Transcript Pharmacy Solutions Comprehensive Continuum In

Pharmacy Medication Adherence and
Condition Monitoring Program
Rx MedAL
Medication Adherence for Life
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To provide hospitals, patients, practitioners, payers, and
home health care professionals with products and
services with a proven process to reduce health care cost
and improve patient outcomes through condition
monitoring and medication adherence in chronic disease.
Congestive Heart Failure
 Diabetes Mellitus
 Hypertension
 Chronic Obstructive Pulmonary Disease (COPD)
 Chronic Autoimmune Disorders (e.g. multiple
sclerosis)

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Prevalence in the United
States
Annual Cost ($345 Billion)
1.76%
$39
10.70%
$78
$218
28.60%
Diabetes
Diabetes
Hypertension
Hypertension
Congestive Heart Failure
Congestive Heart Failure
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ADHERENCE FACTS:
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The #1 problem in treating illness today is
patients' failure to take prescription medications
correctly, regardless of patient age.
32 million Americans are taking three or more
medications daily.
Approximately 125,000 deaths occur annually in
the United States because of non-adherence with
cardiovascular medications.
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The Evidence:
 Medication Adherence Rates are Low
 Averaging only 50 – 65%
The Result:
 Symptoms and Complications Worsen
 Utilization of Inpatient Medical Services Increases
 Total Health Care Costs Increase
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*US patients take less of their medication than is prescribed.
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A 2009 study1 found that the cost of drug-related
morbidity, including poor adherence (not taking
medication as prescribed by doctors) and
suboptimal prescribing, drug administration, and
diagnosis, is estimated to be as much as $289
billion annually, about 13% of total health care
expenditures.
1New
England Healthcare Institute, Thinking Outside the Pillbox:
A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease (August 2009)
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The barriers to medication adherence are many:
 Cost
 Side effects
 Difficulty of managing multiple prescriptions
 Patients’ acceptance and/or understanding of their
disease, forgetfulness, cultural and belief systems
 Imperfect drug regimens
 Patients’ ability to navigate the health care system
 Cognitive impairments, and
 Reduced sense of urgency due to asymptomatic
conditions.
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Adherence Management System:
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Patient in-home biometrics are saved to a database, with
alerts and messages possible.
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Biometric data can be transmitted to the patient, doctor or
other locations with ease.
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Medications are reviewed and evaluated for fulfillment and
adherence with prescribed regimens.
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Motivational Interviewing principles are applied:
 Adherence intent is assessed and monitoring plans developed to
achieve desired outcomes.
 Patient feedback and adherence coaching is provided as appropriate.
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A secure online database collects relevant data and gives clinicians
the ability to assess patient adherence by monitoring the plan of care
for the patient.
Clinicians can access a condition scoring system, that provides a
basic snapshot of the patient’s overall adherence .
Biometric data and adherence scores provide clinicians with an
evaluation tool and a basis for motivational interviewing and
intervention.
The web portal may be used to review patient care notes, biometric
data, historical trends to assist in making adherence assessments.
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A condition scoring system has been developed for three major disease
states and is adaptable to other chronic conditions:
1.
2.
3.
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The condition scoring system is an indicator of adherence and is used to
target areas of concerns and for improvement within each disease state.
o
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Congestive Heart Failure
Diabetes Mellitus
Hypertension
Numerical scoring based on the familiar 1-100 grading system. This
system is easily recognized and understood.
Motivational interviewing techniques are applied to improve scores and
outcomes.
o
Increasing adherence scores are associated with increased cost
savings and reduced hospitalization risk.
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The unique adherence scoring system is calculated based
upon individual biometric data, patient responses, and
medication history.
Each patient receives an individualized adherence plan
targeted to achieve persistence and optimal outcomes.
These scores can be used to trend adherence over time
for each patient and trend adherence over time for
patient populations.
These trends are also compared against baselines and
goals associated with optimal outcomes.
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As adherence scores increase health care costs and hospitalization
risk decrease1
Michael C. Sokol, MD, MS, Kimberly A. McGuigan, PhD, Robert R. Verbrugge, PhD,and Robert S. Epstein, MD, MS,
1
Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost, Medical Care • Volume 43, Number 6, June 2005
Annual Healthcare Cost/Patient by
Adherence Score
$16,498
44%
$11,484
36%
30%
Diabetes
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40-59
20-39
0-19
80-100
60-79
40-59
20-39
$8,887
Hypertension
27%
80-100
39%
60-79
$13,077 $12,978
0-19
$18,000
$16,000
$14,000
$12,000
$10,000
$8,000
$6,000
$4,000
$2,000
$0
Hospitalization Risk by Adherence
Score
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In another study1 hospital re-admission rates for
congestive heart failure patients dropped 57 percent
through the use of wireless technology to monitor their
weight and blood pressure.
1MemorialCare
Health System, Laguna Hills, CA,, A Study of Rehospitalization Rates for Congestive Heart Failure Patinents Receiving Remoted Patient
Monitoring Technology, May, 2009.
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 Glucometer
 Heart Rate and Blood pressure cuff
 Weight Scale
 Pulse Oximeter
 Fully integrated patient information systems and
medication databases
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Patient takes realtime information
using blue tooth
devices
Data is
transmitted to
the secure
online database
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Feedback to
patient, physician,
case manager,
caregiver
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Phase I – Patient Enrollment:
Identification of patients with specific disease (e.g. Diabetes, CHF, hypertension) and
program assignment. Identification from Pharmacy Data Provided or Post Discharge
Information. IVR or Call Center Calls for Enrollment and Initial Coaching and
Compliance Assessment.
Phase II – Ongoing Patient Monitoring:
Patient data and compliance scores are monitored according to the individual adherence
plan assigned to the patient. Alerts, messages, and questionnaires are used to facilitate
communication and direct appropriate actions or interventions. Based on the alert
system, direct intervention is triggered by a adherence coach for further assessment and
escalation as appropriate.
Phase III – Feedback and Reinforcement:
On a monthly basis, patients receive feedback and motivational interviewing based on
the results of their adherence scores. Adherence Intent and motivational interviewing is
used to recognize, reinforce, problem solve, and educate.
Phase IV – Monthly Results Reporting:
Adherence scores are tracked, trended, and reported. Hospitalization rates, home health
visits, and other metrics are tracked.
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Adherence Assessment
 Customer Value
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Motivational Interviewing
 Optimal Patient Outcomes
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Condition Monitoring
 Reduced Health Care Costs
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Improved Adherence
 Return on Investment
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Expected Adherence based on Program Results
 Claims cost data
 Hospital Admission/Re-admission Rates
 Objective data and statistical reporting
 Retention Rates
 Program Evaluation and Patient Satisfaction
 Documented Cost Savings through Improved Adherence
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Transition, Implementation, and Ongoing Monitoring
 Admission and Data Interchange
 Equipment Set-Up and Validation
 Initial Adherence Coaching
 Ongoing monitoring and intervention
 Program Cost offset through Cost Savings
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Customer Value
Improved Adherence
Optimal Clinical Outcomes
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} = ROI
Care Planning and Real Time Monitoring
Patient Coaching and Motivational Interviewing
Medication Adherence
Condition Monitoring
Reduced Costs from Improved Adherence and Outcomes
Reduced Hospital Readmissions
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There are approximately 5.3 million people suffering from
congestive heart failure (CHF) in the United States.
The lifetime risk of developing heart failure at the age of 40 is
20%
Approximately 380,000 people above the age of 65 will be
diagnosed with CHF annually
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A great cause for concern has been the increasing number of
patients being hospitalized with CHF.
The number of patients with CHF discharged from the hospital
rose from 400,000 in 1979 to over 1 million in 2005.
Within 4-6 months after discharge 47% of the patients are
likely to be readmitted.
The five year mortality rate for patients with CHF was 48%
from 1996-2000.
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The estimated total of direct and indirect cost of heart failure
in the United States for 2008 is $34.8 billion with the greatest
share being hospitalizations.
In the commercially insured, Medicare and Medicaid
populations, the single largest health expenditure is inpatient
utilization (nearly 33% in 2005) with 13.3% of all emergency
department visits associated with a hospital admission.
The average cost associated with a CHF hospitalization is
$10,000.
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The estimated total of direct and indirect cost of heart failure
in the United States for 2008 is $34.8 billion with the greatest
share being hospitalizations.
In the commercially insured, Medicare and Medicaid
populations, the single largest health expenditure is inpatient
utilization (nearly 33% in 2005) with 13.3% of all emergency
department visits associated with a hospital admission.
The average cost associated with a CHF hospitalization is
$10,000.
Approximately 14% of Medicare beneficiaries have heart
failure, they account for 43% of Medicare spending
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Reduction in Re-Hospitalizations1
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Program Cost
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Over a three month period realize up to a 57% decline in hospital readmissions, or a 27% hospital admission rate for CHF.
$750 per patient, initial three months.
$150,000 per 200 patients.
Cost savings
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Over a three month period, pre-program admission costs are $1,260,000
per 200 patients.
After enrollment in the program, the cost for total admissions is
$540,000 per 200 patients
Resulting in cost savings of $636,000.
1MemorialCare
Health System, Laguna Hills, CA,, A Study of Rehospitalization Rates for Congestive Heart Failure Patinents Receiving Remoted Patient
Monitoring Technology, May, 2009.
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Putting ROI into Context
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Program Savings/Program Cost
 ($636,000/$150,000)
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$4.24 for every $1 invested
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Complete Continuum of Care
Patient
Assessment
and Training
Condition
Monitoring
Motivational
Interviewing
and
Adherence
Coaching
Optimal
Patient
Outcomes
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Reduced
Health Care
Costs
Return on
Investment
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Next Steps ?
Meeting to discuss and refine the demonstration project proposal
in terms of:
Final study design and methodology
Presentation to Senior Management Teams
Identify and allocate resources
Develop business plan and proformas
Establish organization and work flows
Training and implementation
Patient selection
Program monitoring
Results reporting
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