amcp keynote presentation from avella specialty pharmacy

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

Page: 4 | Confidential and Proprietary

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/

http://hin.com/blog/2013/12/24/infographic-storing-healthcare-data/


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/

http://www.totalassist.com/infographic-healthcare-mobility-doctors-250-likely-tablet/


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.”


What Watson is Doing Now

http://www.youtube.com/watch?v=sIxOM2Y5yuE&feature=youtu.be

Chart Title

By 2016, 8 out of the top 10 branded pharmaceuticals in the U.S. will be

specialty medications.


=+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


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


Integrated Care


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


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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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.


Integrated Real-time Close-Looped Solutions Will Drive the Future of Healthcare


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


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


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.


AIM Provider Portal

Source: https://wellpoint.aimoncology.com/CancerTreatmentPathways.html


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


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

Page: 25 | Confidential and Proprietary Provider Portal


Patient Access and Empowerment

Page: 27 | Confidential and ProprietaryMobile App

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


Patient Education & AdherencePersonalized education appended to patient’s personal health record


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).


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.


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


Study Results

The intervention group showed a 12.6% improvement in adherence rate (MPR)

over the course of the study.


Study Results

Intervention group was 78% more likely not to be hospitalized: Saving $27,852

per month in healthcare costs.


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.”



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?


Xeloda YES 76

Xeloda NO 40

Monitoring Parameters — Did your doctor tell you about the importance of [Xeloda] lab work?


Xeloda YES 64

Xeloda NO 52

Indications — Does the patient know what the [Xeloda] indication is?


Program Validation: Counsel opt-out


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


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


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


Stay Connected

Rebecca M. Shanahan, Esq.CEO of Avella

linkedin.com/pub/rebecca-shanahan/7/100/262

[email protected]