Improving Medication Use with Predictive Analytics and ......Improving Medication Use with Predictive Analytics and Targeted Clinical Programs: Translating Practical Research into

© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 1© 2 0 1 5 R x A n t e , L L C A l l R i g h t s R e s e r v e d .

C o n f i d e n t i a l

Improving Medication Use with Predictive Analytics and Targeted Clinical Programs: Translating Practical Research into a Successful Business

Josh Benner, PharmD, ScDFounder / CEORxAnte, Inc.

Johns Hopkins Bloomberg School of Public HealthDecember 11, 2017

© 2017 RxAnte, Inc. All Rights Reserved. Confidential. 2

Topics

1. My story

2. The problem(s) that bother me

3. The research behind RxAnte

4. How we turned the research into a meaningful business

5. Closing thoughts


My Story

Pharmacist

Public health (pharmacoepi + decision analysis) researcher

ValueMedics

Policy guy

RxAnte


Ineffective medication use is burdening the healthcare system

Source: Quintiles IMS (2016), Express Scripts (2017), Alzheimer’s Association (2017), CDC (2012), American Cancer Society (2014), AHRQ (2011)

$323 $300

$259

$193

$88

$41

0

50

100

150

200

250

300

350

Spend on prescription

drugs

Total cost of under/over/misuse

Alzheimer's Cardiovascular Disease

Cancer Readmissions

$ IN

BIL

LIO

NS

Total prescription drug spend

…exceeds the direct cost of some of the most prevalent medical

concerns in the United States.

The true cost of medications…


As the “true cost of medications” has become better understood, it has begun to drive policy

$300B opportunity

Sources: American Journal of Managed Care; New England Journal of Medicine; National Center for Biotechnology Information.

Real-worldexamples

Overuse

$70B+Annual cost of

prescription opioid abuse

Underuse

$100B+Annual direct cost of

nonadherence to diabetes, hypertension and dyslipidemia

medicines

Misuse

700K+Annual ER visits due to

adverse reactions to prescribed drugs


Real improvement requires overcoming two barriers to progress

Source: Yeaw, J, Benner J, et al. J Manag Care Pharm 2009;(9):728-40

Most interventions are delivered after people stop their meds. The best way to solve non-adherence is to prevent it. 1

Adapted from: Benner J, et al. Value in Health 2002; 5(3):126 and other meta analyses.

The most effective interventions are costly and difficult to scale.2


Incentives to improve medication use are driving new interactions among payers, providers, and patients


About RxAnte

Founded by leaders in health services research, quality improvement, and advanced predictive/causal analytics

OUR TEAM

8M+ lives under management across national and regional health plans, PBMs, health systems, and pharmaceutical manufacturers

OUR CLIENTS

Improve drug therapy outcomes with advanced analytics and targeted clinical programs

OUR MISSION


RxAnte has three common use cases

VALUE OF MEDICINES

CMS Stars

HEDIS

Custom Measures

QUALITY IMPROVEMENT

MEDICAL COST SAVINGS

$ANALYTICS PLATFORM

• Which members?• What to do?• When?• What were the outcomes?

• What did it cost?• What was the ROI?• What will it take to achieve my goals?

Measure drug performance and

enable value-based purchasing

Reduce total cost of care by improving

medication use


RxAnte’s solutions are proven to improve medication use and outcomes by focusing on 4 key elements

Identify members most likely to benefit – prioritize by risk, receptivity, and urgency

Deploy interventions before non-adherence or bad outcomes occur

TARGETING

TIMING

Measure and manage intervention performance constantly to drive outcomes

Right-size intervention strategy to maximize benefit and control cost

EFFECTIVENESS

SCALE

PREDICTIVEANALYTICS

EFFECTIVEOUTREACH


Our solutions all begin with patient-level data and proprietary analytics

CONTACT CENTER

IVR

DIGITAL THERAPEUTICS

STARS HEDIS CUSTOM MEASURES

Quality Improvement

COST OF CARE MANAGEMENT

DRUG PERFORMANCE

VALUE-BASED PURCHASING

Medical Cost

RxAnte Solutions

Analytics Interventions

Program Management & Strategy Support

Drug Value

RXEFFECT™WORKFLOW PLATFORM

Rx Claims

Medical Claims and Eligibility

Other Client Data

$

4 5 5

RxAnteAnalytics Engine

Rx


Predictive analytics can identify patients at risk of suboptimal medication outcomes

The RxAnte Adherence Score™ indicates the likelihood of future adherence at a patient and therapy area level

The Value of Future Adherence Score™ reports avoidable medical costs attributable to medication non-adherence

The Risk of Unsafe Use Score™ identifies patients at risk of unsafe use of prescription opioids

RxAnte’s Value of Intervention™ approach targets patients based on predicted risk, urgency, and receptivity to intervention

WON’TScore 15

MIGHTScore 62

WILLScore 97

The RxAnte Adherence Score™ indicates the likelihood that a patient will be adherent


RxEffect™ is the online outreach solution to improve medication outcomes

RxEffect Outreach Solution

2017

Plan-sponsored QI programfueled by daily data and proprietary analytics and decision support

Targeted to the patientswho need it most, and the doctors, pharmacies, and care coordinators accountable for them

Real-time monitoringof each patient’s refill behavior, and constantly optimized workflow

Configurable solutioncan address a wide range of measures related to prescribing, medication safety, or medication adherence https://www.rxante.com/1490/video-rxeffect/


Then we manage performance on an ongoing basis

Program Management and Strategy

Client Services team advises and supports clients as strategic partners

Continuous monitoring of intervention effectiveness:

deployment rates, reach rates, clinical session rates

Understand weekly members who are adherent, non-adherent,

and still in play to positively impact Star Ratings.

Program EvaluationProcess FidelityBi-annual evaluation of overall and intervention-level performance to

inform ongoing program deployment strategy

Performance Forecasting


65%

70%

75%

80%

85%

2010 ("2012" Stars)2011 ("2013" Stars)2012 ("2014" Stars)2013 ("2015" Stars)2014 ("2016" Stars)2015 ("2017" Stars)2016 ("2018" Stars)

% o

f Mem

bers

Adh

eren

t

Adherence to Chronic Medications among Medicare members (2010-2016)

Antidiabetics MAPD Antidiabetics PDPRenin Angiotensin System Antagonists MAPD Renin Angiotensin System Antagonists PDPStatins MAPD Statins PDP

We’ve been fortunate to be part of a public health program that has meaningful impact


Closing thoughts

The under-use, over-use, and mis-use of prescription drugs is a preventable $300B problem

All stakeholders are paying increasing attention to this issue, in the form of new quality measures and performance incentives

Population health outcomes are a shared responsibility among payers, health professionals, pharmacy, and patients

Researchers with expertise, passion, and creativity in this area are needed: in government, in academia, and in business

Documents

Improving Medication Use with Predictive Analytics and ......Improving Medication Use with Predictive Analytics and Targeted Clinical Programs: Translating Practical Research into