The Michigan Medication Algorithm (MMA) is also known as the Michigan Implementation of Medication Algorithms (MIMA). The MMA is a prescription monitoring program. When the state of Michigan looked into the program it was working in several other states. MMA was heavily modeled after TIMA which is the Texas Implementation of Medication Algorithms Project. The Michigan MMA looks much like TIMA.

The goal of MMA or MIMA is to reduce the number of people on multiple psychotropic medications. The end result is a decision-tree medication algorithm. The algorithm was based on the expert opinions of mental health specialists from Michigan. It is specific to people who have a severe and persistent mental illness such as Schizophrenia, Bipolar Disorder or Major Depression. After diagnosis, participating treatment professionals (those prescribing medication) follow the suggestions found in a series of manuals or papers regarding how and what to prescribe.

The MMA covers pharmacological treatment only. The manuals state that the illness or disease should not be viewed through an “only medications are needed” lens, and other kinds of treatment should or may be used. Pharmacological treatment is the prescribing of medications. In this case the medications are psychiatric medications.

According to the manual for Bipolar Disorder:

Rather than being “cookbook medicine,” the MIMA empowers clinicians to make their own decisions about patient care, guided by the best available evidence to support those decisions.

In other words through MIMA, there is the desire to get and guide treatment decisions through solid evidence-based information. What is desired is an approach to clinical decision-making that yields similar answers in similar situations.

The manuals are available online:

For Bipolar Disorder (PDF Document)

For Schizophrenia (PDF Document)

The Robert Woods Johnson Foundation (RWJF) followed people in the Texas Implementation of Medication Algorithms (TIMA) with the following results which were published in the Journal of Clinical Psychiatry, Archives of General Psychiatry, Schizophrenia Bulletin and in reports to the RWJF.

From the RWJF site:

Key Findings:

Patients with a history of mania or bipolar disease who were treated with medication algorithms experienced a larger initial decrease in the overall severity of psychiatric symptoms compared to patients receiving treatment-as-usual.

There were no differences between the two groups of patients with bipolar disorder in respect to depressive symptoms.

All patients with major depressive disorder improved during the 12-month study period, but patients treated with the algorithm package had significantly greater reductions in symptoms and improvement in mental health functioning than patients receiving treatment-as-usual.

Treatment with the medication algorithm had its major effect on depressed patients within the first three months but continued to exceed the effects of treatment-as-usual for the entire one-year study period.

Substantial symptoms of depression for patients with major depressive disorder remained for the entire one-year study period.

Substantial symptoms of depression for patients with major depressive disorder remained, even among patients who benefited from the algorithm-guided treatment.

For patients with schizophrenia, treatment with the medication algorithm produced better symptom reduction than treatment-as-usual, a difference that was statistically significant but clinically modest.

Based upon change in symptoms and mental health care costs. Cost-effectiveness varied depending upon the disorder being treated.

For major depressive disorder, while clinical outcomes were better in algorithm treatment, the one year treatment cost for improvement was somewhat higher.

For bipolar disorder, both clinical and cost outcomes were better in the algorithm project.

For schizophrenia, cost-effectiveness did not differ between algorithm-based care and treatment-as-usual.

The MMA or MIMA program is voluntary for Michigan doctors. All decisions regarding treatment and medications are made privately between the physician and the patient, and are completely individualized.

From the Michigan Department of Community Health website, some final words from the funder of the project:

“We are please to support this program in Michigan,” said Jack Bailey, Lilly vice president, Business-to-Business. “We have seen a lot of success with it across the country. We believe Medicaid dollars for mental health drugs can be wisely managed by providing education to increase the quality of prescribing practices rather than limiting access to these vital medications.”

Says a mouthful, doesn't he?