Your SlideShare is downloading. ×
0
Teaming	
  with	
  Clinicians	
  	
  
in	
  the	
  Interven3on	
  Process	
  
Clinical	
  Collabora3on	
  Achieves	
  Be9e...
Disclosure	
  Statements	
  
Patrick	
  J.	
  Burns	
  has	
  no	
  financial	
  rela3onships	
  with	
  proprietary	
  en3...
Learning	
  Objec3ves	
  
1.  Differen3ate	
  between	
  threatening	
  and	
  
collabora3ve	
  outreach.	
  	
  
2.  Assem...
Discussion	
  Points	
  
Factors	
  that	
  Influence	
  Outcomes	
  
Risk	
  Iden3fica3on	
  &	
  Interven3on	
  Tools	
  
...
Workers’	
  Compensa3on	
  vs.	
  Group	
  Health	
  
Suburban	
  Home	
   Custom	
  Log	
  Cabin	
  
The	
  Tale	
  of	
  Two	
  Doctors	
  
6	
  
Doctor	
  A	
   Doctor	
  B	
  
Progressive	
  Medical,	
  Inc.	
  	
  -­‐	
...
Factors	
  that	
  Influence	
  Outcomes	
  
7	
  
Number	
  of	
  	
  
Prescribers	
  
Number	
  of	
  	
  
Pharmacies	
  ...
Number	
  of	
  Prescribers	
  
•  West	
  Virginia	
  
•  Evalua3on	
  for	
  doctor	
  shopping	
  
–  Doctor	
  shopper...
Number	
  of	
  Prescribers	
  
•  West	
  Virginia	
  
•  Evalua3on	
  for	
  doctor	
  shopping	
  
–  Doctor	
  shopper...
Number	
  of	
  Pharmacies	
  
•  West	
  Virginia	
  
•  Evalua3on	
  for	
  pharmacy	
  shopping	
  
–  Pharmacy	
  shop...
Number	
  of	
  Pharmacies	
  
•  West	
  Virginia	
  
•  Evalua3on	
  for	
  pharmacy	
  shopping	
  
–  Pharmacy	
  shop...
Number	
  of	
  Prescribers	
  and	
  Pharmacies	
  
12	
  
Uncoordinated	
  Care	
  
Progressive	
  Medical,	
  Inc.	
  	...
Prescribing	
  Behaviors	
  
•  Opioids	
  prescribed	
  early	
  in	
  the	
  claim	
  
•  Days	
  supply	
  of	
  opioid...
Medica3on	
  Pa9erns	
  
•  Type	
  of	
  opioids	
  and	
  claim	
  cost	
  
•  Michigan	
  
–  Final	
  claim	
  cost	
 ...
Medica3on	
  Pa9erns	
  
•  Mul3ple	
  short-­‐ac3ng	
  and	
  long	
  ac3ng	
  opioids?	
  
•  Poten3al	
  drug-­‐drug	
 ...
Body	
  Part/Nature	
  of	
  Injury	
  
•  Ohio	
  
•  Highest	
  costs	
  per	
  claim	
  by	
  body	
  part	
  
–  Lumba...
Demographics	
  of	
  Prescriber	
  
Geographical	
  varia3on	
  of	
  opioid	
  prescribing	
  
•  Acute,	
  work-­‐relat...
Demographics	
  of	
  Prescriber	
  
Geographical	
  varia3on	
  of	
  opioid	
  prescribing	
  
•  135	
  million	
  opio...
Demographics	
  of	
  Prescriber	
  
19	
  
McDonald	
  DC,	
  Carlson	
  K,	
  Izrael	
  D.	
  Geographic	
  varia3on	
  ...
Medica3on	
  Agreement	
  
•  Also	
  know	
  as	
  a	
  “pain	
  contract”	
  
•  Recommended	
  by	
  
–  U.S.	
  Depart...
Medica3on	
  Agreement	
  
•  Informed	
  consent	
  
•  Promotes	
  educa3on	
  
•  Improves	
  compliance	
  
•  Compone...
Medica3on	
  Agreement	
  Sample	
  	
  
22	
  Progressive	
  Medical,	
  Inc.	
  	
  -­‐	
  	
  Copyright	
  2014	
  -­‐	...
Drug	
  Monitoring	
  
•  Urine	
  drug	
  screen	
  
–  U.S.	
  Department	
  of	
  Health	
  and	
  Human	
  Services	
 ...
Effects	
  on	
  Behavior	
  
PaCent	
  
•  “My	
  prescrip3ons	
  are	
  being	
  
monitored”	
  
•  “I	
  may	
  be	
  dr...
Why	
  Some	
  Physicians	
  	
  
Don’t	
  Follow	
  Guidelines	
  
25	
  
KNOWLEDGE	
  
ATTITUDES	
  
BEHAVIORAL	
  	
  
...
RISK	
  IDENTIFICATION	
  &	
  INTERVENTION	
  TOOLS	
  
Risk	
  Iden3fica3on	
  and	
  Interven3on	
  
27	
  ©	
  2014	
  by	
  Principled	
  Strategies,	
  Inc.	
  	
  	
  	
  	
...
Iden3fy	
  Prescriber	
  “Risk”	
  
•  Concept	
  of	
  “risk	
  factors”	
  borrowed	
  
from	
  disease	
  management	
 ...
The	
  PSI	
  Score™	
  
•  Iden3fy/Stra3fy	
  	
  ̶̶	
  	
  Popula3on	
  and	
  Specialty	
  Peers	
  
•  Predict	
  risk...
Prescriber	
  Risk	
  Score	
  Distribu3on	
  
30	
  
High	
  	
  
Risk	
  
Moderate	
  Risk	
   Low	
  Risk	
  
©	
  2014...
Predic3ve	
  Risk	
  Iden3fica3on	
  
31	
  
Which	
  prescribers	
  not	
  currently	
  in	
  the	
  high	
  risk	
  group...
Prescriber	
  Interven3on	
  
IdenCficaCon	
  
•  Risk	
  scored	
  and	
  rank	
  ordered	
  the	
  prescriber	
  popula3o...
Iden3fica3on	
  
•  1,200	
  prescribers	
  iden3fied	
  for	
  engagement	
  
•  ≥	
  98th	
  %ile	
  of	
  the	
  PSI	
  S...
Iden3fica3on	
  
Top	
  Risk	
  Factors	
  
Occurring	
  most	
  frequently	
  among	
  prescribers’	
  top	
  three	
  ris...
Engagement	
  Packet	
  
•  Welcome	
  Le9er	
  	
  ̶̶	
  	
  Personalized	
  and	
  Tailored	
  
•  Risk	
  Factor	
  Wor...
Engagement	
  
•  Outbound	
  scheduling	
  calls	
  
–  Call	
  prescriber’s	
  office	
  to	
  schedule	
  a	
  20-­‐minut...
Consulta3on	
  
•  20	
  to	
  30-­‐minute	
  1:1	
  consulta3on	
  with	
  a	
  
PharmD	
  trained	
  in	
  the	
  progra...
The	
  Tale	
  of	
  Two	
  Doctors	
  
38	
  
Doctor	
  A	
   Doctor	
  B	
  
©	
  2014	
  by	
  Principled	
  Strategies...
A	
  Tale	
  of	
  Two	
  Doctors	
  
39	
  
Scheduling	
  Call	
  
Refuse	
   Schedule	
   Release	
  
Office	
  Visit	
   ...
Follow	
  Up	
  
•  Sa3sfac3on	
  Survey	
  sent	
  within	
  two	
  weeks	
  of	
  appointment	
  
•  Monthly	
  Communic...
Program	
  Resources	
  
•  Service	
  Center	
  
–  Staffed	
  by	
  four	
  administrators	
  and	
  six	
  PharmDs	
  
–...
Measuring	
  Clinical	
  Outcomes	
  
•  Monthly	
  updates	
  to	
  the	
  PSI	
  Score™	
  and	
  risk	
  factor	
  scor...
Post-­‐interven3on	
  Outcomes	
  (12	
  mo)	
  
Endpoint	
   Model	
  Significance	
   P	
  
PSI	
  Score™	
   R	
   Yes	
...
CLINICAL	
  COLLABORATION	
  FOR	
  BETTER	
  OUTCOMES	
  
IN	
  WORKERS’	
  COMPENSATION	
  
Clinical	
  Collabora3on	
  for	
  Be9er	
  Outcomes	
  
Early	
  capture	
  of	
  prescripCons	
  leads	
  to	
  greater	...
Clinical	
  Collabora3on	
  for	
  Be9er	
  Outcomes	
  
Quicker	
  access	
  to	
  informaCon	
  be9er	
  equips	
  
clai...
Clinical	
  Collabora3on	
  for	
  Be9er	
  Outcomes	
  
Quicker	
  access	
  to	
  informa3on	
  
47	
  
Early	
  capture...
Analyze	
  Risk	
  	
  
Predic3ve	
  power	
  of	
  variables	
  change	
  over	
  Cme	
  
48	
  
Percent	
  of	
  
Signifi...
Clinical	
  Collabora3on	
  for	
  Be9er	
  Outcomes	
  
Quicker	
  access	
  to	
  informa3on	
  
49	
  
Early	
  capture...
•  Claims	
  Professional	
  Outreach	
  
•  Physician	
  Outreach	
  
•  U3liza3on	
  Reviews	
  
•  Interven3on	
  Repor...
Commentary	
  
Change	
  in	
  Opioid	
  Use	
  Post	
  DTM	
  DTM	
  Results	
  
MedicaCon	
  Spend	
  per	
  Claimant	
 ...
Commentary	
  
Change	
  in	
  Opioid	
  Use	
  Post	
  Review	
  Success	
  Rate	
  by	
  MedicaCon	
  Class	
  
MedicaCo...
Commentary	
  
Change	
  in	
  Opioid	
  Use	
  Post	
  Review	
  Success	
  Rate	
  by	
  MedicaCon	
  Class	
  
MedicaCo...
The	
  Tale	
  of	
  Two	
  Doctors	
  
54	
  
Doctor	
  A	
   Doctor	
  B	
  
Both	
  trea3ng	
  doctors	
  ul3mately	
  ...
LESSONS	
  LEARNED	
  
Lesson	
  Learned	
  
Carefully	
  cra<ed	
  outreach	
  fosters	
  engagement	
  
•  More	
  recep3ve	
  when	
  it	
  is...
Lesson	
  Learned	
  	
  
Collabora5on	
  can	
  drive	
  posi5ve	
  change	
  
•  Most	
  prescribers	
  	
  
–  are	
  u...
Lesson	
  Learned	
  	
  
Addi5onal	
  Challenges	
  of	
  Pain	
  Management	
  Clinics	
  
•  Members	
  are	
  sent	
  ...
Thank	
  you!	
  
Ques3ons?	
  
Contact	
  Us	
  
Lawrence	
  Feinstein,	
  Ph.D.	
  
Office:	
  (760)	
  230-­‐6326	
  
Email:	
  lawrence.feinstein@safeus...
Contact	
  Us	
  
Tron	
  Emptage,	
  R.Ph.,	
  Chief	
  Clinical	
  Officer	
  
Tron.Emptage@progressive-­‐medical.com	
  
...
Upcoming SlideShare
Loading in...5
×

Tpp 3 joint presentation

179

Published on

Third-Party Payer: Teaming with Clinicians in the Intervention Process - Patrick Burns, Tron Emptage, Dr. Lawrence Feinstein and Dr. Robert Hall

Published in: Health & Medicine, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
179
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
19
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "Tpp 3 joint presentation"

  1. 1. Teaming  with  Clinicians     in  the  Interven3on  Process   Clinical  Collabora3on  Achieves  Be9er  Outcomes   Principled  Strategies,  Inc.   Patrick  J.  Burns,  President   Lawrence  Feinstein,  Ph.D.,  Vice  President,  Clinical  Programs   Progressive  Medical,  Inc.   Tron  Emptage,  R.Ph.,  Chief  Clinical  Officer   Robert  Hall,  MD,  Corporate  Medical  Director   Presenters  
  2. 2. Disclosure  Statements   Patrick  J.  Burns  has  no  financial  rela3onships  with  proprietary  en33es  that   produce  health  care  goods  and  services.     Lawrence  Feinstein  has  no  financial  rela3onships  with  proprietary  en33es   that  produce  health  care  goods  and  services.     Tron  Emptage  has  no  financial  rela3onships  with  proprietary  en33es  that   produce  health  care  goods  and  services.     Robert  Hall  has  no  financial  rela3onships  with  proprietary  en33es  that   produce  health  care  goods  and  services.     2  Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  3. 3. Learning  Objec3ves   1.  Differen3ate  between  threatening  and   collabora3ve  outreach.     2.  Assemble  a  list  of  words  and  phrases  that   reduce  fric3on  and  foster  partnership   between  payors  and  the  physician.     3.  Iden3fy  tools  that  demonstrate  effec3ve   outcomes.     3  Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  4. 4. Discussion  Points   Factors  that  Influence  Outcomes   Risk  Iden3fica3on  &  Interven3on  Tools   Lessons  Learned   Clinical  Collabora3on   Q&A   4  Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  5. 5. Workers’  Compensa3on  vs.  Group  Health   Suburban  Home   Custom  Log  Cabin  
  6. 6. The  Tale  of  Two  Doctors   6   Doctor  A   Doctor  B   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  7. 7. Factors  that  Influence  Outcomes   7   Number  of     Prescribers   Number  of     Pharmacies   Prescribing   Behaviors   Medica3on     Pa9erns   Body  Part/   Nature  of  Injury   Demographics     of  Prescriber   Medica3on     Agreement   Drug     Monitoring   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  8. 8. Number  of  Prescribers   •  West  Virginia   •  Evalua3on  for  doctor  shopping   –  Doctor  shoppers:  Four  or  more  prescribers     in  last  six  months   –           %  of  deceased  pa3ents   –           %  of  living  pa3ents   8   Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  9. 9. Number  of  Prescribers   •  West  Virginia   •  Evalua3on  for  doctor  shopping   –  Doctor  shoppers:  Four  or  more  prescribers     in  last  six  months   –  25  %  of  deceased  pa3ents   –  3.5%  of  living  pa3ents   9   Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  10. 10. Number  of  Pharmacies   •  West  Virginia   •  Evalua3on  for  pharmacy  shopping   –  Pharmacy  shoppers:  Four  or  more  pharmacies     in  last  six  months   –         %  of  deceased  pa3ents   –         %  of  living  pa3ents   10   Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  11. 11. Number  of  Pharmacies   •  West  Virginia   •  Evalua3on  for  pharmacy  shopping   –  Pharmacy  shoppers:  Four  or  more  pharmacies     in  last  six  months   –  17%  of  deceased  pa3ents   –  1%      of  living  pa3ents   •  55%  of  pharmacy  shoppers  were  also  doctor  shoppers   11   Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  12. 12. Number  of  Prescribers  and  Pharmacies   12   Uncoordinated  Care   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  13. 13. Prescribing  Behaviors   •  Opioids  prescribed  early  in  the  claim   •  Days  supply  of  opioids   •  Number  of  fills   •  Morphine  equivalent  dose  (MED)   –  Washington  State   –  120  MED  threshold   13   http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  14. 14. Medica3on  Pa9erns   •  Type  of  opioids  and  claim  cost   •  Michigan   –  Final  claim  cost  ≥  $100,000   –  Short  ac3ng  opioids  →  1.76  more  likely     –  Long  ac3ng  opioids  →  3.94  more  likely   14   White JA, Tao X, Talreja M, Tower J, Bernacki E. The effect of opioid use on workers' compensation claim cost in the State of Michigan. J Occup Environ Med. 2012 Aug;54(8):948-53. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  15. 15. Medica3on  Pa9erns   •  Mul3ple  short-­‐ac3ng  and  long  ac3ng  opioids?   •  Poten3al  drug-­‐drug  interac3ons   –  West  Virginia   –  Opioids  and  benzodiazepines     15   Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  16. 16. Body  Part/Nature  of  Injury   •  Ohio   •  Highest  costs  per  claim  by  body  part   –  Lumbar  spine   –  Shoulder   –  Cervical  spine   •  Industries  with  highest  average  costs  per  claim   –  Transporta3on   –  Warehouse   –  U3li3es  and  Construc3on   16   Dunning  KK,  Davis  KG,  Cook  C,  Kotowski  SE,  Hamrick  C,  Jewell  G,  Lockey  J.  Costs  by  industry  and  diagnosis  among  musculoskeletal  claims  in  a  state  workers  compensa3on   system:  1999-­‐2004.  Am  J  Ind  Med.  2010  Mar;53(3):276-­‐84.     Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  17. 17. Demographics  of  Prescriber   Geographical  varia3on  of  opioid  prescribing   •  Acute,  work-­‐related  low  back  pain   •  Decision  to  use  opioids  related  to  social  condi3ons   •  Massachuse9s  5.7%  vs.  South  Carolina  52.9%   •  79%  of  state  varia3on  explained  by  3  factors   1.  State  household  income  inequality     2.  Number  of  physicians  per  capita     3.  Workers’  compensa3on  cost  containment  effort  score   17   Webster  BS,  Cifuentes  M,  Verma  S,  Pransky  G.  Geographic  varia3on  in  opioid  prescribing  for  acute,  work-­‐related,  low  back  pain  and  associated  factors:  a  mul3level   analysis.  Am  J  Ind  Med.  2009  Feb;52(2):162-­‐71.   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  18. 18. Demographics  of  Prescriber   Geographical  varia3on  of  opioid  prescribing   •  135  million  opioid  prescrip3ons  in  2008   •  37,000  retail  pharmacies   •  Large  varia3on  in  opioids  prescribed   •  Coun3es  having  the  highest  prescribing  rates   ‒  Appalachia   ‒  Southern  and  western  states     Strongest  predictor  of  amounts  prescribed     Number  of  available  physicians…”by  far”   18   McDonald  DC,  Carlson  K,  Izrael  D.  Geographic  varia3on  in  opioid  prescribing  in  the  U.S.  J  Pain.  2012  Oct;13(10):988-­‐96.   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  19. 19. Demographics  of  Prescriber   19   McDonald  DC,  Carlson  K,  Izrael  D.  Geographic  varia3on  in  opioid  prescribing  in  the  U.S.  J  Pain.  2012  Oct;13(10):988-­‐96.   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  20. 20. Medica3on  Agreement   •  Also  know  as  a  “pain  contract”   •  Recommended  by   –  U.S.  Department  of  Health  and  Human  Services     –  American  Academy  of  Pain  Medicine   –  Veterans  Health  Administra3on   –  American  College  of  Occupa3onal  and  Environmental  Medicine  (ACOEM)   –  Official  Disability  Guidelines  (ODG)   20   Payne, R, E Anderson, R Arnold, L Duensing, A Gilson, C Green, C J. Haywood, S Passik, B Rich, L Robin, N Shuler, and M Christopher. "A Rose by Any Other Name: Pain Contracts/agreements." The American Journal of Bioethics : Ajob. 10.11 (2010): 5-12. ACOEM 2011; ODG 2012 Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  21. 21. Medica3on  Agreement   •  Informed  consent   •  Promotes  educa3on   •  Improves  compliance   •  Components   –  Informed  consent  for  treatment  with  medica3on(s)   –  Acceptable  and  unacceptable  behaviors   –  Consequences  for  failure  to  adhere  to  agreement   21   Payne, R, E Anderson, R Arnold, L Duensing, A Gilson, C Green, C J. Haywood, S Passik, B Rich, L Robin, N Shuler, and M Christopher. "A Rose by Any Other Name: Pain Contracts/agreements." The American Journal of Bioethics : Ajob. 10.11 (2010): 5-12. ACOEM 2011 ODG  2012   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  22. 22. Medica3on  Agreement  Sample     22  Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  23. 23. Drug  Monitoring   •  Urine  drug  screen   –  U.S.  Department  of  Health  and  Human  Services   –  ACOEM   –  ODG   •  Iden3fy  possible  drug  misuse  and  abuse   23   Gilbert  et  al.  "Importance  of  Urine  Drug  Tes3ng  in  the  Treatment  of  Chronic  Noncancer  Pain:  Implica3ons  of  Recent  Medicare     Policy  Changes  in  Kentucky."  Pain  Physician  13.2  (2010):  167-­‐86.   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  24. 24. Effects  on  Behavior   PaCent   •  “My  prescrip3ons  are  being   monitored”   •  “I  may  be  drug  tested”   •  “I  signed  an  agreement”   •  “I  could  lose  my  pain  meds”   24   •  Physician   Physician   •  “My  prescribing  habits  are   being  monitored”   •  “I  could  lose  my  license  to   prescribe”   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  25. 25. Why  Some  Physicians     Don’t  Follow  Guidelines   25   KNOWLEDGE   ATTITUDES   BEHAVIORAL     FACTORS   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  26. 26. RISK  IDENTIFICATION  &  INTERVENTION  TOOLS  
  27. 27. Risk  Iden3fica3on  and  Interven3on   27  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.   Rx  Data  Analysis   1:1  Individualized  ConsultaCon     via  Telephone  or  In  person   Prescriber  PSI  Score™  and  Scores  for   Top  Three  Risk  Factors  (out  of  17  total  factors)   #1            Early  Refills   #2            Excessive  Use   #3            Dosage  and  Volume  of  Opioids   Risk  Scoring  of  Prescribers   Monthly  CommunicaCon;  Quarterly  Score  Updates   Prescriber  Resources   Toolkit   Engagement  via   Personalized  Outreach   49  PredicCve   Metrics   Pharmacy   Metrics   Prescriber   Metrics   PSI  Score™   17  Behavioral   Risk  Factors   PaCent   Metrics   Opioid-­‐specific   Metrics  
  28. 28. Iden3fy  Prescriber  “Risk”   •  Concept  of  “risk  factors”  borrowed   from  disease  management   •  At  what  point  would  you  allocate  resources  to     intervene  with  the  following  prescriber?   –  Starts  most  pa3ents  on  highest  dosage   –  Frequently  prescribes  excess  days  supply   –  Is  located  50+  miles  from  many  of  his  pa3ents   –  High  pa3ent  volume  compared  to  specialty  peers   28  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  29. 29. The  PSI  Score™   •  Iden3fy/Stra3fy    ̶̶    Popula3on  and  Specialty  Peers   •  Predict  risky  prescribers  by  iden3fying  trends   •  Individualize  the  interven3on  effort  by  iden3fying     each  prescriber’s  top  three  risk  behaviors   •  Monitor  prescriber  behavior  change  over  3me   •  CQI    ̶̶    Measure  interven3on  effec3veness,  and  improve   •  Comply  with  treatment  direc3ve  to  iden3fy  prescribers   and  members  for  review  of  appropriateness  of  opioid   therapy   29   ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  30. 30. Prescriber  Risk  Score  Distribu3on   30   High     Risk   Moderate  Risk   Low  Risk   ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  31. 31. Predic3ve  Risk  Iden3fica3on   31   Which  prescribers  not  currently  in  the  high  risk  group  will,  in  six  months,  have  a  PSI   Score™  equal  to  or  greater  than  the  cutoff  value  that  defines  “high  risk”,  with  a  90%   confidence  level?   ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  32. 32. Prescriber  Interven3on   IdenCficaCon   •  Risk  scored  and  rank  ordered  the  prescriber  popula3on   •  Iden3fied  1,200  prescribers,  along  with  the  top  3  risk  factors  for  each   Engagement     •  250  prescribers  per  week  for  four  weeks   •  Addi3onal  prescribers  for  two  more  weeks  to  reach  goal  of  1,000   ConsultaCon     •  20-­‐minute  telephone  call  or  office  visit  consulta3on  with  PharmD   •  Printed  materials  including  instruc3ons  to  refer  to  behavioral  health     Follow-­‐up   •  Six  months  follow-­‐up  communica3on  post-­‐appointment   •  Three-­‐month  and  six-­‐month  update  on  PSI  Score™  and  risk  factor  scores   32  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  33. 33. Iden3fica3on   •  1,200  prescribers  iden3fied  for  engagement   •  ≥  98th  %ile  of  the  PSI  Score™  distribu3on   33   High-­‐risk  Prescriber  DistribuCon   by  Specialty    Family  Medicine   23%    Internal  Medicine   22%    Psychiatry   9%    Pain  Management   7%    Surgery   7%    Physical  Medicine  &  Rehab   7%    Anesthesiology   6%    Physician  Assistant   4%    Nursing   4%    Other   12%   ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  34. 34. Iden3fica3on   Top  Risk  Factors   Occurring  most  frequently  among  prescribers’  top  three  risk  factors   34   PaCent-­‐focused  Risk  Factors   Mul3ple  Prescribers   Mul3ple  Pharmacies   Mul3ple  Family  Members   Prescriber-­‐focused  Risk  Factors   Early  Refills  of  Similar  Products   Dosage  and  Volume  of  Opioids   Opioid  with  benzodiazepine  or  carisoprodol  Concomitance   Excessive  Use  of  Controlled  Substances   ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  35. 35. Engagement  Packet   •  Welcome  Le9er    ̶̶    Personalized  and  Tailored   •  Risk  Factor  Worksheets    ̶̶    Each  prescriber’s  top     three  risk  factors   •  Clinical  Advisories  specific  to  each  prescriber’s     risk  factors   •  Pa3ent  Informa3on  Report    ̶̶    List  of  each  prescriber’s   pa3ents  contribu3ng  to  his/her  top  three  risk  factor   scores,  and  their  prescrip3on  informa3on   •  Prescriber  Resources  and  Recommenda3ons    ̶̶    Guides;   assessments;  services  to  refer  to  for  psych  evalua3ons,   rehab,  consulta3on,  and  coordina3on  of  care   35  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  36. 36. Engagement   •  Outbound  scheduling  calls   –  Call  prescriber’s  office  to  schedule  a  20-­‐minute     telephone  call  or  office  visit  with  a  licensed  PharmD   –  Confirm  receipt  of  the  engagement  packet   •  Confirm  the  appointment  72  hours  prior,  by  call  or  email   36  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  37. 37. Consulta3on   •  20  to  30-­‐minute  1:1  consulta3on  with  a   PharmD  trained  in  the  program  protocol   –  Telephone  call     –  Office  visit   •  In  the  first  four  minutes:  Assess  prescriber’s  level  of     mo3va3on  versus  resistance,  and  adjust  objec3ves,  tac3cs,  |and  3ming   accordingly   37  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  38. 38. The  Tale  of  Two  Doctors   38   Doctor  A   Doctor  B   ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  39. 39. A  Tale  of  Two  Doctors   39   Scheduling  Call   Refuse   Schedule   Release   Office  Visit   Telephone  Call   MoCvated  /  CooperaCve   •  Review  the  engagement  packet  materials   •  Explain  the  purpose  of  the  program,  themes,  the   PSI  Score™,  risk  factors,  clinical  recommenda3ons,   Pa3ent  Informa3on  Report   •  Explain  the  program  follow-­‐up,  score  updates,   and  invite  further  discussion   Resistant  /  UncooperaCve   •  Explain  the  purpose  of  the  program,  themes   •  Focus  on  the  resources  to  help  the  prescriber   •  Shorten  appointment;  schedule  follow-­‐up   •  Track  PSI  Score™  over  3me  and  have  Regional   Medical  Director  follow-­‐up  if  necessary   ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  40. 40. Follow  Up   •  Sa3sfac3on  Survey  sent  within  two  weeks  of  appointment   •  Monthly  Communica3ons   –  By  email  unless  prescriber  requests  fax   –  Links  to  short  video  vigne9es  and  addi3onal  materials  on  the  Web   –  Brief  survey  ques3ons   •  Quarterly  Score  Updates   •  Relapse  Monitoring  Based  on  Updated  Scores  and  Trends   40  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  41. 41. Program  Resources   •  Service  Center   –  Staffed  by  four  administrators  and  six  PharmDs   –  Outbound  and  inbound  telephone  calls,     email  and  fax;  dedicated  lines  and  auto-­‐a9endant   •  CRM  System   –  Tracks  all  outbound  and  inbound  communica3ons   –  Collects  data  on  all  aspects  of  the  program   –  Repository  of  all  prescriber  informa3on   –  Automated  opera3onal  and  clinical  reports   41  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  42. 42. Measuring  Clinical  Outcomes   •  Monthly  updates  to  the  PSI  Score™  and  risk  factor  scores  enable  us  to:   –  Measure  change  across  the  prescriber  popula3on  and  within  each     specialty  group   –  Indirectly  measure  adop3on  of  clinical  recommenda3ons   –  Iden3fy  prescriber  trends  as  they  develop,  permizng  early-­‐stage  interven3on  per   prescriber  and  the  popula3on   –  Have  a  con3nuous  feedback  look  to  evaluate  program  impact  and  improve  effec3veness   •  Currently  we  measure   –  Risk   –  U3liza3on  (pharmacy  only)   –  Benefit-­‐to-­‐Cost  (pharmacy  only)   •  In  the  future    we  will  measure  the  aforemen3oned  for  both  pharmacy  and  medical   42  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  43. 43. Post-­‐interven3on  Outcomes  (12  mo)   Endpoint   Model  Significance   P   PSI  Score™   R   Yes   <  0.001   Mul3ple  HCPs   R   Yes   <  0.001   Mul3ple  Pharmacies   R   Yes   <  0.001   Concomitance   R   Yes   <  0.002   Opioid  Prescrip3on  Claims   U   No   Morphine  Equivalent  Dose  (mg)   U   Yes   =  0.020   43   Legend:  R  =  Risk  Factor,  U  =  U5liza5on  Factor   Cost   Model  Significance   P   Savings   Opioid  Rx  Claims   Yes   =  0.041   $2,596,189   Non-­‐opioid  Rx  Claims   Yes   =  0.045   $461,731   Benefit-­‐to-­‐Cost   4.4  :  1   ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  44. 44. CLINICAL  COLLABORATION  FOR  BETTER  OUTCOMES   IN  WORKERS’  COMPENSATION  
  45. 45. Clinical  Collabora3on  for  Be9er  Outcomes   Early  capture  of  prescripCons  leads  to  greater   control  through  connected  programs.   45  Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  46. 46. Clinical  Collabora3on  for  Be9er  Outcomes   Quicker  access  to  informaCon  be9er  equips   claims  professionals  and  clinicians  to  make   decisions.   46   Early  capture  of  prescrip3ons     Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  47. 47. Clinical  Collabora3on  for  Be9er  Outcomes   Quicker  access  to  informa3on   47   Early  capture  of  prescrip3ons     MulC-­‐factor  risk  analysis  based  on  pharmacy   behavior,  the  injury  and  overall  demographics   should  be  applied  to  be9er  predict  the  path     of  a  claim.   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  48. 48. Analyze  Risk     Predic3ve  power  of  variables  change  over  Cme   48   Percent  of   Significance   (aggregated   across  mul3ple   variables)   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  49. 49. Clinical  Collabora3on  for  Be9er  Outcomes   Quicker  access  to  informa3on   49   Early  capture  of  prescrip3ons     MulC-­‐factor  risk  analysis  based  on  pharmacy  behavior,   the  injury  and  overall  demographics  should  be  applied   to  be9er  predict  the  path  of  a  claim.   There  will  always  be  claims  that  mature  into   complicated  situa3ons;  having  the  right  tools  to   apply  at  the  right  Cme  is  essen3al.   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  50. 50. •  Claims  Professional  Outreach   •  Physician  Outreach   •  U3liza3on  Reviews   •  Interven3on  Reports   •  Peer-­‐to-­‐Peer  Review   Clinical  Tools  and  Exper3se   50  Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  51. 51. Commentary   Change  in  Opioid  Use  Post  DTM  DTM  Results   MedicaCon  Spend  per  Claimant   48  (9.3%)  detected  an  illicit   substance     250  (48.6%)  detected   a  Non-­‐Prescribed  Drug   284  (55.3%)  did  not  detect   the  prescribed  medica3on(s)   64%  of  iden3fied  claimants  that  were  tested  had  a  result  inconsistent  with  the   prescriber  therapy   Changes  in  UClizaCon   (based  on  days  supply)   Changes  in  Spend   All  Medica3ons   ↓  21%   ↓  20%   All  Opioids   ↓  24%   ↓  28%   All  Benzodiazepines   ↓  28%   ↑  6%   360  Days  Post  Enrollment  Compared  to  90  Days  Pre-­‐Enrollment   Urine  Drug  Monitoring   Drug  Tes3ng  and  Monitoring  Outcomes  show  significant  decrease  in  u3liza3on     60%   61%   64%   66%   70%   51  Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  52. 52. Commentary   Change  in  Opioid  Use  Post  Review  Success  Rate  by  MedicaCon  Class   MedicaCon  Savings  per  Claimant    $-­‐          $200.00      $400.00      $600.00      $800.00      $1,000.00      $1,200.00      $1,400.00      $1,600.00     91-­‐180  days   181-­‐270  days   271-­‐360  days   Overall  success  rate     70%   Average  decrease  in  opioid  use   8.4%   Average  savings  per  injured  party   $3,586.93   Return  on  investment  (ROI)   8:1   Medica3on     Class   Average  Success   Rate   Average  Savings  per    Successful  Interven3on   Muscle  Relaxants   76%   $    302.78   Dermatologics   73%   $    1,794.08   Seda3ves   65%   $    1,257.18   Opioid  Analgesics   57%   $    2,711.91   NSAIDs   52%   $    563.91   Gastrointes3nal   50%   $    1,014.86   An3convulsants   46%   $    1,630.16   Anxioly3cs   38%   $    244.58   Respiratory   33%   $    1,555.03   An3depressants   31%   $    316.17   Medica3on  Reviews  with  addi3onal  interven3on  via  Peer   to  Peer  Outreach  outcomes  are  measured  separately   Medica3on  Reviews   Medica3on  Reviews  result  in  an  average  $3,500  savings  per  injured  party     52  Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  53. 53. Commentary   Change  in  Opioid  Use  Post  Review  Success  Rate  by  MedicaCon  Class   MedicaCon  Savings  per  Claimant   Overall  success  rate     62%   Average  decrease  in  opioid  use   25.6%   Average  savings  per  injured  party   $5102   Rate  of  achieving  contact  with  prescriber   79%   Return  on  investment  (ROI)   4:1   Medica3on     Class   Average  Success   Rate   Average  Savings  per    Successful  Interven3on   An3-­‐migraine  agents   82%   $  6,662.66   NSAIDs   77%   $  524.23   Laxa3ves   69%   $  131.67   Muscle  Relaxants   65%   $  422.69   Dermatologics   63%   $  1,587.41   Opioid  Analgesics   62%   $  2,995.51   An3convulsants   61%   $  1,077.05   An3depressants   60%   $  723.16   Seda3ves   57%   $  884.56   Anxioly3cs   50%   $  1,290.77    $-­‐          $200.00      $400.00      $600.00      $800.00      $1,000.00      $1,200.00      $1,400.00     91-­‐180  days   181-­‐270  days   271-­‐360  days   Peer  Outreach   Combining  Medica3on  Reviews  with  Peer  Outreach  results  in  an  overall  4:1  ROI     53  Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  54. 54. The  Tale  of  Two  Doctors   54   Doctor  A   Doctor  B   Both  trea3ng  doctors  ul3mately  made  medica3on  changes  based  on   recommenda3ons  from  the  reviewing  physician.  Doctor  B  was  willing  to  partly   compromise.   Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved  
  55. 55. LESSONS  LEARNED  
  56. 56. Lesson  Learned   Carefully  cra<ed  outreach  fosters  engagement   •  More  recep3ve  when  it  is  clearly  understood  that     –  We  are  NOT  claiming  prescriber  is  engaging  in  inappropriate  behavior   –  Our  emphasis  is  on  making  certain  the  injured  party  receives  the  right  medica3on     at  the  right  3me   •  Inclusion  of  detailed  prescrip3on  informa3on  for  the  prescriber’s  own  pa3ents  was  a  major   contributor  to  prescribers’  willingness  to  par3cipate   •  Calls  to  schedule  appointments  must  occur  within    one  week  of  receipt  of     engagement  packets   •  Design  the  Engagement  Packet  mailing  envelope  so  office  staff  can  easily  iden3fy  that  it   contains  pa3ent  PHI  and  must  be  delivered  only  to  the  prescriber   •  Review  of  the  themes  of  the  program  by  PharmD  increased  comfort  and  collabora3on   •  Most  appointments  were  completed  within  20  minutes   •  Member  and  claim  level  informa3on  was  very  useful  in  reconciling  charts  and     taking  ac3on  as  appropriate   56  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  57. 57. Lesson  Learned     Collabora5on  can  drive  posi5ve  change   •  Most  prescribers     –  are  unaware  their  pa3ents  are  engaging  in  aberrant  behavior,  such  as  “doctor  shopping”,   drug  seeking,  or  diversion   –  preferred  an  appointment  by  telephone  call   –  had  read  the  engagement  materials  prior  to  the  appointment   –  believed  that  they  were  already  implemen3ng  adequate  steps/precau3ons  in     their  prac3ce     •  Although  most  prescribers  expressed  concern  about  being  “monitored”  by  the  payor,  by  the   end  of  the  call,  addi3onal  resources  and  tools  were  iden3fied  that  would  help  improve  the   safe  use  of  control  substances   –  Locking  members  into  a  single  pharmacy   –  Specific  lab  tests  including  “no  threshold  tes3ng”  and  “adultera3on  panel”   –  Referrals  for  addic3on  specialists  and  psychological  counseling  services   •  Many  providers  were  not  aware  of  these  addi3onal  resources   57  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  58. 58. Lesson  Learned     Addi5onal  Challenges  of  Pain  Management  Clinics   •  Members  are  sent  back  to  the  PCP  for  ‘follow-­‐up’,  refills  on  controlled  substances,   and  long-­‐term  pain  management   •  PCPs  expressed  a  low  comfort  level  with  managing  chronic  pain  pa3ents  but  felt   they  were  ‘le•  with  no  choice’   58  ©  2014  by  Principled  Strategies,  Inc.                  All  rights  reserved.  
  59. 59. Thank  you!   Ques3ons?  
  60. 60. Contact  Us   Lawrence  Feinstein,  Ph.D.   Office:  (760)  230-­‐6326   Email:  lawrence.feinstein@safeusenow.com     Patrick  J.  Burns   Office:  (760)  230-­‐6323   Email:  patrick.burns@safeusenow.com     60  
  61. 61. Contact  Us   Tron  Emptage,  R.Ph.,  Chief  Clinical  Officer   Tron.Emptage@progressive-­‐medical.com   Robert  Hall,  MD,  Medical  Director   Robert.Hall@progressive-­‐medical.com   61  
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×