Cost-Effective Process to Improve Drug Adherence for Medicare 5-Star

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1 Cost-Effective Process to Improve Drug Adherence for Medicare 5-Star HEALTH ALLIANCE PLAN Presented by Vanita K. Pindolia, Pharm.D. VP, Ambulatory Clinical Pharmacy Programs_PCM

Medicare 5-Star Rating System: CMS Incentive to Improve Quality of Care & Customer Service Medicare uses a Star Rating System to measure how well Medicare Advantage (MA) and Prescription Drug (Part

2 Medicare 5-Star Rating System: CMS Incentive to Improve Quality of Care & Customer Service Medicare uses a Star Rating System to measure how well Medicare Advantage (MA) and Prescription Drug (Part D) Plans perform in several categories Ratings range from 1 to 5 stars for each metric; Each metric has a varied weight scale of 1 to 3 Medicare assigns plans one overall star rating to summarize the plan s performance as a whole Health plans achieving an overall 4 star or higher receive extra federal funding to continue to improve Star metrics Since the bonus payments began in 2012, the percentage of Medicare plans earning 4 stars or more has doubled to 40% (Kaiser Family Foundation, 2016)

3 Medicare 5-Star Rating System 100% 75% 50% 25% 0% 11% 14% 15% 18% 19% 22% Stars 2017 HOS - Health Outcomes Surveys Improvement Measures Pharmacy CAHPS - Member Experience Surveys Customer Service HEDIS - Quality Measures

Drug Adherence: Background By 2020, the number of Americans affected by at least one chronic condition requiring

costs have been attributed to drug non-adherence in the US annually, representing 3% to 10% of total US health care

http://scriptyourfuture.org/wp-content/themes/cons/m/release.pdf,2. Osterberg2005, NEJM, 3. Ho 2009, Circulation, 4.

4 Drug Adherence: Background By 2020, the number of Americans affected by at least one chronic condition requiring medication therapy will grow to 157 million 1-3 In general, between $100 and $300 billion of avoidable health care costs have been attributed to drug non-adherence in the US annually, representing 3% to 10% of total US health care costs 4 Non-adherence causes ~30% to 50% of treatment failures and 125,000 deaths annually 5 References:1. Osterberg2005, NEJM, 3. Ho 2009, Circulation, 4. IMS Institute for Healthcare Informatics Avoidable Costs in US Health Care (2013), 5. Ho 2009, Circulation 6. Ho 2006, Arch IntMed

Medicare 5-Star Rating System: Drug Adherence Metrics Medicare 5-Star: Three Medication Classes Associated with Cardiovascular Disease (CVD) Risk Angiotensin converting enzyme inhibitors and

5 Medicare 5-Star Rating System: Drug Adherence Metrics Medicare 5-Star: Three Medication Classes Associated with Cardiovascular Disease (CVD) Risk Angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARBs) to control blood pressure Statins to control cholesterol Oral diabetes drugs to control blood sugar (HbA1c) Overall performance on these 5-Star three drug metrics is highly dependent on patients with diabetes Patients with diabetes non-adherent to blood pressure medications, or cholesterol drugs or diabetes drugs associated with higher all-cause mortality and all-cause hospitalization rates 1 : Association Between Medication Non-adherence and Outcomes for Patients with Diabetes Medications # of pts (% non-adherent) All-Cause Mortality All-Cause Hospitalization Blood Pressure 6,217 (19.1%) 1.58 times higher 1.44 times higher Cholesterol 6,486 (24.8%) 2.07 times higher 1.39 times higher Diabetes 7,883 (20.3%) 1.39 times higher 1.38 times higher References:1. Ho 2006, Arch Int Med

6 Medicare 5-Star Drug Adherence: HAP Process 2014-Current: Medication Therapy Management (MTM) Program Member Outreach Automated Member letters MTM technicians performed nearly 10,000 annual member outreaches Physician Outreach Automated quarterly letters listing medication fill history for each drug 2015-Current: Reminder calls by HAP s Rx Claims Processor Missed a refill within 5 days of due date Automated calls from contracted Rx Claims Processor 2016: Drug nonadherence member alerts added to HAP CM/DM/MTM IT platform Allows non-adherence conversation to be addressed by all other HAP clinicians

7 Medicare 5-Star Drug Adherence: HAP Process MTM Analysts Performing Member Outreach Pharmacy Interns Trained the Medication Therapy Management (MTM) Analysts Developed Targeted Medication Review (TMR) - Drug Adherence Program Developed Drug Adherence Teaching Guide for Medication Therapy Management (MTM) Analysts Trained MTM Analysts on Drug Adherence TMR program Member Outreach All TMR drug adherence related initial member outreaches transferred from pharmacists to MTM analysts Automated Member letters with drug class specific education message on drug adherence MTM analysts performed nearly 10,000 annual member outreaches to provide verbal education and determine if an appointment should be made with a MTM pharmacist

Medicare 5-Star Drug Adherence: HAP Process Provider Outreach Collaboration with physicians to develop a provider friendly drug adherence tool List of drugs prescribed by any physician that was

8 Medicare 5-Star Drug Adherence: HAP Process Provider Outreach Collaboration with physicians to develop a provider friendly drug adherence tool List of drugs prescribed by any physician that was processed through any US pharmacy How often drugs were actually filled Quarterly Targeted Medication Reviews (TMRs) Member s primary physician received a letter regarding TMR outreach Listing of all medications filled with HAP rxcard

9 Medicare 5-Star Drug Adherence: HAP Results DIABETES DRUGS: Percentage of Patients Achieving Drug Adherence TMR Outreaches 83.3% 83.6% NO TMR Outreaches STATIN DRUGS: Percentage of Patients Achieving Drug Adherence TMR Outreaches NO TMR Outreaches 82.2% n=1, % n=1, % 80.8% n=3, % n=3, % 2014 (n=4,943) 2015 (n=5,515) 2014 (n=14,286) 2015 (n=16,305) At least one TMR outreach was performed for the TMR arms (TMRs provided every quarter so patients would receive 1 to 3 calls peryear) The 2015 non TMR arms received the Rx Claims Processor missed fill calls every month Both arms received the routine dispensing pharmacy prescription refill missed calls The percentage increase in drug adherence rate for the TMR Outreach arms contributed toward HAP achieving 4 & 5-star for those metrics

10 Medicare 5-Star Drug Adherence: HAP Results Cost-Savings/Avoidance from Process Change: Transitioning work from pharmacists to technicians saved $150,000/year Increased adherence to diabetes drugs and statins translates to decreased hospitalization rates yielding cost avoidance of $597,800 (2014) and $695,400 (2015) 2015 Cost Avoidance Calculation for Statin Drugs: STATIN DRUGS: Percentage of Patients Achieving Drug Adherence TMR Outreaches NO TMR Outreaches 2015 Statin Drugs Cost Avoidance: $439, % n=3, % 2014 (n=14,286) 82.2% n=3, % 2015 (n=16,305) 82.2% -79.7% = 2.5% increase in adherence for TMRs 2.5% x 3,650= 91 patients 1 Nonadherent diabetic patients to diabetic drugs are 1.39 times to have more hospitalizations than adherent patients. Therefore, 0.39 x 91 patients = 36 pts hospitalizations prevented 2 Average All-cause hospitalization cost = $12,200/pt(2012) 36 patients x $12,200 = $439,200 Reference: 1. Ho PM et al. Arch Intern Med 2006;166:

Nonadherence to chronic medications contributes to

Nonadherence to chronic medications contributes to BRIEF REPORT Pharmacy-based Interventions to Reduce Primary Medication Nonadherence to Cardiovascular Medications Michael A. Fischer, MD, MS,* Niteesh K. Choudhry, MD, PhD,* Katsiaryna Bykov, PharmD, MS,*