Empowering Health Plans to Control the Future of Medication Adherence

Background

A regional health plan client identified a need to improve member adherence and optimize workflows. They believed a medication adherence strategic solution could support both their parent company and internal goals by realizing efficiencies in drug therapy programs, optimizing their member adherence strategy, and improving medication use. In late 2017, RxAnte partnered with the health plan to successfully launch a comprehensive and data-based medication adherence solution: RxEffect. This analytics and workflow platform is designed to bring scalability to pharmacy outreach and interventions. Customized to a health plan’s unique needs, RxEffect was designed to empower health plans to work more efficiently to provide higher-value care through more effective medication adherence programs.

Program Design and Execution

The RxEffect intervention program ran during the final two months of 2017. During these two months, the health plan pharmacists made outreach efforts directed at improving patient adherence for diabetes, RASA, and statins. The program was designed around these key performance drivers:

• Effective interventions that are collectively capable of achieving the required lift.
• Appropriate targeting directed at members most likely to benefit from interventions.
• Interventions deployed in a timely manner based on the target population.
• Scalable interventions spread over the entire pool of high-priority members
• Unique patients recommended to the program: 7,398

Analyzing the Data

Analysis was restricted to therapies deployed with fills on or before the date of recommendation to ensure fair comparisons between the reached and not reached cohorts. RxAnte’s forecast provided a better metric for tracking to year-end performance than Acumen. It allowed us to see that the health plan continued a trend of year-over-year improvement in adherence rates throughout 2017 .

Results and Adherence Lift

Patients reached by targeted interventions in the RxEffect workflow platform became more adherent. Interventions were successful, resulting in higher-than-ever 90-day fill rates, even compared to already-high fill rates in 2016. Patients reached by intervention converted to 90 days at a higher rate than those never reached. Specifically, of 658 recommended therapies on less than 90-day prescriptions:

• 374 were reached, 51% of which converted to 90-day prescriptions.
• 284 were never reached, 26% of which converted to 90-day prescriptions.

 Impacts on Patient Fill Behavior

Pharmacists using RxEffect to conduct outreach have positive impact on patient fill behavior. Specifically, there were three items of note related to the program impact on member fill behavior – comparing reached and not reached member therapies attempted for outreach with fills due on or before the date of recommendations (to ensure fair comparison):

• Over the course of the two months this program ran, members who were due or late for medication refills and were reached filled their prescriptions at least 7.3 days sooner than those not reached.
• 39% of members reached filled on the day they were reached. Compare this to only 6% of members the program attempted to reach, but ultimately did not reach, filled on the day they were attempted.
• A greater proportion of those reached filled by year-end than those not reached.

Enhanced Operational Efficiencies

RxEffect took on the role of identifying and prioritizing members for outreach and automated the health plan’s adherence program report-outs. This shouldered a moderate amount of the administrative burden typically required for this process. As a result, the plan gained numerous efficiencies during the two months they used RxEffect. Specifically, the health plan realized:

• Maximized pharmacist time through predictive targeting of members most likely to benefit from a given intervention (versus the previous transactional late-to-fill calls).
• Reallocation of two FTEs to clinical activities following the removal of manual processes for program administration, reporting, and member outreach identification.
• Elimination of competing workflows, improving overall process management.
• Improved timeliness of outreach with dashboards that provided real-time monitoring and reporting.

Adherence for 2018 and Beyond

Per the pharmacy analysis, there were 1,516 non-adherent patients at year-end who were do-not-call, had invalid phone numbers, or recommended but not reached in the 2017 adherence program. Taking the next step with medication adherence calls for identifying additional solutions or resources for patients based on common barriers to adherence, which can be captured via RxEffect. Specifically, certain barriers cause adherence rates to decline, and those present an incredible opportunity to refine outreach strategies and methods.

Impacts on the Future of Healthcare

Using RxEffect to orchestrate interventions, customized to a client’s needs and target population, brings a new level of measurement and depth to medication adherence programs. Health plans should consider adding cost-effective, scalable intervention elements, like interactive voice response systems, to drive population-level adherence lift; expanding the RxEffect platform to new measures and populations; and implementing the programs across regions.

RxAnte will continue to monitor the results of RxEffect and make customized improvements with this health plan and other clients. We will explore other opportunities to enhance medication adherence with the platform as well, including the introduction of new modes of outreach to engage patients who are unreachable by phone, focusing on operational deployment, and exploring the effects of barrier resolution.

RxAnte predicted  year-end adherence with 92% accuracy for a population of approximately 47,000 MAPD patients with at least one fill of a diabetes medication, RASA, or statin.

 

RxEffect isn’t the only way we can improve administrative efficiencies and patient outcomes. Let’s talk.