Rx Medal Presentation

Pharmacy Medication Adherence and
Condition Monitoring Program

Rx MEDAL
Medication Adherence for Life

© 2009 Pharmacy Solutions, LLC. All Rights Reserved.

Pharmacy Solutions,

To provide hospitals, patients, practitioners, payers, and
home health care professionals with products and
services with a proven process to reduce health care cost
and improve patient outcomes through condition
monitoring and medication adherence in chronic disease.

 Congestive Heart Failure
 Diabetes Mellitus
 Hypertension
 Chronic Obstructive Pulmonary Disease (COPD)
 Chronic Autoimmune Disorders (e.g. multiple
sclerosis)


Pharmacy Solutions,

Prevalence in the United Annual Cost ($345 Billion)
States

1.76%
$39
10.70% $78
$218
28.60%

Diabetes Diabetes
Hypertension Hypertension
Congestive Heart Failure Congestive Heart Failure


Pharmacy Solutions,

ADHERENCE FACTS:

 The #1 problem in treating illness today is
patients' failure to take prescription medications
correctly, regardless of patient age.
 32 million Americans are taking three or more
medications daily.
 Approximately 125,000 deaths occur annually in
the United States because of non-adherence with
cardiovascular medications.


Pharmacy Solutions,

The Evidence:

 Medication Adherence Rates are Low
 Averaging only 50 – 65%

The Result:

 Symptoms and Complications Worsen
 Utilization of Inpatient Medical Services Increases
 Total Health Care Costs Increase


Pharmacy Solutions,

*US patients take less of their medication than is prescribed.


Pharmacy Solutions,

 A 2009 study1 found that the cost of drug-related
morbidity, including poor adherence (not taking
medication as prescribed by doctors) and
suboptimal prescribing, drug administration, and
diagnosis, is estimated to be as much as $289
billion annually, about 13% of total health care
expenditures.
1New England
Healthcare Institute, Thinking Outside the Pillbox:
A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease (August 2009)


Pharmacy Solutions,

The barriers to medication adherence are many:
 Cost
 Side effects
 Difficulty of managing multiple prescriptions
 Patients’ acceptance and/or understanding of their
disease, forgetfulness, cultural and belief systems
 Imperfect drug regimens
 Patients’ ability to navigate the health care system
 Cognitive impairments, and
 Reduced sense of urgency due to asymptomatic
conditions.


Pharmacy Solutions,

Adherence Management System:
 Patient in-home biometrics are saved to a database, with
alerts and messages possible.
 Biometric data can be transmitted to the patient, doctor or
other locations with ease.
 Medications are reviewed and evaluated for fulfillment and
adherence with prescribed regimens.
 Motivational Interviewing principles are applied:
 Adherence intent is assessed and monitoring plans developed to
achieve desired outcomes.

 Patient feedback and adherence coaching is provided as appropriate.


Pharmacy Solutions,

 A secure online database collects relevant data and gives clinicians
the ability to assess patient adherence by monitoring the plan of care
for the patient.

 Clinicians can access a condition scoring system, that provides a
basic snapshot of the patient’s overall adherence .

 Biometric data and adherence scores provide clinicians with an
evaluation tool and a basis for motivational interviewing and
intervention.

 The web portal may be used to review patient care notes, biometric
data, historical trends to assist in making adherence assessments.


Pharmacy Solutions,

 A condition scoring system has been developed for three major disease
states and is adaptable to other chronic conditions:
1. Congestive Heart Failure
2. Diabetes Mellitus
3. Hypertension
4. COPD

 The condition scoring system is an indicator of adherence and is used to
target areas of concerns and for improvement within each disease state.
o Numerical scoring based on the familiar 1-100 grading system. This
system is easily recognized and understood.
 Motivational interviewing techniques are applied to improve scores and
outcomes.
o Increasing adherence scores are associated with increased cost
savings and reduced hospitalization risk.


Pharmacy Solutions,

 The unique adherence scoring system is calculated based
upon individual biometric data, patient responses, and
medication history.
 Each patient receives an individualized adherence plan
targeted to achieve persistence and optimal outcomes.
 These scores can be used to trend adherence over time
for each patient and trend adherence over time for
patient populations.
 These trends are also compared against baselines and
goals associated with optimal outcomes.


Pharmacy Solutions,

Motivational
Interviewing

Condition Adherence
Monitoring Scoring

Medication
Adherence


Pharmacy Solutions,

 As adherence scores increase health care costs and hospitalization
risk decrease1 Michael C. Sokol, MD, MS, Kimberly A. McGuigan, PhD, Robert R. Verbrugge, PhD,and Robert S. Epstein, MD, MS,
1

Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost, Medical Care • Volume 43, Number 6, June 2005

Annual Healthcare Cost/Patient by Hospitalization Risk by Adherence
Adherence Score Score
$18,000 $16,498
44%
$16,000 $13,077 $12,978 39%
$14,000 $11,484
36%
$12,000 30%
$8,887 27%
$10,000
$8,000
$6,000
$4,000
$2,000
$0
0-19

0-19
80-100
60-79
20-39

40-59

80-100
20-39

40-59

60-79
Diabetes Hypertension


Pharmacy Solutions,

 In another study1 hospital re-admission rates for
congestive heart failure patients dropped 57 percent
through the use of wireless technology to monitor their
weight and blood pressure.

1MemorialCare Health System, Laguna Hills, CA,, A Study of Rehospitalization Rates for Congestive Heart Failure Patinents Receiving Remoted Patient
Monitoring Technology, May, 2009.


Pharmacy Solutions,

 Glucometer
 Heart Rate and Blood pressure cuff
 Weight Scale
 Pulse Oximeter
 Fully integrated patient information systems and
medication databases


Pharmacy Solutions,

Patient takes real- Data is Feedback to
time information transmitted to patient, physician,
using blue tooth the secure case manager,
devices online database caregiver


Pharmacy Solutions,

Phase I – Patient Enrollment:
Identification of patients with specific disease (e.g. Diabetes, CHF, hypertension) and
program assignment. Identification from Pharmacy Data Provided or Post Discharge
Information. IVR or Call Center Calls for Enrollment and Initial Coaching and
Compliance Assessment.
Phase II – Ongoing Patient Monitoring:
Patient data and compliance scores are monitored according to the individual adherence
plan assigned to the patient. Alerts, messages, and questionnaires are used to facilitate
communication and direct appropriate actions or interventions. Based on the alert
system, direct intervention is triggered by a adherence coach for further assessment and
escalation as appropriate.
Phase III – Feedback and Reinforcement:
On a monthly basis, patients receive feedback and motivational interviewing based on
the results of their adherence scores. Adherence Intent and motivational interviewing is
used to recognize, reinforce, problem solve, and educate.
Phase IV – Monthly Results Reporting:
Adherence scores are tracked, trended, and reported. Hospitalization rates, home health
visits, and other metrics are tracked.

Pharmacy Solutions,


Pharmacy Solutions,

 Adherence Assessment  Customer Value

 Motivational Interviewing  Optimal Patient Outcomes

 Condition Monitoring  Reduced Health Care Costs

 Improved Adherence  Return on Investment


Pharmacy Solutions,

Expected Adherence based on Program Results

 Claims cost data
 Hospital Admission/Re-admission Rates
 Objective data and statistical reporting
 Retention Rates
 Program Evaluation and Patient Satisfaction
 Documented Cost Savings through Improved Adherence


Pharmacy Solutions,

Transition, Implementation, and Ongoing Monitoring

 Admission and Data Interchange
 Equipment Set-Up and Validation
 Initial Adherence Coaching
 Ongoing monitoring and intervention
 Program Cost offset through Cost Savings


Pharmacy Solutions,

Customer Value
Improved Adherence
Optimal Clinical Outcomes
} = ROI
 Care Planning and Real Time Monitoring
 Patient Coaching and Motivational Interviewing
 Medication Adherence
 Condition Monitoring
 Reduced Costs from Improved Adherence and Outcomes
 Reduced Hospital Readmissions


Pharmacy Solutions,

 There are approximately 5.3 million people suffering from
congestive heart failure (CHF) in the United States.
 The lifetime risk of developing heart failure at the age of 40 is
20%
 Approximately 380,000 people above the age of 65 will be
diagnosed with CHF annually


Pharmacy Solutions,

 A great cause for concern has been the increasing number of
patients being hospitalized with CHF.
 The number of patients with CHF discharged from the hospital
rose from 400,000 in 1979 to over 1 million in 2005.
 Within 4-6 months after discharge 47% of the patients are
likely to be readmitted.
 The five year mortality rate for patients with CHF was 48%
from 1996-2000.


Pharmacy Solutions,

 The estimated total of direct and indirect cost of heart failure
in the United States for 2008 is $34.8 billion with the greatest
share being hospitalizations.
 In the commercially insured, Medicare and Medicaid
populations, the single largest health expenditure is inpatient
utilization (nearly 33% in 2005) with 13.3% of all emergency
department visits associated with a hospital admission.
 The average cost associated with a CHF hospitalization is
$10,000.


Pharmacy Solutions,

 The estimated total of direct and indirect cost of heart failure
in the United States for 2008 is $34.8 billion with the greatest
share being hospitalizations.
 In the commercially insured, Medicare and Medicaid
populations, the single largest health expenditure is inpatient
utilization (nearly 33% in 2005) with 13.3% of all emergency
department visits associated with a hospital admission.
 The average cost associated with a CHF hospitalization is
$10,000.
 Approximately 14% of Medicare beneficiaries have heart
failure, they account for 43% of Medicare spending


Pharmacy Solutions,

 Reduction in Re-Hospitalizations1
 Over a three month period realize up to a 57% decline in hospital re-
admissions, or a 27% hospital admission rate for CHF.
 Program Cost (Example)
 $750 per patient, initial three months.
 $150,000 per 200 patients.
 Cost savings1
 Over a three month period, pre-program admission costs are $1,260,000
per 200 patients.
 After enrollment in the program, the cost for total admissions is
$540,000 per 200 patients
 Resulting in cost savings of $636,000.
1MemorialCare Health System, Laguna Hills, CA,, A Study of Rehospitalization Rates for Congestive Heart Failure Patinents Receiving Remoted Patient
Monitoring Technology, May, 2009.


Pharmacy Solutions,

Putting ROI into Context (Example)

 Program Savings/Program Cost
 ($636,000/$150,000)

 $4.24 for every $1 invested


RX MEDAL Program Overview

Background Services Facility Cost Facility Value Patient Value ROI

• Decreased Re-
Admission
• Selection Rates • Better • Program
• CHF • Training • Monthly • Better PR Outcomes Cost
• Diabetes • Monitoring Patient • Cost Savings • Reduced Cost • Program
• Hypertension • MI Management • Payer Savings
Fee • Quality of
• COPD • Assessment Contracts Life • $4 : $1
• Reporting • Decrease ED
Visits


Pharmacy Solutions,

Complete Continuum of Care

Motivational
Patient Interviewing Optimal Reduced
Condition Patient Health Care Return on
Assessment and
Monitoring Outcomes Costs Investment
and Training Adherence
Coaching


Pharmacy Solutions,

Next Steps ?

Contact Pharmacy Solutions

http://pharmsolutions.org
info@pharmsolutions.org


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