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Investment in resources that support clinicians and patients closer to the point of care may be the cure for what ails managed care executives.
The transition to value-based care for payers is not about enrolling patients. In four separate meetings this year with major affiliated, yet independent payers, we heard differing needs and priorities:
1. More connectivity with practitioners.
2. A reduction of the cost and risk of non-compliant patients with chronic conditions.
3. Ability to demonstrate the provision of value to corporate plan sponsors.
4. Securing provider preference.
What do they all have in common? A need for clinical team alignment that drives spending down. What can managed care executives do for patients and plan sponsors that simultaneously wring out costs? Invest in resources and tactics that support the patient-clinician relationship, especially for chronically ill patients.
The crucible of value lies in the supporting the relationship between the clinician and the patient. Why? This is the top opportunity to impact the patient experience and demonstrate the importance of therapy compliance, including medication adherence. Yet the time per patient interaction for clinicians continues to shrink. Resources, human and technological, that fill the gaps in patient education, accelerate access to therapy and improve adherence are critical to improving outcomes, thereby maximizing the value of expenditures for payers and plan sponsors.
One of the aforementioned payers described the need for a solution to eliminate $20 million in avoidable costs among a population of less than 1,000 HIV patients. The top driver of those avoidable costs is therapy nonadherence. With a very high level of the HIV population living within 150% of the federal poverty level, prior authorization assistance and expertise within the 340B federal drug assistance program are critical to preventing progression from a now manageable chronic condition (HIV) to AIDS.
Stigma circumvention tactics, particularly those regarding medication, help ensure compliance. So, too, does the development of a trusting relationship between the patient and the patient support staff, including clinical pharmacists. These are two highly effective ways to maximize the value of HIV treatment.
As we reported last year, the University of Alabama’s 1917 Clinic, a Ryan White grantee, presented a study during the 10th International Conference on HIV Treatment and Prevention Adherence. The results showed that out of 157 patients with HIV whose viral loads were not suppressed prior to enrollment in enhanced medication management protocols, 103 have now achieved viral suppression.
Curant Health and Johns Hopkins Medicine’s Meyerhoff Inflammatory Bowel Disease Center revealed in October 2016 that medication therapy management improves adherence more than 30% compared to the standard of care for IBD patients. Curant is providing enhanced medication therapy management (MTM) and specialty pharmacy services for this ongoing study.
Among 110 randomized subjects (24 of which were excluded primarily due to insurance restrictions), 55% of patients in the intervention arm receiving medication therapy management (MTM) were considered to have improved adherence compared to 25% in both control arms.
The preliminary results of Project A.L.I.V.E. (Adherence and Long-term IBD Value-added Effectiveness) were delivered by Principal Investigator and Assistant Professor of Medicine at Johns Hopkins University Sharon Dudley-Brown, PhD, and Curant Health Director of Clinical Pharmacy Vickie Andros, PharmD, in a poster presentation at the 2016 American College of Gastroenterology Annual Scientific Meeting.
Systematic review of the literature validates that once this study is completed, it will contain the first reported long-term adherence data for Crohn’s disease (CD) or ulcerative colitis (UC) and the first data published evaluating the impact of MTM on IBD outcomes.
Project A.L.I.V.E. seeks to “implement and evaluate the effectiveness of an Inflammatory bowel disease (IBD) MTM patient fulfillment model compared to standard care in a large university hospital setting.”
According Dr. Dudley-Brown, CD and UC are chronic, debilitating conditions that can have important economic and clinical implications. In 2004, the annual cost of IBD in the United States was estimated at $1.84 billion. IBD is associated with high morbidity, loss of work productivity and impaired quality of life.
According to the IMS Institute for Health Informatics, medication nonadherence is responsible for more than $200 billion annually in wasted healthcare spending.
“Project A.L.I.V.E. is well on its way to measuring program value for IBD patients and caregivers with preliminary results showing improved adherence in the treatment arm. We anticipate that our enhanced medication therapy management and patient support services will continue to demonstrate project value through outcomes improvement and impact on cost through a reduction in hospitalizations and emergency department visits for this patient population,” Andros says. “Continuing to validate our work alongside Dr. Dudley-Brown, her colleagues, and most importantly improving the lives of people suffering from IBD, is central to our mission.”
It is becoming clear that investment in patient support services and clinical team alignment that provide as much support to the clinicians as they do the patients are value-based investments capable of wringing costs out the system while simultaneously improving outcomes.
Marc O’Connor is chief operating officer for Curant Health. Curant Health provides medication management, patient support and pharmacy fulfillment services for patients nationwide.