Development of a migraine disease management initiative in a managed care plan

Migraine is a common, chronic headache disorder affecting about 26 to 28 million Americans. It is notable for the variability of diagnostic testing, therapeutic interventions and costs, as well as high utilization of healthcare resources, its considerable impact on quality of life and its economic impact for both patients and employers. Moreover, there appears to be low patient satisfaction with migraine care, a wide variability in utilization of physician and emergency department services and increasing pharmacy costs for migraine therapy pies. Standards of care and clinical guidelines for migraine are now available. For these reasons, migraine represents an ideal disorder for a disease management (DM) program. The suggested steps in developing a DM program for migraine include setting appropriate goals. identifying suitable patients, providing components of care and using continuous quality improvement methods to reach targets. A DM management program for migraine in a managed care organization which was developed and implemented is overviewed in this article. Medicaid and commercial enrollees were included. Members with migraine who had greater than or equal to1 migraine-related encounter(s) in the previous year, or query of the pharmacy claims database for members who filled one or more prescriptions for migraine specific medication(s) during the 12-month period, were eligible. The objectives were: an increased proportion of patients with symptom relief and returning to normal activities within 2 hours after taking medicatiom taking prophylactic medications (if experiencing 3 migraine attacks/month) and reporting knowledge of potential migraine triggers; decreased utilization of emergency care for migraine and increased patient satisfaction with migraine treatment and health plan and/or provider. Improved health-related quality of life and reduced level of migraine-related disability compared with baseline were also anticipated. Patient satisfaction with overall migraine treatment was selected as the primary endpoint in the evaluation of the program. Early feedback on outcomes from patients and providers has been very positive. There have been no major unexpected problems to date.