My 2013 PBMI presentation on my thoughts about using data and consumer engagement to shift the pharamcy industry to a industry focused on value as part of the overall health reform efforts.

1. Pharmacy – Data, COEs, Predictive
Models, and Consumer Engagement
George Van Antwerp
VP, Product Development
inVentiv Medical Management
February 2013

2. Caregiver PCP
Patient
Case Manager Pharmacy
Pharmacist Pharma
Health PBM
Insurer
Employer
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3. My Predictions For 2013
1. Reform will happen.
2. Big Data will be a focus.
3. Physicians grab power through “ACOs”.
4. mHealth will drive innovation and patient engagement.
5. Incentives and gamification will become the norm.
6. Home testing and remote monitoring will increase.
7. Pharmacies will address the PCP shortage.
8. Telemedicine will hit a tipping point.
9. Transparency will empower consumers.
10. Generics will no longer be a focus.
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4. Learning Objectives
• Explain the pharmacy industry implications of the shift from Fee For
Service to Outcomes Based Contracting
• List examples of how leading edge companies are using technology
and Big Data to embrace this change
• Outline options for PBMs and pharmacies to take a more active role
within the expanded care team with a focus on the Triple Aim of cost,
quality, and consumer experience
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5. What Is Population Health Management?
Source: Outcomes Guidelines Report Volume 5. (2010). Washington, DC: Care Continuum Alliance
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6. Adherence Is Our Foundation For Growing The
Role Of Pharmacy
• Adherence has been shown to drive lower medical costs1:
– CHF savings $8,881 / year
– Hypertension $4,337 / year
– Diabetes $4,413 / year
– Dyslipidemia $1,860 / year
• Adherence has also been shown to reduce absenteeism by 7 days
per year per patient with chronic diseases (~$1,700 in savings) 2
• Additionally, there is a significant gap between perceived adherence
(which is high) and actual adherence (which is low) signaling a need
for increased intervention3
1 – Health affairs article - http://www.cimit.org/images/events/ciw/Adherence-Health-Affairs.pdf
2 - http://www.drugstorenews.com/article/cvs-caremark-research-finds-link-between-medication-adherence-employee-productivity
3 – Gap in perceived versus actual adherence identified in 2011 Express Scripts Drug Trend Report
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7. Growth Requires Integration Of
Medical And Rx Data
Source: PBMI 2012 Specialty Drug Report, Prime Therapeutics 2012 Drug Trend Report
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8. The Value Of Pharmacy On Quality Is
Increasingly Being Recognized
Source: CVS Caremark 2012 Insights Report
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9. Evidence-based medicine Accountable Care
Warning:
Bundled
Payments New Paradigm VBID
Ahead
Comparative Effectiveness
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10. Pay For Value Not Service
“Fee-for-service payments drive up health care costs and
potentially lower the value of care for two main reasons.
First, they encourage wasteful use, especially of high-cost
items and services. Second, they do nothing to align
financial incentives between different providers.”
Quote from http://www.americanprogress.org/issues/healthcare/report/2012/09/18/38320/alternatives-to-
fee-for-service-payments-in-health-care/
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11. Employer Premiums Tied To Health Outcomes
12%
of employers penalized or
30%
of difference in premiums
incented employees based on allowed by the ACA based on
outcomes in 2011 according to “meeting employer defined
Towers Watson health targets”
http://www.towerswatson.com/united-states/press/5708
http://www.huffingtonpost.com/2012/06/29/health-plans-obese-smokers-supreme-court_n_1636139.html
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12. Outcomes Based Thinking Creates A New
Way Of Looking At The Value Chain
“Dr. Google” Population
Physician
mHealth Pharmacy Health
Encounter
P2P Mgmt
Where did they go from information?
Feeling Sick What information or apps did you prescribe? Cure
Annual Exam How did you improve their PAM score? Remission
Were they satisfied with their experience? Survivorship
Did you pull in their caregiver?
What are their goals?
How will they judge improvement?
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13. People Aren’t A Disease
I can’t wait to lower
X
my A1c by 2 points.
That would be
great!
I hope I’m mobile
enough to take my
grandkids to Disney!
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14. Understanding Consumers Allows For
Information To Be “Prescribed”
Go to this
website
Watch this video
Download this
mobile app
Join this
community
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15. Not about access but about outcomes
Shift from Rx costs to total costs
Transition away from rebates Look at quality of life
Physician and pharmacist collaboration
De-emphasize eRx for PHR and EMR
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16. Lowest Most
Trend Generics
Lowest
Best
Error
Rebates
Rate
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18. Pharmacists Can Influence Key ACO Metrics
• Better Care for Individuals:
– Patient/Caregiver Experience
– Care Coordination/Transitions
• Medication Reconciliation After Discharge from an Inpatient Facility (measure 10)
– Patient Safety
• Better Health for Populations:
– Preventive Health
• Influenza Immunization (measure 26)
• Pneumococcal Vaccination (measure 27)
• Cholesterol Management for Patients with Cardiovascular Conditions (measure 30)
– At-risk population/Frail Elderly Health
– Diabetes Mellitus: Aspirin Use (measure 39)
– Heart Failure: Beta-Blockers Therapy (measure 49)
– Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB)
Therapy (measure 50)
– Heart Failure: Warfarin Therapy for Patients with Atrial Fibrillation (measure 51)
– Coronary Artery Disease (CAD); appropriate drug therapy including antiplatelet therapy, beta-blocker
therapy, ACE/ARB therapy, LDL-cholesterol lowering therapy (measures 52–55, 57)
– Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy (measure 62)
– Osteoporosis Management in Women Who had a Fracture (measure 64)
– Monthly International Normalized Ratio (INR) for Beneficiaries on Warfarin (measure 65)
http://amcp.org/WorkArea/DownloadAsset.aspx?id=9728
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19. Counting Pills Is Not Enough
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20. http://hin.com/blog/2012/12/17/infographic-improving-primary-care-by-expanding-the-role-of-pharmacists/
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21. Examples Of True Outcomes Based Contracting In
Pharmacy Are Limited
• Merck – Cigna Diabetes
• Rebif – Prime Therapeutics MS
• Sanofi – Health Alliance Osteoporosis
• Pfizer – Humana Alzheimers, pain, cardiovascular
• Bayer – Denmark Levitra
• J&J– UK Velcade
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22. Cigna-Merck Diabetes Contract
• The two-part contract with Merck provided discounts if CIGNA
customers with diabetes lowered their blood sugar levels,
regardless of the medication they were taking, and also provided
for additional discounts if people who were prescribed Merck’s drugs
Januvia and Janumet took their medications according to their physicians’
instructions. Discounts will be shared in various ways with CIGNA employer
clients.
• Kang said that the idea of paying less for medications if they are successful
is counter-intuitive and not at all like other performance-based contracts on
the market today. What makes this unique approach so successful is that
everyone’s incentives line up behind helping customers keep their diabetes
under control. CIGNA’s costs are lowered, medication adherence increases,
resulting in health benefits for individuals and improved productivity and
lower health care costs for their employers.
http://www.vbhealth.org/outcomes-based-contracting-2/cigna-merck-obctm-delivers-on-vbbd-dividends
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24. Prime Therapeutics CareCentered Contracting
• Through CareCentered Contracting, pharmaceutical companies
agree to either refund the cost of the drug for patients whose
medication does not work as expected, such as an osteoporosis
patient who suffers a fracture, or cover the cost of treating such
an event. The health outcomes and medication adherence of
patients are not typically factors in pricing negotiations.
• CareCentered Contracting includes these components in order
to reduce uncertainty about the effectiveness of medications and
possible side effects for members and increase accountability
between pharmaceutical manufacturers and health plans.
http://blog.primetherapeutics.com/blog/outcomes-based-contracting
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26. Big Data!! Will It Mean Anything
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27. http://georgevanantwerp.com/2012/01/30/uping-the-rxante-an-adherence-predictive-model/
http://georgevanantwerp.com/2011/10/27/predicting-medication-adherence/
Express Scripts presentation from William Blair Growth Stock Conference 2012
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28. Source: Strecher, Victor, Analysis of medication adherence data for HealthMedia, Inc., 2006.
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29. Of Course…Data Is Only Good If You Can Use It
http://thefuturescompany.com/what-we-do/living-well/
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30. Programs Don’t Work If People Don’t Engage
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31. Do You Really Think That 99 Seconds Is Enough
Time For A Patient To Understand Their Drug?
http://www.thedoctorweighsin.com/what-physicians-spend-10-mins-of-every-conversation-doing-can-drive-or-diminish-patient-engagement/
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32. What Are Some Opportunities For Outcomes-
Based Alignment?
• PBMs contracting with retail pharmacies based on
patient satisfaction or adherence
• Employers contracting with PBMs based on
improvements in overall medical spend
• Linking mail order rates to the patient experience based
on a metric like Net Promoter Score
• Replacing rebate contracting with outcomes based
contracting
• Paying for gaps-in-care addressed at the POS
• Linking employee engagement to lower health
premiums
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33. 12/14/12 Morgan Stanley Presentation from Humana
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34. Pharmacy Focuses On A Narrow Set Of Star
Measures Not The Broader Set
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35. www.nebgh.org/pdf/presentations/bruner072210.ppt
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36. Walgreens’ WellTransitions Program
• Medication review – pharmacists review patients’ prescriptions upon
admission to the hospital and at discharge; check for potential
interactions and simplification of medication regimen
• Bedside medication delivery – Walgreens pharmacy staff member
delivers medication the patient will need to take after discharge to the
patient’s room and offers medication education and instruction
• Patient counseling – pharmacists provide medication counseling to
both the patient and caregiver and work in close communication with
the medical staff
• Regularly-scheduled follow-up calls – pharmacists conduct regular calls
to follow up on patient progress, discuss regimen and answer any
questions or concerns
• 24/7 pharmacist support – pharmacy staff is available to answer patient
questions 24/7 either over the phone or online
http://news.walgreens.com/article_display.cfm?article_id=5648
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38. 38

39. www.omadahealth.com
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40. Shifting The Pharmacy / Pharmacist Role To Be Part
Of The Expanded Care Team Is Critical
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41. Learning Objectives
• Explain the pharmacy industry implications of the shift from Fee For
Service to Outcomes Based Contracting
– Mx and Rx integration of data
– New metrics
– MD collaboration
• List examples of how leading edge companies are using technology
and Big Data to embrace this change
– Predictive adherence models
– Pharma contracting around outcomes
• Explore options for PBMs and pharmacies to take a more active role
within the expanded care team with a focus on the Triple Aim of cost,
quality, and consumer experience
– Prevention
– Engagement
– Re-admissions
– mHealth
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42. Thank You
George Van Antwerp
VP, Product Development
inVentiv Medical Management
george.vanantwerp@inventivMM.com
www.georgevanantwerp.com
@gvanantwerp
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