MemberChoice FORMULARY MANAGEMENT MEDICATION THERAPY MANAGEMENT (MTM) SPECIALTY DRUG MANAGEMENT MEDICATION THERAPY MANAGEMENT Medication Therapy Management 1
$ 290 Billion Wasted in avoidable costs due to medication related problems. $105.4 Billion is attributed to adherence issues Avoidable Costs in U.S. Healthcare: The $200 Billion Opportunity from Using Medicines More Responsibly. Report by the IMS Institute for Healthcare Informatics 2
Estimated Avoidable Healthcare Costs by Medication Related Problems (US$Bn, 2012) Mismanaged polypharmacy in the elderly 1.3 Suboptimal generics use 11.9 Medication errors 20 Antibiotic misuse 35.1 Delayed evidence-based treatment practice 39.5 Nonadherence 105.4 0 20 40 60 80 100 120 Control healthcare costs for your company Pharmacy costs are expected to rise exponentially over the next 3-5 years. Avoidable costs for other services such as acute care and emergency room care can be attributed to non-adherence to medications, gaps in standards of care and medication safety issues for members with chronic conditions. Companies need new and innovative approaches to pharmacy risk management. RxResults can deliver these products. Ways that medication-related problems lead to an increase in healthcare cost More frequent use of the Emergency Room Increased inpatient visits Declining health status Increased pharmacy spending due to duplicate therapies Increased physician visits at the higher cost and intensity of service (rather than preventive/wellness visits) Medication Therapy Management 3
50 % of people taking a chronic medication stop taking it in the first year, with the biggest drop-off occurring in the first month. Insights: Advancing the science of pharmacy care. Fall 2014 Adherence; Why it s so hard and what we can do about it. CVS Health The Cost of Non-Adherence to Medications Avoidable Costs (US$Bn) due to Non-Adherence by Condition Avoidable Costs (US$Bn) due to Non-Adherence by Care Setting 45 80 40 35 30 25 20 15 10 44 24.6 18.6 18.3 70 60 50 40 30 20 73 23.2 5 0 High Cholesterol Diabetes Hypertension Other Chronic Conditions 10 0 5.1 4.8 Hospital Outpatient Pharmacy Emergency Department Your health plan could be paying for inpatient hospital visits, emergency room visits and other medical services that could have been avoided if your members were taking their medications correctly. Most non-adherence situations may be corrected with Medication Therapy Management (MTM) by educating members on the importance of being adherent and how medication non-adherence may have a negative effect on the state of chronic conditions. The RxResults MTM program is designed to address these costs and solve these problems. 4 Avoidable Costs in U.S. Healthcare: The $200 Billion Opportunity from Using Medicines More Responsibly. Report by the IMS Institute for Healthcare Informatics
MEDICATION THERAPY MANAGEMENT RxResults utilizes pharmacists to meet with members, either face-to-face or by phone to identify, prevent & solve medication-related problems. Benefits of MTM Members are healthier and are able to control chronic conditions more successfully Members have fewer visits to the emergency room and may not be hospitalized as frequently Increased member satisfaction & higher employee retention More productive employees Overall reduction in healthcare cost The MTM product offers personalized medication reviews for members that need it most; those with the following chronic conditions: Diabetes, Asthma, COPD, Hypertension, High Cholesterol, Depression and Congestive Heart Failure. Members are invited to review their current medication regimen with their local pharmacist in person, or to speak with an RxResults pharmacist via telephone. Pharmacists review the medication regimen to identify: Medication safety issues such as duplication of medications and undesirable side effects, and adverse drug events due to drug, age or disease interactions Non-adherence to medications Inappropriate medication dosages Gaps in standards of care The member s possible lack of knowledge of the medication regimen and/or condition Resolving these issues could include removing medications from the member s regimen or simply helping the member understand why the medication is prescribed and how best to take the medication. Follow-up appointments may be scheduled to review the progress of the agreed upon action plan and address any new medication issues. This service provides your high cost members with the support they need to remain adherent and resolve other medication related problems. This in turn may reduce medical spending by avoiding high cost emergency and/or hospital inpatient visits. The RxResults Proprietary Analytics Platform uses pharmacy claims to identify members that will benefit from MTM services. The number of chronic conditions a member has, and the number of medications the member takes regularly, are used as factors in the analysis. In addition to these factors, Medication Non-Adherence, Care Gaps and Safety alerts are also used. Adherence gaps are identified using pharmacy claims to calculate the number of days a member was without medication during a specified period of time based on the members prescription fill history. Safety alerts identify members that have filled prescriptions that appear to be inappropriate based on the members age, gender or drugs that may interfere or cause adverse reactions when combined with other medications. Gaps in Standards of Care are used to identify members who may be missing standard therapies that are used to treat their conditions. For example, patients with diabetes who may not be taking medication for high cholesterol. Medication Therapy Management 5
Product Features 10 Million avoidable hospital admissions due to inappropriate use of medications resulted in $140 Billion Wasted Progress is Measured Identify Members for MTM Pharmacist Contacts Member Gaps in Avoidable Costs in U.S. Healthcare: The $200 Billion Opportunity from Using Medicines More Responsibly. Report by the IMS Institute for Healthcare Informatics Pharmacist Follows Up As Needed Pharmacist and Member Create Plan It has been estimated that more than 1 in 5 prescriptions written are never filled. Using various clinical rules, members are identified for participation. RxResults accesses a network of local pharmacists across the country. The best results and outcomes from MTM programs are seen when the member and the pharmacist work together in person. Building a relationship with the local pharmacist will help the member maintain the achieved results in the future. Progress is measured quarterly and shared with the plan sponsor. Reporting shows easy to read graphical representations of results. Savings from the program are calculated once per year. This savings is determined by analysis of pharmacy and medical claims for the 12 month period prior to the start of the MTM program and 12 months after, for each participating member. Trouble Getting Started: Predictors of Primary Medication Nonadherence. American Journal of Medicine 2011 November; 124(11): 1081.e9-1081.e22 6
Testimonial George is 65 and suffers from Diabetes, COPD and hypertension. Bill is George s local Pharmacist. SPRING George does not take his medication regularly 1 Emergency Room Visit for high blood sugar 2 days of missed work due to high blood sugar SUMMER George does not take his medication regularly 1 Emergency Room Visit for difficulty breathing 2 days of missed work due to high blood sugar FALL George rarely takes his medication 1 Emergency Room Visit for difficulty breathing 3 days of missed work due to high blood sugar WINTER George rarely takes his medication 3 day hospital visit due to high blood pressure 4 days of missed work due to high blood sugar RESULTS George without MTM 11 days of missed work 3 Emergency Room Visits, 1 Hospital Visit Low Medication Adherence 2 Hypertension Medications SPRING George meets with Bill to review medications because he does not take them regularly Bill recommends a pre-filled insulin pen because George does not like needles Bill teaches George how to use his inhaler properly SUMMER Bill meets with George again because he still does not take his medicine regularly Bill spoke with George s physician & recommended 1 drug to replace 2 for hypertension George has no ER Visits or missed work days FALL George takes his medicine regularly, his blood sugar and hypertension are better controlled George is learning to eat healthier George has no ER Visits, and is breathing easier because he uses his inhaler regularly 2 missed work days Bill counseled George on eating healthier to control his blood sugar WINTER George takes his medicine regularly George is eating healthier and has lost a little weight No ER Visits, no missed work days RESULTS George with MTM 2 missed work days due to his conditions No Emergency Room Visits, No Hospital Visit High Medication Adherence 1 Hypertension Medication $ Not only does George feel better, his medical costs are now far less than they were last year! 9 fewer days of missed work due to illness Higher Productivity 3 Saved Visits to the ER $2,700 No Hospital Visits $20,000 High Medication Adherence Costing $750 Reduction in Pharmacy Costs Medication Therapy Savings Management $2,400 ($200/month) Total Savings: $24,350 7
8 320 Executive Court, Suite 201 Little Rock, AR 72205 www.rxresults.com 501.367.8402