Introducing ValueOptions Clinical Care Alerts January 2013
Agenda What are Clinical Care Alerts? How does it work? What are the benefits? Questions and Answers 2
The Issue of Poor Medication Adherence Unnecessary hospitalizations Medication escalation 3
The Impact of Non-Adherence Medication-related problems contribute up to 50% of behavioral health admissions, 20% of medical admissions, and increased morbidity and mortality. Medication non-adherence is considered the single most important factor leading to relapse among patients with schizophrenia. Risk of hospitalization for schizophrenia decreases by almost 20% for every 10% increase in medication compliance. Patients with therapy gaps of 30 or more days per prescription have almost five times greater risk of being hospitalized compared with patients whose therapy gaps are 0 to 10 days. American Health & Drug Benefits, August 2009 4
Most Interventions Today Target Patients Directly Physician Research shows patient self-reporting to be highly unreliable. 1 Patient Health Plan PBM Pharmacy 5
Clinical Care Alerts Our Clinical Care Alert automated system identifies and notifies physicians of potential behavioral health, physical health, and medication care gaps in a timely manner. It re-engages physicians in what has become an increasingly member-centric world to close patient-specific care gaps in the entire population while improving quality. 6
Clinical Care Alerts Help Close Care Gaps Works through the patient s trusted advisor the physician closing a key feedback loop Most often closed care gap is Early Discontinuation of Medication Enhances provider collaboration by notifying all physicians related to a specific issue 7
Automated Provider Engagement Behavioral Claim Data ValueOptions Clinical Care Alert Physician Patient 8
Concise Alerts that Support Collaborative Care Sample Medication Adherence Alert 9
Concise Alerts that Support Collaborative Care Sample Lab Monitoring Alert 10
Clinical Care Alert Technology Analytical tools consisting of field-tested, validated rule sets for successful conversion that drives overall cost savings Uses 11,000+ alert rules to screen the entire population and intervene earlier to reduce the chance of consumers becoming high-risk and high-cost Alert rules updated manually on a bi-monthly basis or as needed Enhances provider collaboration by notifying all physicians related to the specific issue in writing so they can work together to coordinate care for the consumer Automated alert generation leads to successful intervention Customized nimble, flexible data exchange structure 11
Clinical Care Alert Automated Process 12
Alert Rules Cover All Chronic Conditions Poor Compliance Early Discontinuation Sub-Optimal Therapy Duplicate Therapy Missing Procedures Alerts Polypharmacy Monitoring Drug-Drug Interactions Age-Inappropriate Therapy Overuse / Substance Abuse 13
Behavioral Health Related Rules Alert Depression Without Antidepressants Follow-Up After Hospitalization for Mental Illness Acute and Continuation Phase Depression Treatment Optimal Practitioner Contacts for Medication Management of Depression Medications that Aggravate Depression Schizophrenia Without Antipsychotics Antipsychotic medications & metabolic screening Bupropion & Eating Disorders Bipolar Disorder Without Mood Stabilizers ADHD Medication Management Example Diagnosed with depression but is not filling prescriptions for an anti-depressant. Consumers hospitalized for treatment of selected mental health disorders but not seen on an ambulatory basis or in intermediate treatment with a mental health provider. Consumers diagnosed with a new episode of depression were treated with antidepressant medication, but discontinued therapy prior to six months. Consumers diagnosed with a new episode of depression and treated with antidepressant medication, but have not had at least three follow-up contacts with a practitioner during the 84-day (12-week) Acute Treatment Phase. Multiple drugs have been reported to cause depression in some consumers. Elderly people are particularly at risk. Consumer appears to have schizophrenia but is not filling prescriptions for an antipsychotic. Consumers treated with an atypical antipsychotic agent that have not had a diabetes screening. Combination bupropion and eating disorder increasing risk of seizures. Consumer appears to have a bipolar disorder, but is not filling prescriptions for a mood stabilizer. Attention deficit hyperactivity disorder (ADHD) consumers on first-line medication that have less than one (1) follow-up visit per year. 14
Questions and Answers