amcp keynote presentation from avella specialty pharmacy
TRANSCRIPT
Specialty Pharmacy:Connecting the Healthcare Industry
Rebecca M. Shanahan, Esq.CEO of Avella
April 3, 2014
“A lot of people in our industry haven't had very diverse experiences. So they don't have enough dots to connect, and they end up with very linear solutions without a broad perspective on the problem. The broader one's understanding of the human experience, the better design we will have.”
- Steve Jobs
Current Forces in Healthcare
“Minute clinics” Primary care office Specialist office
Hospital Outpatient Home health
Hospice Retail pharmacy Specialty pharmacy
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Explosive Growth in Healthcare Data
The healthcare industry is experiencing explosive growth in data: from 500 petabytes in 2013 to 25,000 petabytes by 2020.
= 500 Petabytes
2013 2020
Source: http://hin.com/blog/2013/12/24/infographic-storing-healthcare-data/
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Physicians are Going Mobile
Chart Title 66% of doctors use a tablet for medical purposes
Chart Title More than 50% of doctors using a mobile device report that they aid in decision-making
Chart Title 40% report decreases in administration time due to mobile device usage
Doctors are 250% more likely to own a tablet than other consumers Source: http://www.totalassist.com/infographic-healthcare-mobility-doctors-250-likely-tablet/
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Silo Innovation May not Work
#1 Innovation: Checklists
Hospitals will require health care providers to follow strict protocols for procedures that benefit from routinization—from preparing a patient for surgery to inserting a central line.
“Ten Innovations That Will Transform Medicine”
“Researchers found no significant drop in complication or mortality rates in the three months after the adoption of checklists.”
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What Watson is Doing Now
Chart Title
By 2016, 8 out of the top 10 branded pharmaceuticals in the U.S. will be
specialty medications.
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=+Cashless & Convenient:You don't need cash when you ride with Uber. Once you arrive at your destination, your fare is automatically charged to your credit card on file – no need to tip. We’ll also e-mail you a receipt.
One Tap to Ride:Uber uses your phone's GPS to detect your location and connects you with the nearest available driver. Get picked up anywhere — even if you don't know the exact address.
Patient Access and Empowerment• Physicians, nurses, medical assistants,
practice managers and other staff that influence what specialty pharmacy is used by the patient.
What Specialty Stakeholders Want
Predictable Costs• Value based health care• Bending the cost curve
Documented Quality• Best Practices Clinical & Formulary
Management• Patient & Provider Network Satisfaction• Documented Comparative Outcomes
Integrated Care• Pharmacy & Medical Benefit• Administrative efficiencies• Web based technology interfaces with
protected PHI
Connecting a Disconnected Industry
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Specialty Pharmacy: Linking the Silos
Specialty Pharmacy Healthcare Silos
• Which patients have experienced (1) ER visit / hospitalization or (2) new medical condition?
• Which patients need refills?• QOL Issues/Opportunities• Correlate outcomes differences to
prescriber, patient therapy, outcomes
Safety & Outcomes Compliance & Benefits • What Step Therapy, PA & CPBs• How often is patient missing
doses? Why?• Has patient discontinued
therapy? Why?• Has patient been referred to MD
or manufacturer patient support?
• What disposition?
Patient Data• Lab Values• Patient-specific Data• Skills of Daily Living and
Physical Info• Compliance Rate• Discontinuation & Reasons Why• Drug-Specific Outcomes at
Targeted Levels
Physician Payor Pharma
RESULTS:• Communication• Safety• Adherence• Improved
Outcomes
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Integrated Care
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Conflicting Trends
New Approach Needed:‘Specialty’ Specialty Pharmacy to focus on high-cost, low-population needs
Reining-in the high cost of healthcare
Industry consolidation leveraging volume throughput
Higher-cost specialty drugs for smaller populations of patients
Precision therapy with highly refined patient populations
Economic Clinical
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Drug Development: Rapidly Advancing Arsenal of Very Costly, High Precision Tools
Ref: Robert Mancini et al. Oral Oncolytics: Part 1—Financial, Adherence, and Management Challenges; August 15, 2013, Cancer Network, Oncology Vol. 27, No. 8 © Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.
Courtesy Mark Schoenebaum, ISI Group
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p70 S6K
p70 S6K
mTOR
AKT
P13K
GSK3 a/b
BCR-AB1
Src
Src
P
Predominant inendothelia
Bevacizumab
Bevacizumab
VEGFR3
VEGFR2
VEGFR1
bFGR
IGF-1RP P
P
HER-2
ErbB3PDGFRa/bCetuximab
c-Kit
AZD2171SunitinibDasatinibImatinib
AZD2171SunitinibDasatinibImatinib PF-0299804
BIBW 2992
PPI/DasatinibBEZ235
Dasatinib
PDF184352
SorafenibRAD001
P
P
P
RASP
B-RAF
MEK
ERK1/2PP
p38MAPKP
ERK1/2 p38MAPKP
P
Chemotherapeutic agents(cisplatin/paclitaxeldocetaxel/docetaxel + cisplatin)
Bortezomib
ProteosomeSUBSTRATE
CEL
L C
YCLE
G1
R
S
MG2 17-AAG
STAT1,2,3,5,6P
STAT1,2,3,5,6P
AG490
AZD2171Sunitinib
STAT
JakP
P P
P
P
P
AG1024 /PP1
SU5402AZD2171SunitinibSorafenib
AZD2171ZD6474
SunitinibSorafenib
Tumor cellVEGFs,bFGF
HIF-1abFGFR VEGFR1 VEGFR1 VEGFR3
Endothelial cell
Bevacizumab BevacizumabBlood vessel
AZD2171sunitinib
AZD2171ZD6474sorafenibsunitinib
AZD2171sorafenibsunitinib
SU5402
Waste
Proteins
LBH589
Aggresome
LBH589
ASA404
HDAC
HDAC
Figitumumab
P
EGFR/HER-1
GefitinibErlotinibPF-0299804BIBW 2992
ALKCrizotinib
c-Met
CrizotinibPF-04217903
Drug Specialization: Increasing with Understanding of Biology
© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.
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Integrated Real-time Close-Looped Solutions Will Drive the Future of Healthcare
© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.
SharedHIT
Solutions
Patient
Specialty PharmacyPhysician
Physician:Increasing complexity of
precision therapeutics requires decision support, virtual Clinical
Pharmacist Partner
Patient:Just-In-Time, 3 minute mobile health solutions to empower the patient &
maximize adherence and compliance
Specialty Pharmacy:Rapidly expanding arsenal of high-cost,
low-volume therapeutics demands personalized approach
Ongoing Benefits Management Complexities
Patient:Get the right informationGet the right drug & dose
Get it at the right time
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Specialty Pharmacy: POS & Medical Benefits, Processing World Collide
Considerations
Two billing methodologies converge
Specialty Drug Spend 2014 and beyond
Specialty PharmacyMedication Fulfillment
Point of ServiceDrug Claims Processing
Drug BenefitNCPDP/PBM
One system, non siloes claims data
Strong Integration
Billing requirement differences,
NCPDP/Universal Claim vs. Procedural Coding,
HC15010, EDI vs. snail mail or 837
Traditional Medical Claims Processing
Medical BenefitUB/1500 -837(p)or(i)/Payors
Reimbursement“Rules of Engagement”Managed Care/Payor
Contracting
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PathWare™ Decision Support for Clinical Pathways
Get the Right Drug to the Right Patient at the Right Time© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.
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AIM Provider Portal
Source: https://wellpoint.aimoncology.com/CancerTreatmentPathways.html
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Frameworks SRx Integrator Platform
The New Specialty Pharmacy:Highly configurablePushing/Pulling Data Across dispersed yet shared healthcare continuum.Connecting Patients, Payors, Providers, Drug Manufactures, Specialty Pharmacy for better outcomes (Health/Financial)
Specialty Pharmacy Management
Patient & Payor
Physician/Hospital Management
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Transactional
• Scripts• Authorizations• Fills• Claim Filing• POS/Medical
Data Capture
• Providers• Pharmacy• Patient• Payor
Central Data Repository
and Analytics
• Contract • Patient Management• Claims Management• Audit Risk Mitigation• Better Outcomes
Patients
• Better Compliance• Better Management• Lower Cost• Predictable• Better Outcomes
Single Repository – User Specific InsightsMaking data user defined and easily obtainable
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Patient Access and Empowerment
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Bi-Directional Text Messaging Program
• Text messaging program• Daily reminders to take
medication• Reminders for lab work • Educational tips, e.g. blood
pressure monitoring • Motivational messaging• Patient surveys
• Gather lab values
• Pharmacist intervention for any indication of non-compliance
• Clinician notified• Weekly emails to clinical staff
• Refill Reminders
Bi-Directional Text Messaging ProgramIncrease in Refill Rates After Adoption
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
69.4%
89.4%
Pre-adoption rate
29%Growth in refill rate after adoption of text messaging program
Post-adoption rate
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Patient Education & AdherencePersonalized education appended to patient’s personal health record
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Patient Empowerment
Leading provider of oncology patient portals provides personal health record for connected patient participation
68% visit greater than 4+ times per month
50% of invited patients join portal
Our pilot program demonstrated a 50% increase in medication adherence at month 4 of therapy for Tasigna®
patients using GlowCap (vs. control group).
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Patient Adherence ComparisonAvella GlowCap Users vs. Non-Users
• Early data show Avella patients with GlowCap had better adherence in their first 4 months of therapy.
• The gap between the groups seems to grow overtime, especially for Tasigna patients.
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Documented Quality &Predictable Costs
Dispensing Scorecard Example – Q4, 2013
Pharmacy A
Other specialty pharmacies
Days
Perc
ent F
illed
0-3 4-7 8-14 15-28 29+0%
10%
20%
30%
40%
50%
33%
34%
23%
9%
3%
45%
23%22%
9%
1%
Of first dispenses take place within 3 days, 31% variance between Best Practices & SRx Network.45%
Delayed therapy patients: This gap represents patients who are not receiving medication as quickly as patients in Best Practices SRx
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Study Results
The intervention group showed a 12.6% improvement in adherence rate (MPR)
over the course of the study.
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Study Results
Intervention group was 78% more likely not to be hospitalized: Saving $27,852
per month in healthcare costs.
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Pathway Results Speak for Themselves…
“This analysis affirms that savings on aggregated breast, colon, and lung cancer spending as high as 15% can be achieved in the first year of our pathways program concurrent with as much as a 7% reduction in hospital admissions.”
© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.
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Program Validation: Open-Ended Questions
Drug Response Type Response Count
Xeloda YES 56
Xeloda NO 60
Side Effects — Was the patient aware of [Xeloda] side effects?
Drug Response Type Response Count
Xeloda YES 76
Xeloda NO 40
Monitoring Parameters — Did your doctor tell you about the importance of [Xeloda] lab work?
Drug Response Type Response Count
Xeloda YES 64
Xeloda NO 52
Indications — Does the patient know what the [Xeloda] indication is?
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Program Validation: Counsel opt-out
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Prior Authorization Edit for Telaprevir (Formulary Management)
Goals:• Clinical evaluation of each fill
– RGT• Prevent wastage
– 4th fills denied
Avella Intervention
Clinical Pharmacist Review
325 internal PA’s submitted
6 claims denied due to inappropriate request• 4 requested for 4th fill• 2 requested for patients with VL
>1,000u/ml at week 4
Total Savings of $158,772.90
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Monthly cost of Votrient: $9,240* per patient
• Plan A: Total cost for 30 day supply
• Plan B: Total cost for 15 day increments in 30 days
• Anticipated 10% attrition within 30 days
• $27,720 potential savings in one month for one drug if utilizing Plan B
• 5% savings per month utilizing Plan B
* Based on current AWP
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In Summary
• Explosive growth in SRx pipeline and costs create a demand for industry collaboration.
• Communication, collaboration and technology drive adherence, improve outcomes, and reduce healthcare costs.
• Specialty pharmacies are uniquely positioned to serve as the “healthcare industry connecter”
• Watershed moments in SRx continue – Sovaldi, Imbruvica…more to come
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Stay Connected
Rebecca M. Shanahan, Esq.CEO of Avella
linkedin.com/pub/rebecca-shanahan/7/100/262