Using Clinical Expertise and the Latest Evidence to Build ... · beyond a clinician’s office. ... through advanced analytics, including predictive and machine learning insights

April 3, 2018

Brooke DeFosse, PharmDTim Atkinson, PharmD, BCPS, CPE

Amber Watson, PharmD

Using Clinical Expertise and the Latest Evidence to

Build Effective Solutions for Opioid Use Disorder

Treatment and Reduce Associated Costs

Confidential and Proprietary © 2018 Axial Healthcare, Inc. All rights reserved

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Learning Objectives

Describe a strategy by which health plan claims data can be analyzed to identify patients at-risk for opioid use disorder (OUD).

Connect patients identified as at-risk for OUD with appropriate treatment resources, prioritizing early intervention.

Build patient-centered solutions to support sustained recovery beyond a clinician’s office.

Breakthrough Solutions for Pain and Opioid Care

We are a team of physicians, scientists, pharmacists, technologists, and health plan operators:

• presiding over the nation’s largest structured database of patients in pain and opioid users (over 100 million lives), unlocking deep understanding of these patients through advanced analytics, including predictive and machine learning insights.

• maintaining the most curated compendium of pain treatment and medication evidence-based (EB) literature, fueling personalized Care Pathways to support practitioners.

• driving improved clinical outcomes and mitigated risk by reducing total number of members on opioids, lowering mean MEDD, and limiting dangerous polypharmacy and multi-prescriber activity.

• achieving enhanced financial performance by directing members to the highest quality care at appropriate cost and limiting clinically unwarranted utilization. 3


ANALYTICALLY-DRIVEN TECHNOLOGY-FORWARD CARE-ENABLED

• Products and features fueled by an advanced foundation of claims data from over 100 million members and 2.4 million providers

• Clinically-warranted and evidence-based guidelines structured to assess and stratify existing population health and set appropriate targets for improvement

• Continuous assessments and positive feedback loops that dynamically address changes in behavior and shift focus to accelerate positive trends and improve opportunity areas

Breakthrough Solutions for Pain and Opioid Care

Our breakthrough solutions will decrease costs, optimize coverage and increase quality of care.

• Cloud-based solutions configured to the needs and preferences of end-users

• An agile platform that captures dynamic feedback from its analytic core and delivers information in a timely and actionable manner to the end-user

• Deploying a full suite of products that deliver: decision-support solutions for providers, coping and support tools for patients and reporting and detailed operational assessments for health plan partners

• SOC 2 Type II + HITRUST CSF independent attestation

• Progressing beyond analytics and technology, axialHealthcare’s clinical care team consults with treating providers in an educative and engaging style

• The same care team that provides outreach and support to providers engages the patient through mobile support and other mediums to augment care for high-touch, high-acuity individuals in need of coaching and additional care management

• Outreach is targeted and timely based on continuous analytic assessments that highlight where axialHealthcare’s care team should focus their attention

Proprietary models deliveringinsight into interventions

Secure delivery of dynamic patient-centered information and recommendations

axial’s own pharmacists and coaches working to improve outcomes

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Solution

Practitioner support tools, personalized treatment plans,

and clinical consultation.

Proven network of highestquality and appropriate cost

pain and opioid care facilities.

Mobile support and engagement applications

for pain and OUD patients.

Operating platform that draws on a database of over 100 million lives and the latest clinical evidence to deliver a customized view of pain care and opioid misuse and their associated high costs.


Product Features Function

Risk Identification and Mitigation (RIM) Practitioner Report Scores addiction specialists and other practitioners responsible for the care of patients undergoing treatment for OUD.

Care PathwaysTreatment and intervention recommendations based on Scientific Advisory Board guidelines specific for both identifying the need to diagnose and refer a patient for OUD treatment, as well as best clinical practices for the treatment of OUD patients using office-based medication-assisted treatment (MAT).

Consult Continued outreach from the Clinical Consult Services (CCS) team, which provides in-person and telephonic decision support through targeted provider engagement.

Aberrant Prescribing Pattern (APP) Report

The APP Report notifies the health plan of their current state of network performance as it relates to members either currently being treated for OUD or having gone through previous cycles of treatment and relapse. This allows axialHealthcare to stratify the existing provider population based on cost and quality measures.

Centers of Recovery Excellence (CORE)

CORE is a strategic network solution that identifies providers and clinics providing higher quality and lower cost outpatient-based MAT services and steers patients to these top-tier providers.

Empower Mobile App A mobile application engaging OUD patients with supporting information and resources on recovery, including encrypted text messages to the axialHealthcare CCS team.

Risk Identification and Mitigation (RIM) Patient Report Scores a patient’s current OUD risk level between 0 and 10 to inform the practitioner.

Updated with 3.0, the product line now offers decision support, risk score stratification, network optimization, and other critical features for pain care management and OUD identification and treatment.

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Our Solution for OUD


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Our Solution for OUD

C LINIC AL MANAG EMENT• Proprietary guidelines to denote the inclusion and exclusion criteria

identifying OUD treatment providers

• Coverage area (excluding emergency settings) and patient volume metrics allowing for assessment of coverage

• Providers ranked based on quality of services - assessing presence of psychosocial services, relapse frequency, patient engagement, etc.

ANALYTIC INS IG HTS• Identify OUD patient population

• Stratify OUD patient population by current OUD state: at-risk; unmanaged OUD; in treatment; in recovery

• Analyze opportunity and measure impact of shifting OUD patient populations from at-risk, undiagnosed and/or unmanaged into diagnosed, in treatment, and in recovery

Identifying and improving care for individuals suffering from OUD

At-risk, undiagnosed Diagnosed, unmanaged Diagnosed, managed


OUD Statistics

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DSM-V diagnosis of OUD NSDUH estimated prevalence ofOUD in 2013 at 1.9 million people

2015 CDC report onannual opioid overdoses

– “Problematic pattern of opioid use leading to clinically significant impairment or distress”

– With at least 2 specific criteria within a 12 month period

– 4.3 million reported engaging in non-medical use of prescription opioids in previous month

– Indicates large at risk population

– 33,091 opioid-related overdose deaths

– Driven mainly by deaths from heroin & synthetic fentanyl derivatives


Economic Burden of OUD

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Total economic burden estimated at $78.5 billion annually

A disproportionate percentage of total cost is borne:

Average cost of care per patient with OUD

– $28.9 billion associated with healthcare and substance abuse treatment costs

– Commercial Insurance - 17.9%

– Medicare & Medicaid - 10.3%

– $23,000 - $25,000 per year

– $15,000 of increased cost attributable to OUD annually


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Proliferation of GuidelinesGuidelines for treatment of OUD have been published in:

BRITISH COLUMBIA AUSTRALIA


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Proposed Solution

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Collect widely recognized and clinically validated best practices

Define and track actionable aspects of common elements in the guidelines

System that is analytics-driven, technology-forward, and care-enabled

– Cull the shared elements– Focus on aspects that are measurable– Actionable for health systems

– Data management and solutions approach – Capable of driving high quality outcomes – Lowering healthcare costs


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Identifying GuidelinesMethods

Literature search: Embase, PubMed, and Google Scholar2

Search terms: opioid use disorder, medication assisted treatment, opioid addiction, opioid dependence, and buprenorphine prescribing

15 guidelines were identified

United States: 10International: 5

3 Guidelines independently reviewed by authors and categorized into common elements

Modeled after CDC’s Common Elements in Guidelines for Prescribing Opioids for Chronic Pain

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Identifying Guidelines

4 Inclusion criteria

– US guidelines had to include office-based outpatient treatment recommendations for buprenorphine

– International guidelines were included if medications and treatment paradigms resembled practice in the United States

5 Exclusion criteria

– US guidelines excluded if written for specific state, condition, or age group

– International guidelines were excluded if heroin substitution was allowed, or medications were dispensed or prescribed by non-medical providers

Methods


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Common Elements

Initial list of common elements created based on reviewer consensus

The individual common elements were independently verified in available medical and pharmacy claims data

Criteria not measurable in claims data or based on clinical decision making alone were removed

– Some easily available in claims data

– Others required application of proprietary algorithms

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Results7 Guidelines Utilized

1 United States

– American Society of Addiction Medicine (ASAM)

– Substance Abuse & Mental Health Services Administration (SAMHSA)

– Veteran Affairs/Department of Defense (VA/DoD)

– Federation of State Medical Boards (FSMB)

2 International

– World Health Organization (WHO)

– British Columbia

– Australia


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Features: CORE


- Provides PCPs and pain specialists with a network of MAT centers to refer patients with OUD

- Offers recognition for quality care and increased patient referrals for CORE-designated providers

Centers of Recovery Excellence (CORE)

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Centers Of Recovery Excellence (CORE) Network Design

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Top performing MAT providers identified by evaluating quality of care, including:

Buprenorphine dose Evaluates proportion of a provider’s or practice’s patients on high doses.

Case management Assesses case management practices for a given practice or provider.

High risk Designed to assist providers in assessing patient risk & appropriateness of the OBOT setting based on evidence-based guidelines.

Psychosocial interventions Evaluates proportion of a provider’s or practice’s patients receiving guideline-based psychosocial interventions.

Relapse

Treatment engagement

Measures relapse of patients participating in office-based outpatient treatment (OBOT) plans.

Identifies clinics with higher rates of participation and engagement in treatment plans as indication of treatment quality.

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Features: • Patient Alerts• RIM• Care Pathways

Comprehensive online suite of tools for providers delivering:

• Access to decision support and care pathways• A library of evidence-based resources and guidelines• Identification of patient safety alerts• Proactive and targeted ongoing clinical consultative support

21Confidential and Proprietary © 2018 Axial Healthcare, Inc. All rights reserved


Supports patient-focused outreach and education

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Features: • RIM Patient Report • Empower


Empower Application

axialPATIENT is focused on supplementing care and meeting the engagement needs and preferences of the individual patient

A mobile app that extends a provider’s reach by educating patients, tracking pain triggers and medication usage, and connecting patients with axialHealthcare’s Clinical Consult Services team.

Risk Identification and Mitigation (RIM) Patient Report

A patient risk profile created using advanced analytics and leveraged to deploy the Empower mobile application when applicable.

F E AT U R E D E S C R I P T I O N

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axialHealthcare knows that patient engagement is crucial to affecting patient outcomes and care plans for patients with chronic pain and OUD. We have developed an application that engages OUD patients with supporting information and resources on recovery. The app collects continuous data on behavior and activity, educates the patient on how to take a more active role in their treatment plan, and triggers outreach from axialHealthcare’s clinical care team in cases of escalating patient risk.

Engage and support high risk patients

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• Increased access • High touch, low-impact engagement of high-acuity members• Digital solution at no cost to member expands health plan

relationship beyond financial transactions

• Passively encourages appropriate healthcare utilization (mitigating risk of emergent/urgent care visits)

• Expands treatment to include behavioral health (coping, education, personalized support)

• Patient education enables member autonomy

• Positive feedback between patient and provider, bridged by digital solution data and outreach from pharmacists, engagement specialists, and behavioral health coaches

• Clinical Consult Services strengthened with patient application data and claims history

IM P AC T R E S U LT S

Health PlanMemberSatisfiers

ClinicalEfficiencies

Care Coordination


A Comprehensive + Effective Solution for the Opioid Epidemic

• Health plans receive improved financial performance, comprehensive reporting, and adherence to health plan objectives

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• Patients in pain, on opioids, at high risk, and in OUD are identified

• Practitioners are alerted with risk stratification and personalized care pathways for each patient

• Practitioners are supported and performance is assessed to ensure the ongoing practice of evidence-based medicine

• Providers engage with axialHealthcare’s Clinical Consult Services team

• Practitioners’ reach is extended through a mobile app that educates and connects patients with axialHealthcare’s Clinical Consult Services team

• Practitioners refer patients to top performing advanced pain management and MAT centers

Thank You

Documents

Using Clinical Expertise and the Latest Evidence to Build ... · beyond a clinician’s office. ... through advanced analytics, including predictive and machine learning insights