Prevention Pays

Mercy Hospital’s experience with a community based, patient centric, clinical prevention program

The Mercy Freedom Program

I think clinical prevention programs work?

The Mercy Freedom Program was established as a patient centric, hospital based community program

focused on prevention and utilizing financial incentives to motive patients to comply with nationally recognized

clinical preventive care standards.

Program’s interventions

• Empowers patients to actively participate in improving their health outcomes

• Generates individualized disease-specific “road maps” to implement preventive healthcare guidelines

• Provides discounted prescriptions as incentives for compliance with clinical standards

• Develops a community based, patient generated electronic health record

Legislative corner stone

• Section 340b of the Public Health Service Act (PHS) - enacted 1992 – Limitation on Prices of Drugs Purchased by Covered

Entities– Covered Entities

• Government (i.e. Veteran Hospitals, State, County)• Disproportionate Share Hospitals (> 10 %)

– Medications dispensed must be for those patients that are active members of the system

• outpatient use only

Legislative corner stone

• Covered Patients– Active patients of the institution (i.e. active medical

record)– Covered Prescriptions must be from a Physician that

is a member of the system.

• Controls and Audits– Safeguards to prevent diversion

Program’s targeted population:

Underinsured/uninsured motivated chronically ill patients with expensive, limited, minimal or no drug

benefit coverage

Preferred Provider Organizations (PPO)

Medicare

Indemnity

The program adopted preventive care standards

• US Preventive Service Task Force Guide to Clinical Preventive Services, 2nd Edition

• Clinical preventive services recommended as “A,” reflecting strength of evidence in support of the intervention

• Clinical Evidence, 8th edition

Preventive care strategy

Interventions Primary Prevention Secondary Prevention Tertiary Prevention

Determinants Age/Sex Age/Sex Disease-specific

preventive healthcare “road maps”

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Disease states as defined by the US Preventive Services Task Force

HypertensionElevated Blood

CholesterolCVD (Primary

Prevention)

Osteoporosis ArthritisChronic Renal Failure (CRF)

Thyroid Disease GlaucomaCongestive Heart

Failure (CHF)

DepressionAsthma/Stable

COPD

CVD/Transient Ischemic Attacks

(TIA)

Diabetes (DM)CVD (Secondary

PreventionAtrial Fibrillation

(AF)

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Developed a software system to generate an individualized preventive care road map

A road map is a list of preventive care interventions such as tests, procedures, and screenings defined by the US Preventive Services Task Force that are based on the patients age, gender, and self reported health history.

How to get patients motivated to do clinical prevention

Theory: Clinical prevention programs work by offering financial incentives

Time in months, (longevity of a user)

Number ofpatients

Cash

Third Party Payor (insurance coverage and/or Part D)

The Mercy Freedom Program

• The prevention program empowers patients to actively participate in their health outcomes and utilizes pharmacy discounts (340b) as an incentive to comply with national preventive care standards.

• The software system developed can be easily applied to other interested hospitals

Attracting patients

• Community announcements in local media• Developed patient awareness programs at the

hospital• Education programs for physicians and

hospital employees• Individual meetings with key medical and

hospital professional staff• Word of mouth

Individualized health assessment

• A telephonic health assessment generates a disease specific road map

• The road map is the foundation of the reminder and compliance system

Software automatically generates patient reminder letters and voice activated out

bound calls

• Quarterly reminders to patients to meet specific attributes in their individualized road map

• Quarterly calls to patients reminding them to refill Rx medications

Medical Information• Patient self reports clinical information• Establishes an electronic health record

(includes clinical and pharmacy data)

• Documents a patient specific preventive care “road map” signed by “attending” physician

• Software applies a comprehensive compliance and monitoring system to meet program and government regulations

Pharmacy Information

• Tracks medication utilization

• Provides all out patient drug purchase information to the “attending physician”

• Helps eliminate potential adverse drug interactions

• Provide disease state and drug specific information

Is there enough time for physicians to motivate and educate patient on prevention?

Clinical prevention program works by giving financial incentives

Time in months, (longevity of a user)

Number ofpatients

Cash

Third Party Payor (insurance coverage and/or Part D)

* Cohort is the population of patients who joined the program within the quarter

The average % of enrolled patients who survived categorized by morbidity status

Patient Benefits

• Empowers individuals to actively participate in improving their health outcomes

• Generates an individualized tool (a disease-specific “road maps”) for patients’ use to meet preventive care guidelines

• Provides discounted prescriptions• Better compliance with prescription medications

due to lower acquisition costs and regular reminders

Physician Benefits

Applied Technology• Creation of electronic health record• Tracking of patient’s age, sex, and morbidity

specific preventive care interventions• Patient specific prescription medication and

clinical referrals reported quarterly• Documentation of preventive care compliance to

nationally accepted standards

Physician Benefits

Flexibility• Opportunity to prescribe medications regardless

of formulary or cost to patient• Ensures documentation of quality indicators for

future pay for quality/pay for performance programs

• Improves patient education• Increases regularly scheduled chronic care office

visits

Weighing time and money

Prevention PaysWhat is the Return on investment (ROI)?

Patient Attending Physician

Hospital

Earning a return

Benefits medically by obtaining preventive interventions

•Revenue per office visit

•Meets “Pay for Performance” measures

•Revenue per out patient procedure

•Increase use of high profit interventions

Avoiding a cost

Reduce prescription drug costs

Reduce “risk” of poor patient care

Reduce risk of high cost care (low profit)

Outcomes

•Improved health and reduced morbidity

•Better educated patients•Reduced personal

healthcare costs•Hospital becomes an

important patient advocate