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Gns healthcare carol mccall
1. DISCOVERING WHAT WORKS. AND FOR WHOM.
Leveraging Innovation to
Improve Medication Adherence
Health Innovators Series
November 11, 2014
www.gnshealthcare.com
2. GNS Healthcare Overview
Accelerate intelligent interventions
► Maximize intervention ROI by predicting impact for each individual
► Personalized analytics solution that delivers unmatched speed to
value
– Maximize the value of interventions by matching members to
interventions based on patient-centered predictions
– Optimizes member communications
– Integrates easily in existing health plan business processes
– Measure and continuously improve intervention effectiveness
Today’s Topic: Meaningful Adherence™
Optimizes medication adherence interventions by matching
individuals with their most effective intervention
2
3. GNS Partnerships - Broad Range of Healthcare Constituencies
Health Plans Providers PharmaCos
• Drivers of Drug Switching for
Multiple Sclerosis (claims data)
• Predict Individual Risk for Type 2
Diabetes (EMR data)
• Optimal Drug Regimens for
Rheumatoid Arthritis Treatments
(registry data)
• Drivers of Progression in
Rheumatoid Arthritis (clinical trial
3
data)
• Predict preterm birth with Inova
(genomic, claims, EMR data)
• Evaluate effectiveness of CMS
quality measures (MDS, Oasis,
public health data)
• Predict progression to Type 2
Diabetes (EMR data)
• CHF readmissions and adverse
drug events with Brigham &
Women’s Hospital (EMR data)
• Adherence-driven Adverse Events
with Cambia (claims, consumer,
public health data)
• Progression to MetS with Aetna
(claims, biometric, program data)
• Risk-Adjusted Costs & Drivers
with Cambia (claims, consumer,
public health data)
• Detected Adverse Drug Events
(blinded claims data)
4. Population Health Management
The New ‘Table Stakes’ in Value-Based Healthcare
- Institute for Health Technology Transformation
Identify
Care Gaps
Stratify
Risks
4
Population health management will become a required
core competency in a post-[reform] environment
Engage
Define
Population
Manage
Care
Volume focused
Reactive
One-size-fits-all
Fragmented & siloed
Poorly captured &
instrumented data
Passive
Opaque / unknown
impact
Value driven
Proactive, predictive
Individualized
Integrated & coordinated
Rich & agile data
environment
Engaged
Transparent, ongoing
measurement, rapid-learning
Pre-Reform
Value-Based Healthcare
Automated
& Ongoing
‐ Data integration
‐ Analytics
‐ Reporting
‐ Communication
‐ Engagement
5. 5
Poor Medication Adherence has a Striking Impact
…and is likely to grow
• Non-adherence drives $298B
in excess healthcare costs
– $198B in excess hospital admissions
– $23B in excess emergency room visits
• Only 50% adherence to chronic
medications
• Non-adherence causes
– 1/3 of medication-related hospitalizations
– 10% of admissions overall
– 125,000 deaths (4th leading COD)
• By 2020, more than 157MM people will
have one or more chronic conditions –
most treated with medications
American College of Cardiology
New England Healthcare Institute. ‘Thinking outside the pillbox via Healthcare insights; Express Scripts Lab;
6. “Increasing the effectiveness of adherence
interventions may have a far greater impact
on the health of the population than any
improvement in specific medical treatments.”
- WHO Evidence for Action, 2003
6
Medication Adherence
Big Opportunity in Population
Health Management
7. Poor Adherence and the Risk of Bad Outcomes
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Percent At-Risk For
Medication-Related Admission / ER Visit
< 5% 5-10% 10-25% > 25%
% of Population Taking DOIs
Risk of Event in Next 12 Months
People have very
different risks of
medication-related
events
Knowing this risk
helps identify
where improving
adherence can
reduce it
8. Poor Adherence and the Risk of Bad Outcomes
The relationship
between adherence
(PDC) and future
events isn’t merely
two groups of
‘Adherent’ vs. ‘Not’
separated at 80%
PDC
Adherence and Future Events
Medication Adherence Decile
Future Event Rate
3 Mo PDC
6 Mo PDC
12 Mo PDC
Cardiovascular medications
9. Impact of Poor Medication Adherence
Example population-1 year experience on cardiovascular, oral diab and resp meds
9
Total
individuals
Individuals
on Drugs of
Interest
Total Rx
costs on
Drugs of
Interest
Medication-
Related
Admissions
Medication-
Related ER
Visits
Costs of
Medication-
Related
Adverse Events
Costs of Adverse
Events Caused
by Non-
Adherence
1,000,000 104,521 $40.4M 4,092 9,043 $86.3M $28.8M
Why can’t we eliminate these?
Multiple intervention possibilities, with no “magic bullet”
• Complex decision space has no obvious answers – hard to solve healthcare’s
“Wanamaker Problem”
• Budget constraints dictate choosing who gets interventions
Hard to coordinate selection/interventions
• Interventions frequently delivered from both pharmacy services and care
management
• Opaque selection criteria from outsourced vendors
Feedback loops difficult to operationalize
• Interventions not always well instrumented, monitoring and tracking difficult
• Learning which interventions work best happens slowly, if at all
Plan
Implement
Optimize
What if we optimized around intervention effectiveness?
10. Plan Implement Optimize
• Drives continuous improvement: monitoring, measurement and continuous
10
How to Optimize: Meaningful Adherence™
Maximizes intervention ROI
• Maximizes the ROI of
interventions by precisely
matching individuals to
specific interventions using
value-based selection
• Increases intervention effectiveness by exploiting proprietary data on
Implement
engagement and feedback loops
evaluation of interventions and the individuals in them
• Enhances value-based initiatives
GNS Meaningful Adherence™ uniquely:
Connects adherence to outcomes by identifying where poor adherence is a
cause of adverse events
Optimizes mix of individuals in interventions according to their predicted
intervention ROI
Maximizes the impact Of adherence programs by continuously analyzing
and selecting the most effective interventions
11. 80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
Rules-based selection (e.g. PDC<80%) selects
these 41,114 individuals
Interventions on 16,743 of these
individuals don’t impact their
adverse events
0-10% 10-20% 20-30% 30-40% 40-50% 50-60% 60-70% 70-80% 80-90% 90-100%
Value-based
Selection finds
42,856
individuals
where increasing
adherence yields
positive
intervention ROI
11
Value-Based vs. Rules-Based Selection
Adherence alone doesn’t reveal potential savings across a population
1MM Population: 104,521K individuals taking cardiovascular, oral diabetes & resp medications
#Individuals
Value and rules-based agree on
these individuals
Rules-based selection
misses 18,486 individuals
who could benefit
PDC
Total Value-based
13. 13
Value-Based vs. Rules-Based Selection
3 Example individuals
Lucy
• PDC: 44%
• Rules-based selection
picked Lucy
• Improving Lucy’s
adherence 25% would
have reduced expected
costs by >$14,000
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
The Lucys
Total Value-Based
14. 14
Value-Based vs. Rules-Based Selection
3 Example individuals
Nora
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
• PDC: 29%
• Rules-based selection picked
Nora
• Improving Nora’s adherence
45% would have reduced
expected costs by <$200.
The Noras
Total Value-Based
15. 15
Ethel
• PDC: 82%
• Rules-based selection did
not pick Ethel
• Improving Ethel’s
adherence by 10% would
have reduced expected
cost by >$10,000
Value-Based vs. Rules-Based Selection
3 Example individuals
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
Total Value-Based
The Ethels
16. 16
Value-Based vs. Rules-Based Selection
Adherence alone doesn’t reveal potential savings
Matching individuals to appropriate
intervention requires analytical precision
Value based selection
precisely matches individuals
and maximizes overall ROI
Lucy Nora Ethel
Age 46 24 66
Drugs of Interest (DOIs)
Cardio, Diabetes (oral), Chronic Respiratory
Cardio + Diabetes Cardio + Diabetes Cardio
Current PDC to DOIs 44% 29% 82%
# Unique Pharmacies 2 1 2
Prior Condition-Related Events? Yes No No
Event Costs That Could ‘ve Been
> $14,000
< $200
Avoided with Increase in PCD
25% Increase
45% Increase
> $10,000
10% Increase
17. 17
Designed for a quick start by
optimizing your current interventions
Maximize speed to value
How to Optimize
Meaningful Adherence™
Plan Implement Optimize
Intervention
Planning &
Optimization
Plan the optimal mix
of interventions to
maximize ROI
Implementation
& Ongoing
Selection
Identify “high value”
individuals for
specific interventions
Continuous
Improvement
Evaluate which
interventions work
best and for whom
18. 18
Risk
GNS Modeling
& Analytics
Medical claims
Eligibility
Rx claims
Other data as
available (Labs,
Survey, EHR,
Demographics,
etc.)
Engagement
Efficacy
ROI
1. Scope the opportunity
2. Model your current and/or
planned interventions
• Forecasts ROI
• Supports budget requests
3. Optimize individual selection for
current interventions
• Improves your bottom line day 1
4. Measure and evaluate ongoing
interventions
5. Understand and plan potential
new interventions
Monitoring
A/B
Testing
Intervention
Getting started
Optimize your current interventions
Optimize operations
Optimize strategy
19. Planning
•Risk Models
• Risk of Rx-related adverse
events (CVD, Diabetes,
Respiratory conditions)
•Efficacy Models
•Quantifies where Madh
reduces risk
•Engagement Analytics
•People more likely to
participate
•ROI Analytics
•Best intervention match to
maximize impact
•Net impact and
individualized ROIs
•Population-level forecasts
of results
Implementation
•A/B Testing Analytics
•Participation needed for
statistical power
• Intervention & Control
groups, algorithmic
matching
•ROI Analytics
•Dynamic ROIs based on
new data
•Monitoring & Reporting
•Tracks and reports on
participants, adherence
and events
•Risk-Models
•Ongoing monitoring of risk
model performance
Evaluation
• Intervention Analytics
•How much interventions
are driving Madh
•Main drivers of effect
•Efficacy Models
•Quantifies where Madh
reduces risk
•Engagement Analytics
•People more likely to
participate
19
Modeling & Analytics Suite for Meaningful Adherence™
20. GNS Population Health Solutions
Accelerate intelligent interventions
Plan Implement Optimize
Meaningful Actions Accelerator
(MAX)
Analytics &
Models
Risk
Engagement
MeasureBase
Efficacy
Adverse Events
• Medication Adherence
• Rx-related gaps in care
• Falls & Fractures
• Re-admits
• Pre-term births
Disease Progression
• Progression to Metabolic
Syndrome
• MetS to Type II Diabetes
• Type II Diabetes to CKD
• Progression of major chronics
(Asthma, COPD,CVD)
Comparative Effectiveness
• Rheumatoid Arthritis
• Multiple Sclerosis
• Multiple Myeloma
• Diabetes
20
A solution
platform for
optimizing
population
health
management
processes
ROI
REFSTM Machine
Learning Platform
21. We Have Reached a Janus Moment
Data-Intensive Discovery
“With the arrival of the data-intensive
computing paradigm,
[we have] reach a Janus
moment, where we are both
looking forward and backward.”
– Clifford Lynch
22. Achieving Value-Based Healthcare Won’t Be Easy…
The First Theorem of Science
“It is impossible to convince anyone of any
true thing that will cost him money.”
But, it Will be Worth it!
• To reward value, we must know what is valuable
• Adherence is a bright-spot of opportunity
‐ Build Population Health Mgt competencies
‐ Forge new partnerships and re-imagine
business models
• Use analytics to identify & drive value
– Identify and individualize opportunities
– Harness ‘test & learn’ environments whose
analytics learn and re-orient to new circumstances
– Accelerate data-driven, value-based innovations
- Robert Laughlin, Different Universe
