Ian Duncan: Predictive risk in a US pharmacy
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Ian Duncan: Predictive risk in a US pharmacy Ian Duncan: Predictive risk in a US pharmacy Presentation Transcript

  • Proprietary & Confidential, Property of Walgreen Co. July 8, 2013 Predictive Risk in a U.S. Pharmacy
  • Proprietary & Confidential, Property of Walgreen Co. ©20132 Introductions Author of several books and peer-reviewed studies in healthcare management and predictive modeling. Published 2008 (*new ed. October 2013) May 2011 Ian Duncan FSA FIA FCIA MAAA. Vice President, Clinical Outcomes, Analytics Reporting; Head of Clinical Research, Walgreen Co. Chicago. Adjunct Professor at UC Santa Barbara and Adjunct Research Professor, Georgetown Dept. of Health Administration. Board member, Massachusetts Health Insurance Connector Authority (Exchange).
  • Proprietary & Confidential, Property of Walgreen Co. ©20133 Begin with a New Strategic Vision . . . . Begin with a New Strategic Vision . . . . Purpose Help people get, stay and live well. Brand Mantra Well at Walgreens: happy and healthy made easy. Vision To be the first choice in health and daily living for everyone in America… and beyond. Mission In communities across America, be the trusted advisor and convenient multichannel provider of innovative pharmacy, health and wellness solutions, consumer goods and services. A destination where health and happiness come together to help people get well, stay well and live well.
  • Proprietary & Confidential, Property of Walgreen Co. ©20134 . . and transition beyond the corner drugstore to be One Destination for Wellness Immunizations s Workplace Health Centers & Pharmacies s Health Testing s Community Pharmacy s Take Care ClinicsSM s Adherence Programs; Wellness Initiatives Specialty Pharmacy & Infusion Services Health Systems Solutions: Outpatient Pharmcies and WellTransitions Home Infusion Mail & Mobile Pharmacy s
  • Proprietary & Confidential, Property of Walgreen Co. ©20135 Walgreens Core Strategies Deliver the Well Experience Transform the customer experience across all touch points, channels and formats Transform the Role of Community Pharmacy Offer unparalleled access to innovative, high quality, affordable health and wellness services within our communities Create an efficient global platform Become the first global pharmacy-led health and wellbeing enterprise
  • Proprietary & Confidential, Property of Walgreen Co. ©20136 Global Leadership – Walgreens and Alliance Boots  Largest global pharmacy solutions provider  Largest global purchaser of prescription drugs  Over 1 billion prescriptions filled annually  $53 billion in branded pharmaceutical purchases  370 pharmaceutical wholesale distribution centers worldwide  12,000 points of care located in more than 25 countries  More than 8000 of the best corners in America  More than 300,000 healthcare professionals  8 million in-store customer visits daily  More than 1.5 million online customer visits daily
  • •Boots international countries: UK, ROI, Thailand, Netherlands, Middle East, Sweden, Norway •Alphega: UK, France, Italy, Spain, Czech republic, Germany, Netherlands, Russia •Wholesale countries: France, UK, Turkey, Spain, Germany, Russia, The Netherlands, Czech Republic, Norway, Egypt, Lithuania, •Romania, Algeria, Croatia, Bosnia, Serbia, Slovenia, China, Italy, Portugal, Switzerland •Alliance Boots Retail Take Care Clinics Take Care Worksites Health Systems Pharmacy Mail Home Infusion/RT Specialty Unequalled Global Presence Walgreens ©2013 Walgreen Co. All rights reserved. 7
  • Proprietary & Confidential, Property of Walgreen Co. Predictive Modeling Applications in the Pharmacy Space
  • Proprietary & Confidential, Property of Walgreen Co. ©20139 Begin with a New Strategic Vision . . . . Three Predictive Modeling Examples 1. Targeting non-adherent customers 2. Stratifying End-of-Life Patients in our Accountable Care Organizations 3. Identifying Medicare and Health Insurance Exchange patients for wellness visits and Risk Assessments
  • Race Composition Ave. Household Income Unemployment Rate % White Collar Workers % Houses Vacant % Houses Owned Patient Level Age Gender Enabling Factors Patient Level Inferred Disease Severity Comorbidities Monthly Rx Costs Medication Adherence Community (Block Group Level) Predisposing Factor Patient Reported Knowledge of Disease Knowledge of Drug Health Beliefs Block Group Level Marital Status Ethnicity Education Occupation Patient Level Co-pay Plan Type Drug Regimen Block Group Level Average Income Unemployment Rate Need Factors Patient Reported Illness Perception Beliefs in Meds Lack of symptoms Patient Level Medication Complexity # medications # prescribers Patient Past Behavior Drug Profile Side Effects Dosage Frequency Patient Level Prior Proportion of Days Covered Late Refills Generic Drug Utilizations % Transient Population % Seasonal Population % Bachelor Degree & Above Ave. Vehicles/Household Accessibility of Pharmacy Population Growth Indicator A Conceptual Model of Medication Adherence
  • Proprietary & Confidential, Property of Walgreen Co. ©2013 Actual PDC and Non-Adherence Rate in 6 & 12 Month Periods from the Index Fill – New to Therapy 63.93% 72.55% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% 6 Month % Non- Adherence 12 Month % Non- Adherence 0.58 0.48 0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00 6 Month PDC 12 Month PDC 11 Actual PDC Non-Adherence Rate
  • Proprietary & Confidential, Property of Walgreen Co. ©2013 100.0% 99.7% 98.5% 95.3% 89.3% 79.6% 65.9% 43.7% 16.1% 1.4% 64.0% 64.1% 64.6% 65.6% 67.6% 70.6% 74.5% 80.5% 86.0% 92.3% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% >=0% >=10% >=20% >=30% >=40% >=50% >=60% >=70% >=80% >=90% %ofTotalPatients Predicted Risk % of Total Patients Positive Predictive Value (PPV) 12 Positive Predictive Value and % of Total Patients by Cumulative Predicted Risk
  • Proprietary & Confidential, Property of Walgreen Co. ©2013 13 Overview – ACO Clinical Programs (1) Prevent over-medicalized End-Of-Life (EOL) care. (2) Prevent unplanned Transitions in care. (3) Prevent Ambulatory-Care-Sensitive (ACS) hospitalizations.* (4) Improve decision-making for Preference- Sensitive Treatments * especially for patients with a combination of acute + chronic + mental health issues. Key Point: High Opportunity ≠ High Cost or High Risk Score. High cost and/or highly intervenable patients
  • Proprietary & Confidential, Property of Walgreen Co. ©2013 Preventing over-medicalized End-Of-Life care ↑ Population health ↓ Administrative burden ↓ Per capita cost ↑ Patient experience Reduction in inappropriate life-sustaining treatments within 6 months of death, including a reduction in ER visits.2 Dedicated case managers to support physicians in caring for complex patients that are at very high risk of over- medicalized end-of-life care as defined by Barnato et al.2 Home- hospice care associated with significantly lower average costs ($12,434 versus $4,761 per year in 2007 dollars).5 Patients receiving in- home palliative care report significantly higher satisfaction and quality of life.6 Clinical Program: • Education for physicians and their staff on how to instigate end-of-life conversations.3 • Program to encourage patients to complete advance directives, consisting of materials, a helpline, and a registry.4 • Patient access to hospice and palliative care. • Symptom-focused case management for very high-risk patients.3 1 Zhang B, Wright AA, Huskamp HA, et al. Health care costs in the last week of life: associations with end-of-life conversations. Archives of Internal Medicine. 2009;169(5):480 2 Barnato AE, Farrell MH, Chang CC, Lave JR, Roberts MS, Angus DC. Development and validation of hospital "end-of-life" treatment intensity measures. Medical Care. 2009;47(10):1098-1105 3 Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008; 300(14):1665-73 4 Nicholas L, Langa KM, Iwashyna TJ, Weir DR. Regional variation in the association between advance directives and end-of-life Medicare expenditures. JAMA 2011; 306(13):1447-53 5Shnoor Y, Szlaifer M, Aoberman AS, Bentur N. The cost of home hospice care for terminal patients in Israel. Am J Hosp Palliat Care. 2007 Aug-Sep;24(4):284-90 6 Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, McIlwane J, Hillary K, Gonzalez J. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc. 2007 Jul;55(7):993-1000.
  • 15 End of Life Predictive Model – Performance of Model on Medicare 5% Database Out of a 10,000 attributed life group, we would expect 430 overmedicalized deaths (4.3%). Based on our model, approximately 46% of these members will have risk scores >.95. 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0% 0-10% 10-15% 16-20% 21-25% 26-30% 31-35% 36-40% 41-45% 46-50% 51-55% 56-60% 61-65% 66-70% 71-75% 76-80% 81-85% 86-90% 91-95% 96-100% % of Total OM Deaths % of Total OM Deaths
  • Proprietary & Confidential, Property of Walgreen Co. ©2013 What is a Medicare/Exchange Wellness Visit? Components Welcome to Medicare Preventive Visit Medicare Yearly Wellness Visit • Medical/Social History √ √ • Depression Screening √ √ • Mood Disorders Screening √ √ • Functional Ability Screening √ √ • Falls Risk Screening √ √ • Home Safety Screening √ √ • Physical Exam (height, weight, blood pressure, BMI, visual acuity, other factors as appropriate) √ √ • End-of-Life Planning √ • Education, Counseling and Referral √ √ • Written plan for appropriate screenings and other covered Part B preventive services √ √ 16 Walgreens unparalleled access to clinical (drug) data allows us to identify, stratify and outreach to patients for this (free) service.
  • Proprietary & Confidential, Property of Walgreen Co. ©2013 Improving 22 Stars/HEDIS Measures:  Functional Status  Advanced Directive  BMI Measurement  Adult Access to Preventive/Ambulatory Health Services  Flu Vaccine  Pneumo Vaccine TAKE CARE CLINIC MEDICARE WELLNESS VISIT ADDITIONAL BIOMETRICS  Breast Cancer Screening  Colorectal Cancer Screening  CV Care – Cholesterol Screening  Diabetes Care – Cholesterol Screening  Glaucoma Testing  Improving or Maintaining Physical Health  Improving or Maintaining Mental Health  Osteoporosis Testing  Diabetes Care – Cholesterol Controlled  Diabetes Care – Blood Sugar Controlled (HbA1C)*  Colorectal Cancer Screening – Fecal Occult Blood Test* Impact up to 6 Stars measures via services provided during the visit Impact up to 8 Stars measures via education provided during the visit Impact up to 5 Part B services via education provided during the visit  Diabetes Screening – Fasting Blood Glucose  Pap Tests and Pelvic Examination  Prostate Cancer Screening  HIV Screening of At-Risk Patients  U/S Screening for Abdominal Aortic Aneurysm Impact up to 3 Stars measures via additional biometric services 17
  • Proprietary & Confidential, Property of Walgreen Co. ©2013 Personalized Wellness Plan  Easy-to-understand wellness plan  Delivered face-to-face with a clear explanation of the findings and clear explanation of follow-up recommendations  Educates patients about potential gaps in care  8 Star measures  5 Part B services  Individualized approach that facilitates member adherence with recommended follow-up services 18
  • Proprietary & Confidential, Property of Walgreen Co. ©2013 Improving HCC Coding & Quality Measures Drive improvements in HCC coding and 6-14 Medicare Stars and HEDIS measures: INCREASED ACCESS/PARTICIPATION  Expand member access to convenient locations, open 7 days a week  Increase member awareness in high-traffic Walgreens retail locations and through marketing/communications support  Deliver care guided by evidence-based frameworks and assessment tools  Improve member adherence with an exceptional patient experience and an easy-to- understand Personalized Wellness Plan  Coordinate care with members’ Primary Care Physician through electronic transmission of informative visit summary  Connect patients with identified gaps in care to needed services  Receive timely, comprehensive data to improve HCC coding and Stars/HEDIS measures  Identify at-risk patients for case management and disease management programs CLINICAL EXCELLENCE CARE COORDINATION TIMELY DATA SHARING 19