Featured Health Business Daily Story, Feb. 5, 2014
Reprinted from DRUG BENEFIT NEWS, biweekly news and proven cost management strategies for health plans, PBMs, pharma companies and employers.
Insurers, PBMs and pharmacies have myriad ways to make sure patients physically obtain their medications, from monitoring patients at the point of sale to automatic mail-order refills. But how can anyone be sure what happens once the patient is at home with that medication?
“That’s the piece that has always been missing in medication adherence,” observes Mesfin Tegenu, R.Ph., president of PerformRx, LLC, a wholly owned subsidiary of the AmeriHealth Caritas Family of Companies. And adherence is especially important for those “who are on multiple medications, who are confused about how many pills to take or when to take them,” he asserts. “So our goal is to see how we can help patients comply and how we can make sure that they take their medications.”
Moreover, when you consider that 5% to 10% of members account for about 70% of overall resources, it makes sense from a return-on-investment (ROI) perspective to target at least 5% of that group, he points out. As a result, the PBM has recently deployed three new information-gathering technologies to target nonadherent members who have some of the highest overall health care costs. They are:
(1) PillStation. Through a unique, camera-based technology, members are armed with a box that can accommodate a seven-day supply of multiple medications (each day is separated into morning, afternoon and evening). When the tray is opened, “an image of activity” triggers an alert to the PillStation service center, where people are literally “watching what’s going on in those pill boxes,” explains Tegenu. “They know that the pills are still there [if the box hasn’t been opened]. I think it’s the missing link between medication adherence, where you get the prescription to the patients and we don’t know what happens after this. Now we can help them take the medication properly.”
About a year ago, PerformRx began working with SentiCare, which developed the technology and has since been acquired by RxAdvance, to ship PillStations to more than two dozen members who were taking at least 15 prescription medications. Patients who were identified for the pilot were given the opportunity to opt out and “a few” indicated that they were not interested, he says. If the service desk observed noncompliance, it notified PerformRx, whose pharmacists would follow up with the members’ physicians while SentiCare nurse case managers would reach out to patients. “That coordination makes a difference and works really well,” stresses Tegenu. At the same time, the box is Bluetooth-enabled so that if patients have a question about their medication they can press a button and be connected to the service center, he adds.
The results were impressive enough for the PBM to expand that pilot this year to more than 100 patients. All patients who used the tool demonstrated improved compliance and there was an overall reduction in health care costs, says Tegenu. And at the end of the year, many participants were ultimately disappointed that their boxes were going away. Many of the “polypharmacy” users targeted in the initial pilot had diabetes or congestive heart failure, but the pilots are not limited to those conditions, he clarifies. Plan sponsors pick up the cost of the boxes, which run about $800 per member per year, he adds.
If results from the new pilot show a significant reduction in health care costs and improvement in quality, PerformRx will consider incorporating the tool into its Drug Therapy Management program.
(2) TMED Hepatitis C Management Program. PerformRx has also partnered with TMED to put 3G-enabled tablet computers in the hands of newly diagnosed hepatitis C patients on triple therapy to help them monitor their condition by responding to a daily health survey. Through a simple application on the tablet, patients can enter information such as when they take their medications and what side effects they’re experiencing, and PerformRx is able to run reports to view patient responses and quickly identify those who show “early warning signs to proactively address problems before they become emergencies.” The company can also set up medication reminders for patients to view on the tablets. “Eventually our goal is for people to load an application into their smartphones” that would allow PerformRx to collect this information, explains Tegenu.
Adherence rates to the Response Guided Therapy protocols for members included in the program will be compared to similar hepatitis C members not included in the program. An increase of 5% or more in patients achieving optimal adherence will be considered successful, while secondary outcomes include 10% of patients remaining on triple therapy until sustained virologic response is achieved, and overall referral to case management and/or health care professional for coordination of care. The first year of this initiative will cost approximately $1,200 per member, but avoiding medical costs associated with treatment failures for hep C far outweigh those estimated costs, he says.
(3) Memotext. The third initiative PerformRx is employing to “ultimately change medication-taking behavior” targets members diagnosed with asthma. Members subscribed to the service will receive text-message reminders, personalized messages and questionnaires. Through that program, the PBM has the ability to gather information about patients’ attitudes toward health and potential barriers to following their medication regimen fully through responses sent via text. This model allows PerformRx to tailor its outreach methods in real time — based on current patient data — to meet specific patient needs, and increases the likelihood that the intervention will succeed in improving health-related outcomes, maintains Tegenu. The PBM expects to achieve a 299% ROI through the use of this technology.
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