatment (DMT) expenditures and improve outcomes. Methods We conducted stakeholder meetings, reviewed pharmacy utilization data, and abstracted information in...

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Autores principales:	Annette Langer‐Gould, Stephen C. Cheng, Bonnie H. Li, Michael H. Kanter
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/b2d72556b04543fdaace7e951537f3da
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spelling	oai:doaj.org-article:b2d72556b04543fdaace7e951537f3da2021-11-22T11:11:52ZThe Multiple Sclerosis Treatment Optimization Program2328-950310.1002/acn3.51472https://doaj.org/article/b2d72556b04543fdaace7e951537f3da2021-11-01T00:00:00Zhttps://doi.org/10.1002/acn3.51472https://doaj.org/toc/2328-9503Abstract Objective To design and implement a health system level intervention to reduce escalating multiple sclerosis (MS) disease modifying treatment (DMT) expenditures and improve outcomes. Methods We conducted stakeholder meetings, reviewed pharmacy utilization data, and abstracted information in subsets of persons with MS (pwMS) from the electronic health record to identify gaps in, and barriers to improving, quality, and affordability of MS care in Kaiser Permanente Southern California. These results informed the development and implementation of the MS Treatment Optimization Program (MSTOP). Results The two main gaps identified were under‐prescribing of highly effective DMTs (HET, 4.9%) and the preferred formulary DMT (20.9%) among DMT‐treated pwMS. The main barriers identified were prescribers’ fear of rare but serious HET side effects, lack of MS‐specific and health systems science knowledge, Pharma influence, evidence gaps, formulary decisions‐based solely on costs, and multidirectional mistrust between neurologists, practice leaders, and health plan pharmacists. To overcome these barriers MSTOP developed four strategies: (1) risk‐stratified treatment algorithm to increase use of HETs; (2) an expert‐led ethical, cost‐sensitive, risk‐stratified, preferred formulary; (3) proactive counter‐launch campaigns to minimize uptake of new, low‐value DMTs; and (4) discontinuation of ineffective DMTs in progressive, non‐relapsing MS. The multicomponent MSTOP was implemented through education, training, and expanding access to MS‐trained providers, audit and feedback, and continual evidence reviews. Interpretation The causes of wasteful spending on MS DMTs are complex and require multiple strategies to resolve. We provide herein granular details of how we designed and implemented our health system intervention to facilitate its adaption to other settings and conditions.Annette Langer‐GouldStephen C. ChengBonnie H. LiMichael H. KanterWileyarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENAnnals of Clinical and Translational Neurology, Vol 8, Iss 11, Pp 2146-2154 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Annette Langer‐Gould Stephen C. Cheng Bonnie H. Li Michael H. Kanter The Multiple Sclerosis Treatment Optimization Program
description	Abstract Objective To design and implement a health system level intervention to reduce escalating multiple sclerosis (MS) disease modifying treatment (DMT) expenditures and improve outcomes. Methods We conducted stakeholder meetings, reviewed pharmacy utilization data, and abstracted information in subsets of persons with MS (pwMS) from the electronic health record to identify gaps in, and barriers to improving, quality, and affordability of MS care in Kaiser Permanente Southern California. These results informed the development and implementation of the MS Treatment Optimization Program (MSTOP). Results The two main gaps identified were under‐prescribing of highly effective DMTs (HET, 4.9%) and the preferred formulary DMT (20.9%) among DMT‐treated pwMS. The main barriers identified were prescribers’ fear of rare but serious HET side effects, lack of MS‐specific and health systems science knowledge, Pharma influence, evidence gaps, formulary decisions‐based solely on costs, and multidirectional mistrust between neurologists, practice leaders, and health plan pharmacists. To overcome these barriers MSTOP developed four strategies: (1) risk‐stratified treatment algorithm to increase use of HETs; (2) an expert‐led ethical, cost‐sensitive, risk‐stratified, preferred formulary; (3) proactive counter‐launch campaigns to minimize uptake of new, low‐value DMTs; and (4) discontinuation of ineffective DMTs in progressive, non‐relapsing MS. The multicomponent MSTOP was implemented through education, training, and expanding access to MS‐trained providers, audit and feedback, and continual evidence reviews. Interpretation The causes of wasteful spending on MS DMTs are complex and require multiple strategies to resolve. We provide herein granular details of how we designed and implemented our health system intervention to facilitate its adaption to other settings and conditions.
format	article
author	Annette Langer‐Gould Stephen C. Cheng Bonnie H. Li Michael H. Kanter
author_facet	Annette Langer‐Gould Stephen C. Cheng Bonnie H. Li Michael H. Kanter
author_sort	Annette Langer‐Gould
title	The Multiple Sclerosis Treatment Optimization Program
title_short	The Multiple Sclerosis Treatment Optimization Program
title_full	The Multiple Sclerosis Treatment Optimization Program
title_fullStr	The Multiple Sclerosis Treatment Optimization Program
title_full_unstemmed	The Multiple Sclerosis Treatment Optimization Program
title_sort	multiple sclerosis treatment optimization program
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/b2d72556b04543fdaace7e951537f3da
work_keys_str_mv	AT annettelangergould themultiplesclerosistreatmentoptimizationprogram AT stephenccheng themultiplesclerosistreatmentoptimizationprogram AT bonniehli themultiplesclerosistreatmentoptimizationprogram AT michaelhkanter themultiplesclerosistreatmentoptimizationprogram AT annettelangergould multiplesclerosistreatmentoptimizationprogram AT stephenccheng multiplesclerosistreatmentoptimizationprogram AT bonniehli multiplesclerosistreatmentoptimizationprogram AT michaelhkanter multiplesclerosistreatmentoptimizationprogram
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The Multiple Sclerosis Treatment Optimization Program

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