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See clearly. Make better decisions. Reduce costs. - www.artemetrx.com Optimizing Data Analytics for Quality and Economic Outcomes Robert Littrell, Pharm.D.

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Presentation on theme: "See clearly. Make better decisions. Reduce costs. - www.artemetrx.com Optimizing Data Analytics for Quality and Economic Outcomes Robert Littrell, Pharm.D."— Presentation transcript:

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

2 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - A healthcare cost containment company that leverages data to develop and implement blueprints for healthy cost savings Artemetrx, LLC

5 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - 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 Health Plans

7 See clearly. Make better decisions. Reduce costs. - What Artemetrx Helps You “Do” We do this by providing: A “Back Office” Health Management Team Data Integration and Analysis including Web Application Intervention Programs Consulting Our healthcare clinicians, data analysts and experts partner with you to support efforts to: S EE C LEARLY M AKE B ETTER D ECISIONS R EDUCE C OST & I MPROVE H EALTH 12 3

8 See clearly. Make better decisions. Reduce costs. - Tools, Interventions, People S EE C LEARLY M AKE B ETTER S TRATEGIES & D ECISIONS I MPROVE H EALTH & R EDUCE C OST 1 23 Internal Review Monthly Customer Interaction Implement Customized Interventions Measure Outcomes Data Acquisition Data Integration Data Synthesis/Analysis Web Application Tangible Hard-Dollar Defensible 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 Analysts Healthcare Analysts Physicians Pharmacists Nurses Data Analysts Healthcare Analysts Physicians Pharmacists Nurses Health Educators Health Coaches Data Analysts Healthcare Analysts

9 See clearly. Make better decisions. Reduce costs. - Data Aggregation Medical Claims Prescription Claims Eligibility Provider Workers Compensation Behavioral Health HRAs Laboratory Data Productivity Assessments Others……

10 See clearly. Make better decisions. Reduce costs. - Sample Data Providers ZenithTPANGS AmericanCommonwealth Admin WalgreensMedImpactCHA WachoviaMedical Mutual OhioBlue Grass Family Health United HealthCareMedco HealthBCBS of Tennessee UnisysLexicomBCBS Minnesota Underwriters Safety/ClaimsKroger RxBCBS of Florida T. Davis and AssociatesIRMBCBS of Alabama RestatHumanaAnthem PrincipalFirst HealthAetna Prescriptions RxExpress ScriptsAdvancePCS/Caremark PharmaCareEDSACS

11 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - Sample Intervention #1: PPI

13 See clearly. Make better decisions. Reduce costs. - Findings from Data Integration/Analysis

14 See clearly. Make better decisions. Reduce costs. - Clinical Underpinning A: Duration of Therapy 87% > 60 days of therapy

15 See clearly. Make better decisions. Reduce costs. - Financial Considerations *based on ~120,000 lives across 11 employers in GA, IN, KY OH, TN, & WI

16 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - Pressure for Chronic Use is Continuous “…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….” “…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….” “…This program is supported by funds from WYETH PHARMACEUTICALS….”

18 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - Proven PPI Program Cost Savings Western Southern 16,000 life group PPI PMPM –Pre: $6.00 –Post: $2.50 Total Annual Savings: $672,000 Extendicare 12,000 life group PPI PMPM –Pre: $1.80 –Post: $0.60 Total Annual Savings: $172,800 Tangible Hard-Dollar Defensible

20 See clearly. Make better decisions. Reduce costs. - Kentucky Medicaid PPI Savings

21 See clearly. Make better decisions. Reduce costs. - Sources of Artemetrx Savings for Kentucky Medicaid Program Total StateFederal Recommended and 28 Day Refill Limit $ 1,600,000 $ 491,840 $ 1,108,160 Implemented Atypical Anti-Psychotic $ 8,500,000 $ 2,612,900 $ 5,887,100 PPI Utilization $ 25,000,000 $ 7,685,000 $ 17,315,000 Subtotal $ 35,100,000 $ 10,789,740 $ 24,310,260 PMPM $ 3.45 $ 1.06 $ 2.39 Recommended and Yet Skeletal Muscle Relaxant Abuse $ 4,100,000 $ 1,260,340 $ 2,839,660 To Be Implemented Claim Paid After Recipient Death $ 200,000 $ 61,480 $ 138,520 Impotence Agent Use $ 900,000 $ 276,660 $ 623,340 Liquid Zyrtec Utilization $ 1,000,000 $ 307,400 $ 692,600 Innapproriate Marinol Use $ 420,000 $ 129,108 $ 290,892 CCI Edit Violation $ 2,000,000 $ 614,800 $ 1,385,200 OTC Payments for LTC Members $ 6,000,000 $ 1,844,400 $ 4,155,600 Subtotal $ 14,620,000 $ 4,494,188 $ 10,125,812 PMPM $ 1.44 $ 0.44 $ 1.00 Total $ 49,720,000 $ 15,283,928 $ 34,436,072 PMPM $ 4.89 $ 1.50 $ 3.39 Pct100.00%30.74%69.26%

22 See clearly. Make better decisions. Reduce costs. - Sample Intervention #2: Voluntary Tablet Splitting

23 See clearly. Make better decisions. Reduce costs. - Findings from Data Integration/Analysis

24 See clearly. Make better decisions. Reduce costs. - Clinical Underpinning

25 See clearly. Make better decisions. Reduce costs. - Financial Considerations $2.89 $2.83 $2.84 $1.83 $1.45 ( ↓ 49%) ½½ $1.41 ( ↓ 50%) ½ $1.42 ( ↓ 22%) Average Plan Cost for Lipitor Tablets by Tablet Strength

26 See clearly. Make better decisions. Reduce costs. - Avg Cost/Day of Lexapro Therapy $1.84 $1.72 ½ $0.92 ( ↓ 47%) $1.45 $0.86 ( ↓ 41%) ½

27 See clearly. Make better decisions. Reduce costs. - Avg Cost/Day of Zoloft Therapy $1.95 $1.87 ½½ $0.97 ( ↓ 50%) $0.97 ( ↓ 48%)

28 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - WSF Tablet Splitting Cost Savings (based on 50% conversion in voluntary tablet splitting program) Brand Name Net Savings- Member Net Savings- PlanNet Savings Pct. CRESTOR$4,940.85$20, LEXAPRO$8,260.60$18, LIPITOR$42,038.04$155, SERTRALINE HYDROCHLORIDE$510.00$1, SIMVASTATIN$1,120.00$9, ZOCOR$9,120.00$24, ZOLOFT$5,901.67$13, Totals$71,891.16$242,979 Plan $242, Members $ 71, Total $314,870.16

31 See clearly. Make better decisions. Reduce costs. - Sample Intervention #3: DiabetesHEALTH Disease Management

32 See clearly. Make better decisions. Reduce costs. - WSF Diabetes HEALTH: Current Status Participation Goal: 40 members in Cincinnati area Group Education Sessions completed Individual sessions well underway *

33 See clearly. Make better decisions. Reduce costs. - Participant Group Profile

34 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - Sample Intervention #4: Incentive Management Web Tool/Program

37 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - Additional Examples of Services & Programs

39 See clearly. Make better decisions. Reduce costs. - FSA/CDHP Letter Generated by Artemetrx From Client or Employee Data Logo stored in database 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 See clearly. Make better decisions. Reduce costs. - Health Risk Assessment/Self-Report Tools Multiple survey instruments supported and can vary by population or program.

41 See clearly. Make better decisions. Reduce costs. - Relative Increase in Claims Cost by BMI Risk and Age

42 See clearly. Make better decisions. Reduce costs. - Sample of HRA Reporting and Analysis

43 See clearly. Make better decisions. Reduce costs. - Integration of Medical and Time/Attendance Data

44 See clearly. Make better decisions. Reduce costs. - Diabetes Quality of Care Diabetes Quality of Care Metrics

45 See clearly. Make better decisions. Reduce costs. - Quality of Care: Depression

46 See clearly. Make better decisions. Reduce costs. - Provider Profiling: Diabetes

47 See clearly. Make better decisions. Reduce costs. - 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 See clearly. Make better decisions. Reduce costs. - Tools and People S EE C LEARLY M AKE B ETTER S TRATEGIES & D ECISIONS I MPROVE H EALTH & R EDUCE C OST 1 23 Internal TriHealth Review Monthly Customer Interaction Implement Customized Interventions Measure Outcomes Data Acquisition Data Integration Data Synthesis/Analysis Web Application Tangible Hard-Dollar Defensible 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 Analysts Healthcare Analysts Physicians Pharmacists Nurses Data Analysts Healthcare Analysts Physicians Pharmacists Nurses Health Educators Health Coaches Data Analysts Healthcare Analysts

49 See clearly. Make better decisions. Reduce costs. - Questions/Discussion/Name-Calling/Joke-Telling


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