Improving Medication Use with Predictive Analytics and ......Improving Medication Use with Predictive Analytics and Targeted Clinical Programs: Translating Practical Research into
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© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 1© 2 0 1 5 R x A n t e , L L C A l l R i g h t s R e s e r v e d .
C o n f i d e n t i a l
Improving Medication Use with Predictive Analytics and Targeted Clinical Programs: Translating Practical Research into a Successful Business
Josh Benner, PharmD, ScDFounder / CEORxAnte, Inc.
Johns Hopkins Bloomberg School of Public HealthDecember 11, 2017
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 2
Topics
1. My story
2. The problem(s) that bother me
3. The research behind RxAnte
4. How we turned the research into a meaningful business
5. Closing thoughts
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 3
My Story
Pharmacist
Public health (pharmacoepi + decision analysis) researcher
ValueMedics
Policy guy
RxAnte
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 4
Ineffective medication use is burdening the healthcare system
Source: Quintiles IMS (2016), Express Scripts (2017), Alzheimer’s Association (2017), CDC (2012), American Cancer Society (2014), AHRQ (2011)
$323 $300
$259
$193
$88
$41
0
50
100
150
200
250
300
350
Spend on prescription
drugs
Total cost of under/over/misuse
Alzheimer's Cardiovascular Disease
Cancer Readmissions
$ IN
BIL
LIO
NS
Total prescription drug spend
…exceeds the direct cost of some of the most prevalent medical
concerns in the United States.
The true cost of medications…
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 5
As the “true cost of medications” has become better understood, it has begun to drive policy
$300B opportunity
Sources: American Journal of Managed Care; New England Journal of Medicine; National Center for Biotechnology Information.
Real-worldexamples
Overuse
$70B+Annual cost of
prescription opioid abuse
Underuse
$100B+Annual direct cost of
nonadherence to diabetes, hypertension and dyslipidemia
medicines
Misuse
700K+Annual ER visits due to
adverse reactions to prescribed drugs
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 6
Real improvement requires overcoming two barriers to progress
Source: Yeaw, J, Benner J, et al. J Manag Care Pharm 2009;(9):728-40
Most interventions are delivered after people stop their meds. The best way to solve non-adherence is to prevent it. 1
Adapted from: Benner J, et al. Value in Health 2002; 5(3):126 and other meta analyses.
The most effective interventions are costly and difficult to scale.2
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 7
Incentives to improve medication use are driving new interactions among payers, providers, and patients
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 8
About RxAnte
Founded by leaders in health services research, quality improvement, and advanced predictive/causal analytics
OUR TEAM
8M+ lives under management across national and regional health plans, PBMs, health systems, and pharmaceutical manufacturers
OUR CLIENTS
Improve drug therapy outcomes with advanced analytics and targeted clinical programs
OUR MISSION
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 9
RxAnte has three common use cases
VALUE OF MEDICINES
CMS Stars
HEDIS
Custom Measures
QUALITY IMPROVEMENT
MEDICAL COST SAVINGS
$ANALYTICS PLATFORM
• Which members?• What to do?• When?• What were the outcomes?
• What did it cost?• What was the ROI?• What will it take to achieve my goals?
Measure drug performance and
enable value-based purchasing
Reduce total cost of care by improving
medication use
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 10
RxAnte’s solutions are proven to improve medication use and outcomes by focusing on 4 key elements
Identify members most likely to benefit – prioritize by risk, receptivity, and urgency
Deploy interventions before non-adherence or bad outcomes occur
TARGETING
TIMING
Measure and manage intervention performance constantly to drive outcomes
Right-size intervention strategy to maximize benefit and control cost
EFFECTIVENESS
SCALE
PREDICTIVEANALYTICS
EFFECTIVEOUTREACH
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 11
Our solutions all begin with patient-level data and proprietary analytics
CONTACT CENTER
IVR
DIGITAL THERAPEUTICS
STARS HEDIS CUSTOM MEASURES
Quality Improvement
COST OF CARE MANAGEMENT
DRUG PERFORMANCE
VALUE-BASED PURCHASING
Medical Cost
RxAnte Solutions
Analytics Interventions
Program Management & Strategy Support
Drug Value
RXEFFECT™WORKFLOW PLATFORM
Rx Claims
Medical Claims and Eligibility
Other Client Data
$
4 5 5
RxAnteAnalytics Engine
Rx
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 12
Predictive analytics can identify patients at risk of suboptimal medication outcomes
The RxAnte Adherence Score™ indicates the likelihood of future adherence at a patient and therapy area level
The Value of Future Adherence Score™ reports avoidable medical costs attributable to medication non-adherence
The Risk of Unsafe Use Score™ identifies patients at risk of unsafe use of prescription opioids
RxAnte’s Value of Intervention™ approach targets patients based on predicted risk, urgency, and receptivity to intervention
WON’TScore 15
MIGHTScore 62
WILLScore 97
The RxAnte Adherence Score™ indicates the likelihood that a patient will be adherent
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 13
RxEffect™ is the online outreach solution to improve medication outcomes
RxEffect Outreach Solution
2017
Plan-sponsored QI programfueled by daily data and proprietary analytics and decision support
Targeted to the patientswho need it most, and the doctors, pharmacies, and care coordinators accountable for them
Real-time monitoringof each patient’s refill behavior, and constantly optimized workflow
Configurable solutioncan address a wide range of measures related to prescribing, medication safety, or medication adherence https://www.rxante.com/1490/video-rxeffect/
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 14
Then we manage performance on an ongoing basis
Program Management and Strategy
Client Services team advises and supports clients as strategic partners
Continuous monitoring of intervention effectiveness:
deployment rates, reach rates, clinical session rates
Understand weekly members who are adherent, non-adherent,
and still in play to positively impact Star Ratings.
Program EvaluationProcess FidelityBi-annual evaluation of overall and intervention-level performance to
inform ongoing program deployment strategy
Performance Forecasting
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 15
65%
70%
75%
80%
85%
2010 ("2012" Stars)2011 ("2013" Stars)2012 ("2014" Stars)2013 ("2015" Stars)2014 ("2016" Stars)2015 ("2017" Stars)2016 ("2018" Stars)
% o
f Mem
bers
Adh
eren
t
Adherence to Chronic Medications among Medicare members (2010-2016)
Antidiabetics MAPD Antidiabetics PDPRenin Angiotensin System Antagonists MAPD Renin Angiotensin System Antagonists PDPStatins MAPD Statins PDP
We’ve been fortunate to be part of a public health program that has meaningful impact
© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 16
Closing thoughts
The under-use, over-use, and mis-use of prescription drugs is a preventable $300B problem
All stakeholders are paying increasing attention to this issue, in the form of new quality measures and performance incentives
Population health outcomes are a shared responsibility among payers, health professionals, pharmacy, and patients
Researchers with expertise, passion, and creativity in this area are needed: in government, in academia, and in business
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