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

See clearly. Make better decisions. Reduce costs. - www.artemetrx.com

Optimizing Data Analytics for Quality and Economic Outcomes

Robert Littrell, Pharm.D.Founder and Chief Executive OfficerArtemetrx, LLCPhone: (859) 277-1447Email: [email protected]

National Behavioral Health ConsortiumSan Diego, CASeptember 6, 2007


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


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


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

Artemetrx, LLC


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


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


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:

SEE

CLEARLY

MAKE BETTER

DECISIONS

REDUCE COST &IMPROVE HEALTH1 2 3


Tools , Interventions, People

SEE

CLEARLY

MAKE BETTER

STRATEGIES & DECISIONS

IMPROVE HEALTH

& REDUCE COST1 2 3

Internal Review

Monthly CustomerInteraction

Implement CustomizedInterventions

MeasureOutcomes

Data Acquisition

Data Integration

Data Synthesis/Analysis

Web Application

TangibleHard-DollarDefensible

Data AggregationData Warehousing

Health Risk AppraisalsMember Surveys

Personal Health Records

Predictive ModelingProvider Profiling

Consulting

Customized Intervention ProgramsPopulation Health Management

Case ManagementRx Formulary Management

FSA SupportHealth & Productivity Management

Data AnalystsHealthcare Analysts

PhysiciansPharmacists

NursesData Analysts

Healthcare Analysts


NursesHealth EducatorsHealth CoachesData Analysts

Healthcare Analysts


Data Aggregation

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


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


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


Sample Intervention #1: PPI


Findings from Data Integration/Analysis


Clinical Underpinning A: Duration of Therapy

87% > 60 days of therapy


Financial Considerations

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


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.)


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….”


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


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



Kentucky Medicaid PPI Savings


Sources of Artemetrx Savings for Kentucky Medicaid

Program Total State Federal

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

Pct 100.00% 30.74% 69.26%


Sample Intervention #2:Voluntary Tablet Splitting


Findings from Data Integration/Analysis


Clinical Underpinning


Financial Considerations

$2.89

$2.83

$2.84

$1.83$1.45(↓49%)

½

½ $1.41(↓50%)

½ $1.42(↓22%)

Average Plan Cost for Lipitor Tablets by Tablet Strength


Avg Cost/Day of Lexapro Therapy

$1.84

$1.72

½

$0.92(↓47%)

$1.45

$0.86(↓41%)

½


Avg Cost/Day of Zoloft Therapy

$1.95

$1.95

$1.87½

½

$0.97(↓50%)

$0.97(↓48%)


WSF Voluntary, Targeted TabletSplitting 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


WSF Voluntary, Targeted TabletSplitting Program

599; 69%

191; 22%

77; 9%

Opt In Unable Decline

• 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


WSF Tablet Splitting Cost Savings(based on 50% conversion in voluntary tablet splitting program)

Brand NameNet 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

Plan $242,979.00

Members $ 71,891.16

Total $314,870.16


Sample Intervention #3:DiabetesHEALTH Disease Management


WSF Diabetes HEALTH: Current Status

• Participation Goal: 40 members in Cincinnati area• Group Education Sessions completed• Individual sessions well underway

*


Participant Group Profile


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


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


Sample Intervention #4:Incentive Management Web Tool/Program


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


Additional Examples of Services & Programs


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


Health Risk Assessment/Self-Report Tools

Multiple survey instruments supported and can vary by population or program.


Relative Increase in Claims Cost by BMI Risk and Age


Sample of HRA Reporting and Analysis


Integration of Medical and Time/Attendance Data


Diabetes Quality of Care

Diabetes Quality of Care Metrics


Quality of Care: Depression


Provider Profiling: Diabetes


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%


Tools and People

SEE

CLEARLY

MAKE BETTER

STRATEGIES & DECISIONS

IMPROVE HEALTH

& REDUCE COST1 2 3

Internal TriHealthReview

Monthly CustomerInteraction

Implement CustomizedInterventions

MeasureOutcomes

Data Acquisition

Data Integration

Data Synthesis/Analysis

Web Application


Data AggregationData Warehousing

Health Risk AppraisalsMember Surveys

Personal Health Records

Predictive ModelingProvider Profiling

Consulting

Customized Intervention ProgramsPopulation Health Management

Case ManagementRx Formulary Management

FSA SupportHealth & Productivity Management

Data AnalystsHealthcare Analysts


NursesData Analysts

Healthcare Analysts


NursesHealth EducatorsHealth CoachesData Analysts

Healthcare Analysts


Questions/Discussion/Name-Calling/Joke-Telling

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

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data analysts

data analytics

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