New Alignments in Data-Driven Care Coordination & Access for Specialty Products: Insights from the DIMENSIONS Report
Our Objectives By the end of the session, participants will understand: Evolving demands to define value for specialty products and the role of population health Opportunities for specialty pharmacies to deliver enhanced services to measure patient outcomes Platforms, tools, and insights from data-driven care coordination for specialty products
The Public Dialogue Around Drug Pricing Has Intensified 600 News Coverage Over Last 10 Years Number of News Articles 500 400 300 200 100 2006: Medicare Part D enacted 2009: Affordable Care Act Signed into Law 2013: Sovaldi Approved by FDA 2015: Increase in inquiries by elected officials, presidential candidates, academics, and physicians into cost of drugs Coverage Gap 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Drug Prices Transparency Medicare Negotiation To conduct our review of media coverage over the last 10 years, we used the paid news archive service Factiva.com. Review includes print (newspaper), online (online newspapers and blogs), and broadcast* (affiliate and cable) and excludes paid subscription-based trades, press releases, duplicate news stories (e.g., wire pickups or reruns on broadcast news).
Manufacturers Seek to Collect Data to Define Value Stories for Diverse Stakeholders Manufacturers traditionally focused on generating evidence for FDA approval but interest is growing to include real-world and health economics data Payers Clinical outcomes Safety Cost and value Access Manufacturers HTA Clinical outcomes Risk/benefits Cost and value PAC/SNF Hospital C-suite Patient Physician Guideline Developers
Evolution Toward Patient Engagement Outcomes Product support programs that integrate specialty pharmacy must continue to evolve in order to incorporate new patient engagement opportunities such as outcomes measurement Distribution and Hot-lines to Integrated Full Service Patient Experience Centers Call Center Product Information PAP Access Support Ancillary Services Data Aggregation REMS Support Robust Engagement Platforms Strategic Distribution Outcomes Measurement Specialty pharmacies, manufacturers, payers need to better coordinate overlapping efforts for patient engagement and outcomes data
SPPs Are At the Key Junction to Capture Data Insights and Drive Data Driven Interventions SPP Opportunity for Robust Data Coordination and Analytics Customer Care In-Take Patient Education Program Enrollment Product Coordination Pharmacies dispense Rx Product Administration Reimbursement Support Coverage Authorizations Cost Share
Payers See Value of Expanding Role of SPP Channel Payer Rationale for Using SPPs Better Data on Drug Utilization Cost Savings Improve Drug Adherence Improve Quality Oversight and Management Reduce Physician Acquisition Incentives 77% of payers favor distribution through an SPP 1. DIMENSIONS Specialty Management Solutions. Issue Brief: Specialty Pharmacy Provider (SPP) Channel Management. December 2014. 2. DIMENSIONS 2015 Survey: Specialty Pharmacy Channel Management (Payers).
A Variety of Stakeholders Drive Specialty Models That Integrate Specialty Care and Data Payer Formulary Management Prior Authorization (PA)/Appeals Specialty Pharmacy Mandates Pharma Manufactures and Markets Products Product Advocacy Limited Distribution Administration Training In Constant Pursuit of Opportunities to Decrease Abandonment and Improve Adherence Meaningful Data Patient/Caregiver Core Business Driver and Should ALWAYS Be First Priority Diagnosed With Chronic Illness and Prescribed a Costly Biologic Little to No Understanding of Access May Need Financial Assistance Abandonment and Adherence Issues Common With Specialty Medications Specialty Pharmacy Biologic Coordinator/ Insurance Coordinator Want Simplified Access Make Every Effort to Work With Cross-Stakeholders to Ensure Patient Receives Prescribed Biologic at the Lowest Cost Need Visibility of Referral Tracking Through Benefits Verification, PA & Appeals, and Beyond Prescriber Value Ease of Prescribing Desire Reduced Office Administration Burden Anticipate and Assume Patient Compliance to Prescribed Biologic 8
Case Study: Avella Deploys Mobile Applications to Improve HIV Patient Adherence 3x More likely to remain on therapy Percent Improvement 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% HIV Patients Achieving Viral Suppression Avella HIV Mobile Patients Avella HIV Non- Mobile Patients US HIV Population
Clinical and Claims Data Are Crucial To Manage Population Health for Specialty Products Specialty pharmacy can play an important role for a more complete view of patients and help bridge physician and payer interventions CARE DELIVERY PROCESSES AND PATIENT PERCEPTION Patient demographics Medical history, medications Problem list Diagnoses, lab tests Procedures, providers Specialty Pharmacy READILY AVAILABLE, HIGHLY STRUCTURED ACROSS FULL CARE CONTINUUM Mortality rates Complications Access to health services Length of stay Charges for care provided CLINICAL DATA CLAIMS DATA 1. Health Catalyst. Whitepaper: Why Population Health Management Strategies Need Both Clinical and Claims Data. 2014. Available at: https://www.healthcatalyst.com/wp-content/uploads/2014/11/clinical-claims-2014-10-18a.pdf Accessed March 22, 2016
SPPs Can Expand their Role in Providing Actionable Insights Payer Data SPECIALTY PHARMACY SERVICES Manufacturer Access Services Data Health Economics Claims Analysis Predictive/Simulation Modeling Actuarial Analysis Public Policy Analyses Clinical Program Evaluation
New Platforms Can Drive Specialty Care Coordination Through Population Health Data PAYER & ACO ENVIRONMENTS VARIOUS DATA SOURCES BIG DATA ANALYTICS COMMUNICATION PLATFORMS RETAIL-BASED CLINICS MORE 2 REGISTRY DESIGN, RESEARCH & PROPRIETARY FUNCTIONALITY PATIENTS & PROVIDERS INTERFACE RESEARCH, PHARMA & LIFE SCIENCES
Case Study: epass helps Walgreens Access Patients with Analytically-Driven Decision Support Administrative Claims PATIENTS & PROVIDERS INTERFACE epass - web-based decision support for face-to-face assessments and supplemental encounters in the office, pharmacy, clinics and patient home Supplemental Datasets (e.g. abstracted medical records) Medication Prescription And Adherence History Diagnostic Results Provider Encounter History epass: Electronic Patient Assessment Solution Suite
Data Capabilities are Evolving Quickly to Create Differentiated Engagement Opportunities for Specialty Care Coordination OUTCOMES BASED CONTRACTS Payers and ACO Environments INNOVATE CLINICAL TOOLS AND PATHWAYS SPECIALTY PHARMACY PROVIDERS IDENTIFY PATIENTS FOR CLINICAL RESEARCH Patients and Providers IMPROVE ADHERENCE AND COMPLIANCE COMMUNICATE PATIENT-SPECIFIC VALUE PROPOSITION Life Sciences Expanding the role of specialty pharmacy providers can bridge care transitions and various stakeholder perspectives
Call to Action Fully understand the evolving definition of value and how value based payment models work in order to identify opportunities in population health management Seek opportunities to provide additional data-driven services that measure patient outcomes and improve specialty care coordination Engage with advanced data analytics and technology platforms to enhance analytically driven patient engagement strategies Questions? To receive the latest DIMENSIONS materials or speak to your local Janssen Representative, visit booth XXX.