Key Learnings Pharmacy Access Project. Key Learnings and Applications. Changes in Medication Adherence Rates. Jack Mahoney, MD Medical Director

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1 Key Learnings Pharmacy Access Project Jack Mahoney, MD Medical Director Medications adherence rates in VBID group increased consistently across all study periods. 2 Changes in Medication Adherence Rates Baseline Data on file: 3 1

2 Medications adherence rates in VB group increase consistently across all study periods. VB was associated with a significant change in drug mix Consistent with ADA/Nathan Protocol 4 Medication Use Three year change in drug mix Percentage change in medication utilization from baseline to year 3 Brand Generic Insulin The percentage of people using insulin in the combined intervention cohort increased significantly by year 3 (51%). Generic utilization increases in both the DM and DM plus value based cohorts were similar by year 3. Brand name drug utilization decreased in the DM only cohort. VB+DM DM Data on file: 5 Type II Diabetes Treatment Recommendation Nathan DM et al. Diabetes Care. 2008;31:

3 Diabetes Drug Treatment Pathways: DM Cohorts No Diabetes Rx* VBID: 15% Traditional Plan: 22% Metformin + 2 VBID: 17% Metformin + 3 VBID: 2% Traditional Plan: 4% Metformin + 1 Traditional Plan: 15% VBID: 22% Metformin Only Traditional Plan: 22% Insulin Only Other Treatments VBID: 11% VBID: 12% VBID: 21% Traditional Plan: 9% Traditional Plan: 11% Traditional Plan: 16% Of the Metformin treatments, the majority of patients in both plan designs are taking Metformin plus one additional drug in Year 3. In Year 3, the VBID cohort has more patients taking other prescription drug treatments than patients in the traditional plan design. More patients are without a diabetes prescription in the traditional plan design than in the new plan design in Data on file: * Indicates difference between new and traditional plan design is statistically significant (p<.05) 7 Medications adherence rates in VB group increase consistently across all study periods. VB was associated with a significant change in drug mix Consistent with ADA/Nathan Protocol Some evidence of improved patient engagement and behavior change in VB group Adherence to care guidelines Financial performance in VB group driven by decreased utilization of outpatient services. Lower cost exposure shared between member and plan sponsor. 8 Care Management Adherence to Care Guidelines Percentage of Covered Members Receiving Care at Year 3 VB + DM DM VB Only No Int HbA1c 69% 61% 58% 55% PCP Visits 89% 73% 87% 86% Lipid Test 69% 59% 63% 63% Urinalysis 56% 5 53% 49% Data on file: 9 3

4 All Cause Total Cost Experience Both cohorts covered by disease management showed sustained negative three year trend for all medical costs. The cohort with the combined intervention had the most favorable experience. Data on file: 10 Total Diabetes Related Costs 45% 4 35% 3 25% 2 15% 1 5% Lowest cost growth over three years was found in the cohort with the combined interventions. DM alone reduced the cost growth by 33% while the combined intervention produced a reduction of more than 5 as compared to the external control. Data on file: 11 Total Diabetes Related OOP The cohort with the combined intervention consistently had the lowest out of pocket exposure related to their diabetes care. Data on file: 12 4

5 Total Diabetes Net Pay by Plan Sponsor 5 45% 4 35% 3 25% 2 15% 1 5% The cohort with the combined intervention consistently had the lowest net plan sponsor payments for diabetes care. Data on file: 13 Drivers of Change in Diabetes Related Cost Inpatient cost per member decreased steadily for both groups with disease management as opposed to the external control experience. The greatest decrease in inpatient cost was observed in the cohort with both disease management and the value based pharmacy design. Data on file: 14 Drivers of Change in Diabetes Related Cost The cohort with both disease management and value-based pharmacy design consistently had decreases in outpatient cost. The disease management only cohort, as well as the external control had increased outpatient costs in all three years. Data on file: 15 5

6 New programs must include Patient engagement tools/communications Focus on members gaining self management skills Not just being managed Critical role for PCP engagement Potential role for formulary management 16 Implementing Learnings New Program Strategy Patient Engagement Employer Value Based Plan Design Diabetes Education Coaching PCP Involvement Endocrinology Consultation 17 THANK YOU! QUESTIONS? Jack Mahoney, MD Medical Director Gibson T et al. Health Affairs 2011; 30(1):