Third-Party Payer: Proactive Identification and Intervention Approaches

1. Third-Party Payer Track:
Proactive Identification and
Intervention Approaches
Presenters:
• Rochelle Henderson, PhD, Senior Director of Research, Express
Scripts, Inc.
• Joseph Anderson, MBA, Director of Analytics, Helios
• Tron Emptage, RPh, Chief Clinical Officer, Helios
Moderator: J. Kevin Massey, MS, Program Administrator, Division of
Public Health, Delaware Department of Health and Social Services,
and Member, Rx Summit National Advisory Board

2. Disclosures
• Rochelle Henderson, PhD, has disclosed no relevant, real or
apparent personal or professional financial relationships with
proprietary entities that produce health care goods and
services.
• Joe Anderson, MBA – Employment: Helios
• Tron Emptage, RPh – Employment/Stockholder: Helios
• J. Kevin Massey, MS, has disclosed no relevant, real, or
apparent personal or professional financial relationships with
proprietary entities that produce healthcare goods and
services.

3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– Kelly Clark – Employment: Publicis Touchpoint Solutions;
Consultant: Grunenthal US
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center
– Carla Saunders – Speaker’s bureau: Abbott Nutrition

4. Learning Objectives
1. Explain the role of predictive analytics and
statistical models to identify high-risk claims.
2. Describe strategies for intervening in high-risk
claims to help injured workers and control costs.
3. Identify characteristics associated with chronic
opioid use in a newly injured worker population.
4. Outline proactive strategies for curbing opioid
abuse and misuse by chronic users.

5. Rx Drug Summit
Proactive Identification and
Intervention Approaches
Rochelle Henderson, PhD
Senior Director of Research, Express Scripts

6. Disclosure Statement
• Rochelle Henderson, PhD has disclosed no
relevant, real or apparent personal or
professional financial relationships with
proprietary entities that produce health care
goods and services.

7. Learning Objectives
1. Explain the role of predictive analytics and
statistical models to identify high-risk claims.
2. Describe strategies for intervening in high-risk
claims to help injured workers and control costs.
3. Identify characteristics associated with chronic
opioid use in a newly injured worker population.
4. Outline proactive strategies for curbing opioid
abuse and misuse by chronic users.

8. Pain Treatment in America
Challenges in the practice of pain care1
Evolving evidence2
Approaches to better management for healthier outcomes3

9. Paying a High Price
259 million prescriptions for
painkillers written in 2012
50 Americans die every
day from prescription drug
poisoning

10. Using Data and Analytics to Dig Deeper

11. Prescribing Patterns Put Patients at
Risk
Dangerous
Combinations of Drugs
Dangerous
Combinations of
Doctors

16. Rigorous Inferential Approach
Opioid Prescribing
Physicians
Outlier
Detection
Method
Identification

17. Key Findings
• Over 60% of WC uppermost
prescribers prescribe opioids
to 2 or fewer patients
• On average, WC uppermost
prescribers write:
– more 30-day adjusted opioid
prescriptions per user
– longer days’ supply
– more than 7 times higher
average cost for opioid
prescription per user per day of
therapy 0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
WC GH Mixed
% Uppermost Opioid
Prescribers

18. We Need to Strike a Balance

19. Proactive Identification and
Intervention Approaches
Presented by
Joe Anderson, MBA
Director of Analytical Services
Tron Emptage, M.A., R.Ph.
Chief Clinical Officer

20. Disclosure Statement
• Joe Anderson, MBA, Employment: Helios
• Tron Emptage, RPh, Employment/Stockholder: Helios

21. INDUSTRY TRENDS

22. Use of Narcotics and Other Medication Classes
First Year After Injury
22
59%
52%
30%
10%
57%
55%
29%
10%
53%
56%
30%
9%
0%
10%
20%
30%
40%
50%
60%
Narcotic Analgesics NSAIDS Skeletal Muscle Relaxants Dermatologics
2010 2011 2012

23. Medication Use Over Time
23
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10
Analgesics Narcotics Anti-inflammatory Skelatal MuscleRelaxers
Anti-Convulsant Dermatologic Antidepressant

24. Factors that Influence Outcomes
24
Number of
Prescribers
Number of
Pharmacies
Prescribing
Behaviors
Medication
Patterns
Body Part/
Nature of Injury
Demographics
of Prescriber
Medication
Agreement
Drug
Monitoring

25. SO WHAT ARE WE TO DO?

26. Predictive Analytics
Using a Multivariate Statistical Model to
Predict High Pharmacy Cost Claimants
26
Correlate early data
about an injured
worker…
… with resulting long-
term spend of that
injured worker.
Workers injured in 2010 Resulting pharmacy costs in 2013
(DEPENDENT VARIABLE)

27. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 4 6 9 12 18 24
Geographic and other Demographics Prescriber: Demographics of Treating Prescriber
Injury: Body Part, Nature of Injury Pharmacy Behavior
PercentofSignificance
(AggregatedAcrossMultipleVariables)
Months Since Date of Injury
Predictors Change as Claims Age

28. Clinical Analytics
Intervening on High-Cost Claims
Intervention Type Cost per Claim

29. Pharmaceutical Companies Use Network Analysis to Identify and
Target Influential Doctors with Advertising
Source: ”Drug Marketers Use Social Network Diagrams to Help Locate Influential Doctors” May 16, 2013
http://www.nytimes.com/interactive/2013/05/16/business/PHARMA.html?ref=business

30. This Is Also an Effective Technique to Understand Injured
Workers’ Risk for Long Term Prescription Drug Use
Long-Term Pharmacy Cost of Injured Worker,
Based on Initial Prescriber’s Connectedness
Long-TermPharmacyCostofInjuredWorker
Initial Prescriber’s Connections with Other Prescribers

31. Science + Science = Outcomes

32. Data Analytics + Clinical Expertise = Better outcomes

33. Individualized Analysis + Clinical Review = Better Outcomes
Physician
Letters
Pharmacist
Medication
Review
Physician
Medication
Review
Medication
Monitoring

34. Declining Claim Duration
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48
2010 2011
2012 2013
Months since Date of Injury
Percent of Injured
Workers Filling
Prescription
Medications

35. 35
A total program solution
consisting of comprehensive data,
risk analysis, and clinical tools will
greatly decrease the likelihood of a
long-term claim.

36. Thank You

37. Third-Party Payer Track:
Proactive Identification and
Intervention Approaches
Presenters:
• Rochelle Henderson, PhD, Senior Director of Research, Express
Scripts, Inc.
• Joseph Anderson, MBA, Director of Analytics, Helios
• Tron Emptage, RPh, Chief Clinical Officer, Helios
Moderator: J. Kevin Massey, MS, Program Administrator, Division of
Public Health, Delaware Department of Health and Social Services,
and Member, Rx Summit National Advisory Board