Pub Date : 2015-09-15DOI: 10.18553/JMCP.1997.3.3.317
Eric Bobal
OBJECTIVE: To estimate the prevalence of changes to the initial treatment regimen of hypertensive patients in a managed care setting and to identify the factors having the most impact on the cost of treatment. Utilization patterns specifically related to angiotensin converting enzyme inhibitors (ACEls) and calcium channel blockers (CCBs) were looked at because of their particular cost impact. Secondary goals were to assess the types of changes made to therapy and to estimate the ACEI/CCB concomitancy rates (the number of patients receiving both medications at the same time) among these hypertensive patients, and the cost impact of these. DESIGN: In May 1995, a survey regarding the treatment of hypertension in managed care was faxed to a random sampling of pharmacy directors of 250 large (greater than 40,000 enrollees) managed care plans throughout the United States. A total of 29 pharmacy directors completed and returned the survey; all responses were included in the study analysis. The 29 plans represent...
{"title":"Trends in the Treatment of Hypertension within Managed Care Organizations: A National Survey of HMO Pharmacy Directors","authors":"Eric Bobal","doi":"10.18553/JMCP.1997.3.3.317","DOIUrl":"https://doi.org/10.18553/JMCP.1997.3.3.317","url":null,"abstract":"OBJECTIVE: To estimate the prevalence of changes to the initial treatment regimen of hypertensive patients in a managed care setting and to identify the factors having the most impact on the cost of treatment. Utilization patterns specifically related to angiotensin converting enzyme inhibitors (ACEls) and calcium channel blockers (CCBs) were looked at because of their particular cost impact. Secondary goals were to assess the types of changes made to therapy and to estimate the ACEI/CCB concomitancy rates (the number of patients receiving both medications at the same time) among these hypertensive patients, and the cost impact of these. DESIGN: In May 1995, a survey regarding the treatment of hypertension in managed care was faxed to a random sampling of pharmacy directors of 250 large (greater than 40,000 enrollees) managed care plans throughout the United States. A total of 29 pharmacy directors completed and returned the survey; all responses were included in the study analysis. The 29 plans represent...","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68351458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.1997.3.5.548
A. Petitta
OBJECTIVE: The purpose of this study was to analyze the economic and health outcomes of implementing a preferred agent (HMG-CoA) reductase inhibitor policy in a managed care population. DESIGN: A Markov model with three states was constructed: 1) alive with no cardiac or coronary heart disease (CHD), 2) alive with CHD; and, 3) dead. In the model patients can move from one state to another as a function of CHD risk factors and expected changes in the lipid levels secondary to therapy. Event rates for CHD-related hospitalizations are also predicted. Health care costs included hospitalization costs for CHD events and HMG-CoA drug costs. Risk factor data were collected on a random sample of 150 patients of the 3,500 managed care patients receiving HMG-CoA therapy. Outcomes were modeled until age 80. Results were generated for a baseline of one year before and six months after implementation of the policy. SETTING: Group practice managed care organization. PATIENTS: Patients receiving HMG-CoA reductase inhibit...
{"title":"The Cost-Effectiveness Impact of a Preferred Agent HMG-CoA Reductase Inhibitor Policy in a Managed Care Population","authors":"A. Petitta","doi":"10.18553/JMCP.1997.3.5.548","DOIUrl":"https://doi.org/10.18553/JMCP.1997.3.5.548","url":null,"abstract":"OBJECTIVE: The purpose of this study was to analyze the economic and health outcomes of implementing a preferred agent (HMG-CoA) reductase inhibitor policy in a managed care population. DESIGN: A Markov model with three states was constructed: 1) alive with no cardiac or coronary heart disease (CHD), 2) alive with CHD; and, 3) dead. In the model patients can move from one state to another as a function of CHD risk factors and expected changes in the lipid levels secondary to therapy. Event rates for CHD-related hospitalizations are also predicted. Health care costs included hospitalization costs for CHD events and HMG-CoA drug costs. Risk factor data were collected on a random sample of 150 patients of the 3,500 managed care patients receiving HMG-CoA therapy. Outcomes were modeled until age 80. Results were generated for a baseline of one year before and six months after implementation of the policy. SETTING: Group practice managed care organization. PATIENTS: Patients receiving HMG-CoA reductase inhibit...","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68351851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.1997.3.6.651
Taeho Oh
{"title":"Do We Measure Up in Reducing Morbidity and Mortality","authors":"Taeho Oh","doi":"10.18553/JMCP.1997.3.6.651","DOIUrl":"https://doi.org/10.18553/JMCP.1997.3.6.651","url":null,"abstract":"","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68352054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.1999.5.2.150
K. Fairman
CONCLUSION: The following principles should guide project planning and questionnaire construction: 1) enlist the respondent's interest and trust; 2) maintain trust by keeping respondent burden to a minimum; 3) provide an attractive product; 4) avoid confusing, threatening, or biased questions; and 5) ensure that the questionnaire is consistent with planned data analyses. Several additional procedures enhance the usefulness of survey results: pretesting,
{"title":"Going to the Source: A Guide to Using Surveys in Health Care Research","authors":"K. Fairman","doi":"10.18553/JMCP.1999.5.2.150","DOIUrl":"https://doi.org/10.18553/JMCP.1999.5.2.150","url":null,"abstract":"CONCLUSION: The following principles should guide project planning and questionnaire construction: 1) enlist the respondent's interest and trust; 2) maintain trust by keeping respondent burden to a minimum; 3) provide an attractive product; 4) avoid confusing, threatening, or biased questions; and 5) ensure that the questionnaire is consistent with planned data analyses. Several additional procedures enhance the usefulness of survey results: pretesting,","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67487806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.2001.7.2.142
B. Mcfarland
OBJECTIVE: To review data on the comparative costs of antidepressants. DESIGN: Review of data from articles identified in a Medline search, meeting presentations, and independent market research that are relevant to the costs associated with treating depression. Studies were included if they compared depression treatment costs with tricyclic antidepressants to those with one of the leading selective serotonin reuptake inhibitors (SSRIs) or if they compared treatment costs among the leading SSRIs. Data were extracted on drug acquisition costs, concomitant medications, dose titration, multitablet/multi-capsule therapy, duration of therapy, and overall treatment costs. RESULTS: SSRIs may be more costeffective than tricyclic antidepressants because they are associated with lower health care utilization. Assessment of economic outcomes with SSRI therapy can be based on identified cost drivers, including dose titration and the need for multi-tablet therapy. Among the SSRIs, the uses of nonpharmaceutical health ...
{"title":"Depression in Managed Care: Costs of Selective Serotonin Reuptake Inhibitors","authors":"B. Mcfarland","doi":"10.18553/JMCP.2001.7.2.142","DOIUrl":"https://doi.org/10.18553/JMCP.2001.7.2.142","url":null,"abstract":"OBJECTIVE: To review data on the comparative costs of antidepressants. DESIGN: Review of data from articles identified in a Medline search, meeting presentations, and independent market research that are relevant to the costs associated with treating depression. Studies were included if they compared depression treatment costs with tricyclic antidepressants to those with one of the leading selective serotonin reuptake inhibitors (SSRIs) or if they compared treatment costs among the leading SSRIs. Data were extracted on drug acquisition costs, concomitant medications, dose titration, multitablet/multi-capsule therapy, duration of therapy, and overall treatment costs. RESULTS: SSRIs may be more costeffective than tricyclic antidepressants because they are associated with lower health care utilization. Assessment of economic outcomes with SSRI therapy can be based on identified cost drivers, including dose titration and the need for multi-tablet therapy. Among the SSRIs, the uses of nonpharmaceutical health ...","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67489163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.2001.7.4.283
J. Fischer, R. M. Mowers, David J. Ormerod, Ellen S. Burriss
OBJECTIVE: Shift selective serotonin reuptake inhibitor (SSRI) market share in a large integrated health system to a more cost-effective alternative without the need for therapeutic interchange. SETTING: University of California Davis Medical Group (UCDMG). PRACTICE INNOVATION: Integrate the managed care team into the routine operation of the medical group clinics. Influence prescribing patterns by a program of continuous physician education, giving the messages that (1) citalopram was the most costeffective SSRI; (2) fluoxetine is the least cost-effective, especially at doses above 20 mg; and (3) that citalopram should be considered as initial therapy for depression and for patients not achieving optimal therapy on their current SSRI. OUTCOMES MEASURES: Change in market share for SSRIs: prescriptions for citalopram and fluoxetine were monitored for a year after the physician education program began. RESULTS: Market share for citalopram increased dramatically. Starting below the reported national usage, t...
{"title":"Driving Market Share in an Integrated Health System without Therapeutic Interchange","authors":"J. Fischer, R. M. Mowers, David J. Ormerod, Ellen S. Burriss","doi":"10.18553/JMCP.2001.7.4.283","DOIUrl":"https://doi.org/10.18553/JMCP.2001.7.4.283","url":null,"abstract":"OBJECTIVE: Shift selective serotonin reuptake inhibitor (SSRI) market share in a large integrated health system to a more cost-effective alternative without the need for therapeutic interchange. SETTING: University of California Davis Medical Group (UCDMG). PRACTICE INNOVATION: Integrate the managed care team into the routine operation of the medical group clinics. Influence prescribing patterns by a program of continuous physician education, giving the messages that (1) citalopram was the most costeffective SSRI; (2) fluoxetine is the least cost-effective, especially at doses above 20 mg; and (3) that citalopram should be considered as initial therapy for depression and for patients not achieving optimal therapy on their current SSRI. OUTCOMES MEASURES: Change in market share for SSRIs: prescriptions for citalopram and fluoxetine were monitored for a year after the physician education program began. RESULTS: Market share for citalopram increased dramatically. Starting below the reported national usage, t...","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67489607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.2001.7.4.292
D. Nau, Joshua D. Blevins, Stephen Neal
OBJECTIVE: To assess the ability of community pharmacists to identify managed care patients with diabetes who are not achieving therapeutic goals. SETTING: A network of independent community pharmacists in West Virginia and southeastern Ohio in collaboration with The Health Plan of the Upper Ohio Valley. METHODS: Pharmacists conducted assessments of patients’ glycemic control (HbA1c ), blood pressure (BP), lipid levels (total cholesterol, low-den sity lipoprotein [LDL], high-density lipoprotein [HDL], triglycerides), and body mass index (BMI). The therapeutic goals were: HbA 1c less than 7%, BP lower than 130/85 mmHg, total cholesterol under 200 mg/dl, LDL less than 100mg/dl, HDL lower than 45 mg/dl, triglycerides under 200 mg/dl, and BMI lower than 30. These indices were measured during scheduled appointments in the pharmacy by pharmacists who had completed a certificate program in diabetes care. Reports on each patient’s status, along with recommendations, were sent to the patient’s physician. RESULTS: Fifty-four persons were enrolled in the pharmacist program and complete clinical data were obtained for 47 patients. The following percentages of patients were identified as not achieving the therapeutic goal for a particular measure: HbA1c: 63.9%, BP: 56.3%, total cholesterol: 38.3%, LDL: 69.8%, HDL: 76.5%, triglycerides: 57.4%, BMI: 61.9%. Patients who were not reaching the therapeutic target were referred to their physicians for additional evaluation. CONCLUSION: Pharmacists can identify a substantial number of persons with diabetes who are not achieving the goals for HbA 1c , blood pressure, lipids, and weight. This approach can facilitate the continuous assessment and improvement of care for managed care enrollees with diabetes.
{"title":"Collaborating with Community Pharmacists to Improve the Quality of Diabetes Care in an IPA-model HMO","authors":"D. Nau, Joshua D. Blevins, Stephen Neal","doi":"10.18553/JMCP.2001.7.4.292","DOIUrl":"https://doi.org/10.18553/JMCP.2001.7.4.292","url":null,"abstract":"OBJECTIVE: To assess the ability of community pharmacists to identify managed care patients with diabetes who are not achieving therapeutic goals. SETTING: A network of independent community pharmacists in West Virginia and southeastern Ohio in collaboration with The Health Plan of the Upper Ohio Valley. METHODS: Pharmacists conducted assessments of patients’ glycemic control (HbA1c ), blood pressure (BP), lipid levels (total cholesterol, low-den sity lipoprotein [LDL], high-density lipoprotein [HDL], triglycerides), and body mass index (BMI). The therapeutic goals were: HbA 1c less than 7%, BP lower than 130/85 mmHg, total cholesterol under 200 mg/dl, LDL less than 100mg/dl, HDL lower than 45 mg/dl, triglycerides under 200 mg/dl, and BMI lower than 30. These indices were measured during scheduled appointments in the pharmacy by pharmacists who had completed a certificate program in diabetes care. Reports on each patient’s status, along with recommendations, were sent to the patient’s physician. RESULTS: Fifty-four persons were enrolled in the pharmacist program and complete clinical data were obtained for 47 patients. The following percentages of patients were identified as not achieving the therapeutic goal for a particular measure: HbA1c: 63.9%, BP: 56.3%, total cholesterol: 38.3%, LDL: 69.8%, HDL: 76.5%, triglycerides: 57.4%, BMI: 61.9%. Patients who were not reaching the therapeutic target were referred to their physicians for additional evaluation. CONCLUSION: Pharmacists can identify a substantial number of persons with diabetes who are not achieving the goals for HbA 1c , blood pressure, lipids, and weight. This approach can facilitate the continuous assessment and improvement of care for managed care enrollees with diabetes.","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67489661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.2001.7.5.386
S. Walton, B. Arondekar, N. Johnson, G. Schumock
OBJECTIVE: To describe a model for analyzing the unnecessary costs associated with outpatient prescription fill quantities and to apply the model to prescription data from the Veterans Administration’s Chicago Health Care System (VACHCS) to examine costs under various scenarios. DESIGN: The model developed here included the cost of drugs, quantity of drug wasted, and the cost to fill the prescription, and is used to determine and compare the total unnecessary costs (TUC) of different prescription fill quantities. The model was applied to the VACHCS outpatient prescription records for two formulary hydroxymethyl glutaryl coenzyme A (HMGCoA) reductase-inhibitor drugs to determine TUC for 30- and 90-day fills. Sensitivity analysis was used to analyze changes in the TUC over a range of possible values for each variable in the model. RESULTS: A total of 16,990 prescriptions met the study inclusion criteria, of which 21.4% were for a 30-day supply and 78.6% for a 90-day supply. For 30-day and 90-day prescriptions, the average prescription cost per day was $0.56 and $0.54, respectively; quantity wasted was 1.06 days and 5.33 days; and TUC per prescription were $5.62 and $3.17. Sensitivity analysis demonstrated that the 90day policy maintained lower TUC for most scenarios with the exception of very high drug costs. CONCLUSION: Prescription benefit managers will find this model informative for determining policies for prescription fill quantities.
{"title":"A Model for Comparing Unnecessary Costs Associated with Various Prescription Fill-Quantity Policies: Illustration Using VA Data","authors":"S. Walton, B. Arondekar, N. Johnson, G. Schumock","doi":"10.18553/JMCP.2001.7.5.386","DOIUrl":"https://doi.org/10.18553/JMCP.2001.7.5.386","url":null,"abstract":"OBJECTIVE: To describe a model for analyzing the unnecessary costs associated with outpatient prescription fill quantities and to apply the model to prescription data from the Veterans Administration’s Chicago Health Care System (VACHCS) to examine costs under various scenarios. DESIGN: The model developed here included the cost of drugs, quantity of drug wasted, and the cost to fill the prescription, and is used to determine and compare the total unnecessary costs (TUC) of different prescription fill quantities. The model was applied to the VACHCS outpatient prescription records for two formulary hydroxymethyl glutaryl coenzyme A (HMGCoA) reductase-inhibitor drugs to determine TUC for 30- and 90-day fills. Sensitivity analysis was used to analyze changes in the TUC over a range of possible values for each variable in the model. RESULTS: A total of 16,990 prescriptions met the study inclusion criteria, of which 21.4% were for a 30-day supply and 78.6% for a 90-day supply. For 30-day and 90-day prescriptions, the average prescription cost per day was $0.56 and $0.54, respectively; quantity wasted was 1.06 days and 5.33 days; and TUC per prescription were $5.62 and $3.17. Sensitivity analysis demonstrated that the 90day policy maintained lower TUC for most scenarios with the exception of very high drug costs. CONCLUSION: Prescription benefit managers will find this model informative for determining policies for prescription fill quantities.","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67489929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.2001.7.S2.1
W. Berge, O. Shoheiber, D. Giaquinta, E. Cannon, G. Ledgerwood
{"title":"New Challenges to Old Standards in the Treatment of Rhinitis","authors":"W. Berge, O. Shoheiber, D. Giaquinta, E. Cannon, G. Ledgerwood","doi":"10.18553/JMCP.2001.7.S2.1","DOIUrl":"https://doi.org/10.18553/JMCP.2001.7.S2.1","url":null,"abstract":"","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67490107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/jmcp.2001.7.s2.7
W. Berger, O. Shoheiber, D. Giaquinta, E. Cannon, G. Ledgerwood
{"title":"Evaluating Utilization Patterns","authors":"W. Berger, O. Shoheiber, D. Giaquinta, E. Cannon, G. Ledgerwood","doi":"10.18553/jmcp.2001.7.s2.7","DOIUrl":"https://doi.org/10.18553/jmcp.2001.7.s2.7","url":null,"abstract":"","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67490223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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