Third-Party Payer Track: Proactive Identification and
Intervention Approaches
Presenters:
• Rochelle Henderson, PhD, Senior Director of Research, Express Scripts, Inc.
• Joseph Anderson, MBA, Director of Analytics, Helios
• Tron Emptage, RPh, Chief Clinical Officer, Helios
Moderator: J. Kevin Massey, MS, Program Administrator, Division of Public Health, Delaware Department of Health and Social Services, and Member, Rx Summit National Advisory Board
Disclosures
• Rochelle Henderson, PhD, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.
• Joe Anderson, MBA – Employment: Helios
• Tron Emptage, RPh – Employment/Stockholder: Helios
• J. Kevin Massey, MS, has disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.
Disclosures
• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
• The following planners/managers have the following to disclose:– Kelly Clark – Employment: Publicis Touchpoint Solutions;
Consultant: Grunenthal US– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center– Carla Saunders – Speaker’s bureau: Abbott Nutrition
Learning Objectives
1. Explain the role of predictive analytics and statistical models to identify high-risk claims.
2. Describe strategies for intervening in high-risk claims to help injured workers and control costs.
3. Identify characteristics associated with chronic opioid use in a newly injured worker population.
4. Outline proactive strategies for curbing opioid abuse and misuse by chronic users.
Rx Drug SummitProactive Identification and
Intervention Approaches
Rochelle Henderson, PhDSenior Director of Research, Express Scripts
Disclosure Statement
• Rochelle Henderson, PhD has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.
Learning Objectives
1. Explain the role of predictive analytics and statistical models to identify high-risk claims.
2. Describe strategies for intervening in high-risk claims to help injured workers and control costs.
3. Identify characteristics associated with chronic opioid use in a newly injured worker population.
4. Outline proactive strategies for curbing opioid abuse and misuse by chronic users.
Pain Treatment in America
Challenges in the practice of pain care 1
Evolving evidence2
Approaches to better management for healthier outcomes3
Paying a High Price
259 million prescriptions for painkillers written in 2012
50 Americans die every day from prescription drug
poisoning
Prescribing Patterns Put Patients at Risk
Dangerous Combinations of Drugs
Dangerous Combinations of
Doctors
Key Findings• Over 60% of WC uppermost
prescribers prescribe opioids to 2 or fewer patients
• On average, WC uppermost prescribers write: – more 30-day adjusted opioid
prescriptions per user
– longer days’ supply
– more than 7 times higher average cost for opioid prescription per user per day of therapy 0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
WC GH Mixed
% Uppermost Opioid Prescribers
Proactive Identification and Intervention Approaches
Presented by
Joe Anderson, MBA
Director of Analytical Services
Tron Emptage, M.A., R.Ph.
Chief Clinical Officer
Disclosure Statement
• Joe Anderson, MBA, Employment: Helios
• Tron Emptage, RPh, Employment/Stockholder: Helios
Use of Narcotics and Other Medication ClassesFirst Year After Injury
22
59%
52%
30%
10%
57%55%
29%
10%
53%56%
30%
9%
0%
10%
20%
30%
40%
50%
60%
Narcotic Analgesics NSAIDS Skeletal Muscle Relaxants Dermatologics
2010 2011 2012
Medication Use Over Time
23
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10
Analgesics Narcotics Anti-inflammatory Skelatal Muscle Relaxers
Anti-Convulsant Dermatologic Antidepressant
Factors that Influence Outcomes
24
Number of Prescribers
Number of Pharmacies
PrescribingBehaviors
Medication Patterns
Body Part/Nature of Injury
Demographics of Prescriber
Medication Agreement
Drug Monitoring
Predictive AnalyticsUsing a Multivariate Statistical Model to Predict High Pharmacy Cost Claimants
26
Correlate early data about an injured
worker…
… with resulting long-term spend of that
injured worker.
Workers injured in 2010 Resulting pharmacy costs in 2013
(DEPENDENT VARIABLE)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 4 6 9 12 18 24
Geographic and other Demographics Prescriber: Demographics of Treating Prescriber
Injury: Body Part, Nature of Injury Pharmacy Behavior
Pe
rcen
t o
f Si
gnif
ican
ce(A
ggre
gate
d A
cro
ss M
ult
iple
Var
iab
les)
Months Since Date of Injury
Predictors Change as Claims Age
Pharmaceutical Companies Use Network Analysis to Identify and Target Influential Doctors with Advertising
Source: ”Drug Marketers Use Social Network Diagrams to Help Locate Influential Doctors” May 16, 2013
http://www.nytimes.com/interactive/2013/05/16/business/PHARMA.html?ref=business
This Is Also an Effective Technique to Understand Injured Workers’ Risk for Long Term Prescription Drug Use
Long-Term Pharmacy Cost of Injured Worker, Based on Initial Prescriber’s Connectedness
Lon
g-Te
rm P
har
mac
y C
ost
of
Inju
red
Wo
rke
r
Initial Prescriber’s Connections with Other Prescribers
Individualized Analysis + Clinical Review = Better Outcomes
Physician Letters
Pharmacist Medication Review
Physician Medication Review
Medication Monitoring
Declining Claim Duration
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48
2010 2011
2012 2013
Months since Date of Injury
Percent of Injured Workers Filling
Prescription Medications
35
A total program solution consisting of comprehensive data, risk analysis, and clinical tools will greatly decrease the likelihood of a long-term claim.
Third-Party Payer Track: Proactive Identification and
Intervention Approaches
Presenters:
• Rochelle Henderson, PhD, Senior Director of Research, Express Scripts, Inc.
• Joseph Anderson, MBA, Director of Analytics, Helios
• Tron Emptage, RPh, Chief Clinical Officer, Helios
Moderator: J. Kevin Massey, MS, Program Administrator, Division of Public Health, Delaware Department of Health and Social Services, and Member, Rx Summit National Advisory Board