Featured Health Business Daily Story, Sept. 2, 2014
Reprinted from DRUG BENEFIT NEWS, biweekly news and proven cost management strategies for health plans, PBMs, pharma companies and employers.
When it comes to targeting patients for medication adherence interventions, many health plans continue to rely on pharmacy claim “triggers” such as a prescription not being picked up and retrospective adherence measures such as a medication possession ratio below 80% for a certain period of time. But only 7% of plans recently surveyed by AllazoHealth are using the newer method of predictive analytics to prioritize patients at risk of not taking their medications. Nevertheless, 60% of respondents said they are planning to use predictive analytics in the future.
“There’s different scopes of how much predictive analytics companies are using and what you can do in the space, but the main pieces of it are predicting ahead of time who won’t be adherent to their medications so that you can intervene on those patients proactively, and predicting how patients will respond to different types of interventions,” AllazoHealth CEO Clifford Jones tells DBN. “And these three different broad categories are not mutually exclusive; programs will often combine different versions so you can do trigger-based approaches and then do the outreaches based on the predictive analytics in combination with the trigger.”
To conduct its research, the firm interviewed 30 health plans, including 19 small plans with fewer than 200,000 members and 11 large plans with 200,000 lives or more. Interviews were conducted via telephone over a 10-week period in spring 2014.
“While there’s been a lot of research on medication adherence and different intervention programs…there hasn’t really been a very comprehensive, wide-ranging survey going over the breadth of actual interventions and targeting methods that are used across the industry and how they’re dispersed across different types of organizations,” explains Jones of why the firm conducted the survey. The New York-based health care analytics firm provides medication adherence solutions to PBMs, health insurers, accountable care organizations and providers.
While survey respondents reported applying medication adherence programs to a wide range of disease states, the most common areas targeted for intervention were cardiovascular disease states (see chart, below). But 65% of plans said they may expand their adherence programs to more disease states, and would most likely extend adherence interventions to asthma and chronic obstructive pulmonary disease patients.
How plans are conducting interventions varies, but most use a combination of intervention types and intervention channels, finds AllazoHealth. The four common intervention channels are phone-based outreach, direct mail, provider-centric methods and face-to-face visits.
While 90% of all plans surveyed rely on some type of phone-based system, 67% report using live call interventions but only 7% say they use text messages to remind patients to refill or pick up their medications. Jones suggests that low adoption of text message reminders isn’t surprising because they come with certain challenges, such as the difficulty of getting patients to opt in to receive the messages and not being able to include protected health information in the texts because they’re not secure messages. One way companies have tried to get around that is by launching mobile-based applications, but Jones says so few companies surveyed use such apps that they were not included in the survey report.
The majority of organizations (77%) rely heavily on direct mail campaigns (e.g., letters, brochures and newsletters), but those present challenges when reaching patients of a low socioeconomic group and a low level of medical education, observes the company. Specifically, 82% of large plans said they use direct mail, compared to 74% of smaller organizations. The survey also broke out large and small plans’ use of provider-centric channels, and found that 68% of small organizations engage physicians and non-physicians to deliver interventions to patients, while 82% of large plans rely on provider-centric interventions. Overall, 73% of survey respondents use providers to perform adherence interventions.
For face-to-face interventions (which 50% of all respondents said they use), most plans indicated a preference for in-person pharmacy visits because it allows pharmacies to follow patients and receive reports on their adherence that they can then send to their PBMs, adds the company.
Meanwhile, the survey shows that most use some combination of in-house and outsourced interventions, while 33% handle all aspects of their intervention program and only 7% have an intervention program that is completely performed by contracted pharmacies, PBMs or medication adherence vendors.
The survey also asked plans how they rate the effectiveness of their medication adherence program, and found that most (67%) view it as “moderately effective.” Jones asserts that by using only trigger-based targeting or retrospective analyses to identify patients in need of intervention, plans aren’t getting much bang for their buck. “If they’re not doing something predictive, it’s just ineffective in the way that they’re targeting patients to receive interventions. So they end up spending a substantial amount of money on interventions and they don’t really maximize the impact that they could have, even with their current set of interventions,” he contends.
How AllazoHealth conducts predictive analytics on behalf of clients is by collecting pharmacy claims data and demographic information from the plan, as well as any available data on what interventions those patients are already receiving (which the company also tracks as the interventions are delivered). AllazoHealth then uses that information to predict each patient’s adherence to each of their medications — “which enables our clients to proactively intervene with those patients before they stop taking their medication, because at that point it’s much harder to change that behavior and get that patient to restart their medication,” explains Jones.
AllazoHealth also predicts how patients will respond to the different types of interventions so that the client can better target patients with the interventions that are most likely to have an impact. “So our clients send us data, we do all our analytics and we provide that intervention targeting and patient prioritization back to them, along with our predictions, which they then act on,” says Jones. He adds that the AllazoHealth system is a “continually learning system,” so as each intervention is performed and fed back to the system, AllazoHealth and its clients can use that information to continue to improve the effectiveness of the medication adherence program. This type of “feedback loop” is especially helpful when plans incorporate new intervention techniques and tools into their adherence programs, he says.
View the study report at http://allazohealth.com/mco-adherence-study.
SOURCE: A Comprehensive Survey of Managed Care Organization (MCO) Medication Adherence Programs – Part 1, AllazoHealth, August 2014. View the full report at http://allazohealth.com/mco-adherence-study.
For valuable insight and expert analysis on pharmacy benefit management trends, check out Drug Benefit Trends and Strategies, available at the AIS MarketPlace. Available as a printed book and a CD version, this well-organized resource serves as an “Executive Summary” of pharmacy benefits corporate activity with details of financial results, leadership changes, enrollment statistics, and mergers and acquisitions activity and includes a directory of pharmacy benefit vendors.
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