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Optimizing Data Analytics for Quality and Economic Outcomes

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Presentation on theme: "Optimizing Data Analytics for Quality and Economic Outcomes"— Presentation transcript:

1 Optimizing Data Analytics for Quality and Economic Outcomes
National Behavioral Health Consortium San Diego, CA September 6, 2007 Robert Littrell, Pharm.D. Founder and Chief Executive Officer Artemetrx, LLC Phone: (859)

2 Brief Introduction/Background
Presentation Outline Brief Introduction/Background Personal Corporate What We Do How We Do It Program Examples and Results Private: Western Southern, Extendicare, City of Cincinatti Public: Kentucky Medicaid Miscellaneous Sampling of Leveraging Data Questions/Discussion/Name-Calling/Joke-Telling

3 Introduction/Background
Personal Overview Degrees/License: Doctor of Pharmacy/R.Ph. Experience: University of Kentucky College of Pharmacy 1989 – 1992: Teaching and Pain Management Practice 1992 – 1995: Teaching, Research and Psychiatric Practice 1996 – 2000: IT Administration, Outcomes Development, Teaching 2000 – 2004: Technology Development, Administration, Research Corporate Overview Founded in 2003 by Robert Littrell & Robert McIntyre Underlying technology developed at University Corporate headquarters in Lexington, Kentucky Privately held

4 Artemetrx, LLC A healthcare cost containment company that leverages data to develop and implement blueprints for healthy cost savings

5 Value Proposition: Tools, Interventions, People
Tools & clinically sound interventions that are Data-driven Member-focused/Member-friendly Minimally disruptive Market proven Personnel Clinically-oriented managment Technically sound Customer focused

6 Target Markets Initial Focus Self-funded Employers (>500 lives)
State Medicaid Programs Health Plans Present Focus Self-Funded Employers (>1,000 lives) Strategic Partners Employer Coalitions Regional Healthcare Organizations (hospital) Associations/Trade Groups Vendors to State Medicaid Programs

7 What Artemetrx Helps You “Do”
Our healthcare clinicians, data analysts and experts partner with you to support efforts to: 1 SEE CLEARLY 2 MAKE BETTER DECISIONS 3 REDUCE COST & IMPROVE HEALTH We do this by providing: A “Back Office” Health Management Team Data Integration and Analysis including Web Application Intervention Programs Consulting

8 Tools , Interventions, People
1 SEE CLEARLY 2 MAKE BETTER STRATEGIES & DECISIONS 3 IMPROVE HEALTH & REDUCE COST Data Aggregation Data Warehousing Health Risk Appraisals Member Surveys Personal Health Records Predictive Modeling Provider Profiling Consulting Customized Intervention Programs Population Health Management Case Management Rx Formulary Management FSA Support Health & Productivity Management Data Acquisition Internal Review Implement Customized Interventions Data Integration Tangible Hard-Dollar Defensible Data Synthesis/Analysis Monthly Customer Interaction Measure Outcomes Web Application Data Analysts Healthcare Analysts Physicians Pharmacists Nurses Data Analysts Healthcare Analysts Physicians Pharmacists Nurses Health Educators Health Coaches Data Analysts Healthcare Analysts

9 Data Aggregation Medical Claims Prescription Claims Eligibility Provider Workers Compensation Behavioral Health HRAs Laboratory Data Productivity Assessments Others……

10 Sample Data Providers ACS EDS PharmaCare AdvancePCS/Caremark
Express Scripts Prescriptions Rx Aetna First Health Principal Anthem Humana Restat BCBS of Alabama IRM T. Davis and Associates BCBS of Florida Kroger Rx Underwriters Safety/Claims BCBS Minnesota Lexicom Unisys BCBS of Tennessee Medco Health United HealthCare Blue Grass Family Health Medical Mutual Ohio Wachovia CHA MedImpact Walgreens Commonwealth Admin NGS American ZenithTPA

11 Typical Customer Pathway
State of the Union Analysis Data Acquisition/Integration Analysis SOU Presentation with Recommendation General Engagement Monthly data acquisition and analysis Monthly teleconferences with insights and recommendations Access to key portions of web application Customized Programs/Services

12 Sample Intervention #1: PPI

13 Findings from Data Integration/Analysis

14 Clinical Underpinning A: Duration of Therapy
87% > 60 days of therapy

15 Financial Considerations
*based on ~120,000 lives across 11 employers in GA, IN, KY OH, TN, & WI

16 Among top 10 Rx spend for most payors
Program Example: PPIs Among top 10 Rx spend for most payors Primarily indicated for acute treatment (<= 8 wks)* Most treatment is for >8 weeks Generic is available OTC is available Direct to consumer advertising is unrelenting *AFP. 2003;68(6). (Note: Guideline based upon Institute for Clinical Symptom Improvement GERD guideline.)

17 Pressure for Chronic Use is Continuous
“…Enrollment is automatic when you fill your prescription the first time at our pharmacy. The program also provides you with useful refill reminder letters, so you won’t forget to pick up your medication when you need it….” “…Symptoms may subside quickly when taking PROTONIX, but the actual healing may take longer. So its important that you keep taking PROTONIX, every day, for as long as your doctor recommends….” “…This program is supported by funds from WYETH PHARMACEUTICALS….”

18 Example of Intervention: PPI Program
Change Benefit Structure to: Cover 60 days of any prescription PPI Preauthorization for > 60 days Implement Program to Include: Communicate change/introduce program via general and targeted mailing Direct phone call from doctoral level pharmacist Explain benefit change Counsel client on non-drug management of “GERD” Offer and provide 60 day trial of OTC PPI Facilitate (or perform) PA process Provide “Proactive” PA for greater than 60 days

19 Proven PPI Program Cost Savings
Western Southern 16,000 life group PPI PMPM Pre: $6.00 Post: $2.50 Total Annual Savings: $672,000 Tangible Hard-Dollar Defensible Extendicare 12,000 life group PPI PMPM Pre: $1.80 Post: $0.60 Total Annual Savings: $172,800

20 Kentucky Medicaid PPI Savings

21 Sources of Artemetrx Savings for Kentucky Medicaid
Program Total State Federal Recommended and 28 Day Refill Limit $ ,600,000 $ ,840 $ 1,108,160 Implemented Atypical Anti-Psychotic $ ,500,000 $ 2,612,900 $ 5,887,100 PPI Utilization $ ,000,000 $ 7,685,000 $ 17,315,000 Subtotal $ ,100,000 $ 10,789,740 $ 24,310,260 PMPM $ $ $ Recommended and Yet Skeletal Muscle Relaxant Abuse $ ,100,000 $ 1,260,340 $ 2,839,660 To Be Implemented Claim Paid After Recipient Death $ ,000 $ ,480 $ ,520 Impotence Agent Use $ ,000 $ ,660 $ ,340 Liquid Zyrtec Utilization $ ,000,000 $ ,400 $ ,600 Innapproriate Marinol Use $ ,000 $ ,108 $ ,892 CCI Edit Violation $ ,000,000 $ ,800 $ 1,385,200 OTC Payments for LTC Members $ ,000,000 $ 1,844,400 $ 4,155,600 $ ,620,000 $ 4,494,188 $ 10,125,812 $ $ $ $ ,720,000 $ 15,283,928 $ 34,436,072 $ $ $ Pct 100.00% 30.74% 69.26%

22 Sample Intervention #2: Voluntary Tablet Splitting

23 Findings from Data Integration/Analysis

24 Clinical Underpinning

25 Financial Considerations
Average Plan Cost for Lipitor Tablets by Tablet Strength $2.89 $2.83 $2.84 $1.45 (↓49%) $1.83 $1.41 (↓50%) $1.42 (↓22%)

26 Avg Cost/Day of Lexapro Therapy
$1.84 $1.72 $1.45 $0.92 (↓47%) $0.86 (↓41%) 26

27 Avg Cost/Day of Zoloft Therapy
$1.95 $1.95 $1.87 $0.97 (↓50%) $0.97 (↓48%) 27

28 WSF Voluntary, Targeted Tablet Splitting Program
Comprehensive pre-program member communications Focused on high volume, high cost prescription drugs Cholesterol Meds Lipitor/Zocor & Simvistatin Antidepressants Lexapro/Zoloft & Sertraline Telephonic contact by pharmacists Offer participation Evaluate appropriateness Mail instructions and tablet splitter Contact physician and pharmacy

29 WSF Voluntary, Targeted Tablet Splitting Program
867/1476 Members (Rxs) contacted to date 69% opt-in rate 22% inappropriate for splitting 253 verified change in rx claims data Mean annualized savings per member = $402 Mean annualized savings for 253 members = $102,000

30 WSF Tablet Splitting Cost Savings
(based on 50% conversion in voluntary tablet splitting program) Plan $242,979.00 Members $ 71,891.16 Total $314,870.16 Brand Name Net Savings-Member Net Savings-Plan Net Savings Pct. CRESTOR $4,940.85 $20,419 24.92 LEXAPRO $8,260.60 $18,340 21.90 LIPITOR $42,038.04 $155,475 20.26 SERTRALINE HYDROCHLORIDE $510.00 $1,533 24.73 SIMVASTATIN $1,120.00 $9,891 17.25 ZOCOR $9,120.00 $24,025 13.07 ZOLOFT $5,901.67 $13,296 24.53 Totals $71,891.16 $242,979

31 Sample Intervention #3: DiabetesHEALTH Disease Management

32 WSF Diabetes HEALTH: Current Status
Participation Goal: 40 members in Cincinnati area Group Education Sessions completed Individual sessions well underway *

33 Participant Group Profile

34 Diabetes HEALTH Intervention
A comprehensive diabetes education and support program Modeled after Asheville Project model and the American Diabetes Association (ADA) guidelines/materials Workplace, on-site services for diabetes education and skills training Self-management counseling and health coaching from healthcare professionals Quality of care assessments including clinical and laboratory metrics Cost of care analysis

35 Diabetes HEALTH Web Module
Integrated into core Artemetrx application Diabetes HEALTH information linked directly to health claims, Rx claims, demographic information and provider data Allows for: Enrollment of members Online completion of outcomes surveys Documentation of interventions and clinical measures Review of all prescription and medical claims by health coach Tickler system for important labs, visits, surveys, etc. Automated electronic communication with participants Access to important data by multiple professionals Reporting and analysis

36 Sample Intervention #4: Incentive Management Web Tool/Program

37 Our Latest Product Introduction
Member specific logins with individualized incentive offers Tracks participation and “rewards” Linked directly to HRA, claims, and other related data Allows for ongoing analysis of program effectiveness

38 Additional Examples of Services & Programs

39 FSA/CDHP Letter Generated by Artemetrx
Logo stored in database From Client or Employee Data Text of letter can be customized Medical out of pocket expenses from health claims Rx out of pocket expenses from RX claims Can add estimate of savings from participation

40 Health Risk Assessment/Self-Report Tools
Multiple survey instruments supported and can vary by population or program.

41 Relative Increase in Claims Cost by BMI Risk and Age

42 Sample of HRA Reporting and Analysis

43 Integration of Medical and Time/Attendance Data

44 Diabetes Quality of Care
Diabetes Quality of Care Metrics

45 Quality of Care: Depression

46 Provider Profiling: Diabetes

47 Provider-Based Initiative to Improve Diabetic Care
Provider Side Improvements 100% of identified diabetics had A1Cs checked 80% of diabetics were given Rx’s for renal protective ACEs per ADA/EBM guidelines Indicators for other risk factors were monitored consistently (i.e., lipids and blood pressures) Rx Compliance Rates w/ Integrated Data None (0%) 29% Low (0-24%) 06% Mod (25-49%) 12% Good (50-74%) 16% High (75%+) 38%

48 1 2 3 Tools and People SEE CLEARLY MAKE BETTER STRATEGIES & DECISIONS
IMPROVE HEALTH & REDUCE COST Data Aggregation Data Warehousing Health Risk Appraisals Member Surveys Personal Health Records Predictive Modeling Provider Profiling Consulting Customized Intervention Programs Population Health Management Case Management Rx Formulary Management FSA Support Health & Productivity Management Data Acquisition Internal TriHealth Review Implement Customized Interventions Data Integration Tangible Hard-Dollar Defensible Data Synthesis/Analysis Monthly Customer Interaction Measure Outcomes Web Application Data Analysts Healthcare Analysts Physicians Pharmacists Nurses Data Analysts Healthcare Analysts Physicians Pharmacists Nurses Health Educators Health Coaches Data Analysts Healthcare Analysts

49 Questions/Discussion/Name-Calling/Joke-Telling


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