CBI conference highlights three turnaround strategies to plug the gaps in patient adherence.
New insights into customer behavior fostered by the revolution in information technology are finally being applied to the age-old quandary of why most patients stop taking prescribed medications after a few months of therapy. This was a key conclusion of last month’s 11th annual Forum on Patient Adherence sponsored by Pharm Exec’s sister organization, the Center for Business Intelligence (CBI). The optimism of the more than 200 registered participants was reflected in what has become a regular feature of the Forum: the Strategic Patient Adherence Awards, which recognize excellence in adherence programs administered by drug manufacturers, PBM organizations, and—for the first time this year—employers.
“Our 2012 awards reflect the increasing capacity to leverage technology so that it can be tailored to the needs and motivations of the individual patient,” said judging panel member Robert Nauman, principal at BioPharma Advisors. “The insights follow—and the harvest is rich.” At a Forum discussion on the winning entries, all the judges noted that technology was enabling improvements in the design of programs, including the ability to reach out to more constituencies and to build coalitions, with a multiplier effect on results. Applicants are also doing better in addressing ROI, which is essential for maintaining support for these programs among senior management. “We call it the ‘why factor,’” Larry Boress, CEO of the Midwest Business Group on Health, said during the panel debate.
PBM giant Medco—now Express Scripts, after a merger with its former rival approved earlier this spring—snagged the award in the managed care category for its Specialist Pharmacy Care model, which builds on a network of Therapeutic Resource Centers staffed by trained Specialist Pharmacists to provide members with customized information on their condition. This takes the form of periodic written materials, alerts, and, if necessary, direct contact by phone or in person. The company applied its proprietary Health Action Plan software technology to develop individual profiles of member’s priority conditions, number of medications, gaps in treatment, and potential opportunities for cost savings through preventive care interventions. The network of Specialist Pharmacists has been trained to interpret this highly integrated data set and to make appropriate contacts with the member or his/her physician on ways to ensure medicines are taken for the duration of treatment.
To obtain the greatest benefits, the initiative is focused on 15 prevalent chronic care conditions that account for some 96 percent of Express Scripts total pharmacy spend. “Our company has enormous channels of data that we have synthesized into a tool directed to empowering the pharmacist as advocate for the patient,” Ellen Franzblau-Isaac, Director, Clinical Quality, told Pharm Exec. “Their access to this easily referenced data brings the pharmacist to another professional level, much higher than the norm. It has had a positive impact on member engagement as well as the job performance satisfaction of the employees who serve them.” Franzblau-Isaac relates that the toughest part of the program is classifying members within the 15 covered conditions, since it is often the case that members suffer from multiple chronic disorders.
Coming out tops in the employer category was Chicago-based Evive Health, which serves a varied industry client base with programs that apply insights from data to create personalized adherence communications that shape and change patient behavior, in a positive way. It was recognized for the breadth and variety of these communication programs—applied to a pool of nearly one million covered lives since 2008—in improving evidence-based care, including medication adherence, using new tools like the lessons from behavioral economics. “We have borrowed much of our engagement strategies from outside of healthcare,” relates CEO Peter Saravis. The main delivery channel is direct mail, but the messaging is cutting-edge. “Our goal is not simply to remind the patients about taking their medicine. We build beyond that with approaches designed to elicit a response and persuade them to reveal something about themselves that we can apply to good use later, this time emphasizing prevention and wellness extending beyond the simple act of taking the pill. It’s all about the right information, at the right time, and in the right way.” The judges were particularly impressed by Evive’s ability to document an average 15 to 28 percent increase in adherence over baseline in the populations covered by its sponsor programs.
Rounding out the winners was German-based drug manufacturer Boehringer Ingelheim, which applied the findings of a novel 2009 study on factors that lead patients to cycle off medications—The 11 Dimensions of Non-adherence—to create a highly focused, pharmacist-driven, patient-specific adherence program covering some 950 patients using prescribed B-I chronic use medications. The Patient Empowerment Program was built around a customized non-branded website, integrated with sophisticated pharmacy management software and offering easy access for participating patients. Patients start the process by completing an assessment, which generates an individual patient profile from the 11 dimensions of non-adherence. This profile provides an ongoing series of printed intervention tactics to share with patients when they fill or re-fill a prescription.
On the pharmacist side, a simple training module was designed to introduce the concept of the 11 dimensions and to demonstrate how to administer the program, from using the website to guidance on how to structure the discussion with patients. “Our goal from the start was to design a program that conforms to the workflow of the pharmacy—something that would complement their tasks, not compete with them,” Robert Belknap, Executive Director Trade Sales and Operations, told Pharm Exec. There is a perception that all a pharmacist does is point to “sign here” when you pick up a prescription. “This is an untrue depiction of a profession that wants to do more and has the skills and accessibility to get results from patients. Our program is designed to unlock the potential of the profession by making it easier for them to engage with the person on the other side of the counter.”
For its part, B-I has already unearthed a rich pool of data and insights from the program and is now considering how to “seed it” for a wider audience. “The template is literally something that everyone can own,” says Belknap. “There is no downside, as it represents a win for all—patient, payer, retailer, and manufacturer.”