www.gnshealthcare.com

Leveraging Innovation to

Improve Medication Adherence

DISCOVERING WHAT WORKS. AND FOR WHOM.

Health Innovators SeriesNovember 11, 2014

GNS Healthcare OverviewAccelerate 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

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• 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 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)

PharmaCosProvidersHealth Plans

GNS Partnerships - Broad Range of Healthcare Constituencies

Population Health ManagementThe New ‘Table Stakes’ in Value-Based Healthcare

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Identify Care Gaps

Stratify Risks

Engage

Manage Care

Define Population

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

-Refo

rm

Valu

e-B

ased H

ealth

care

Population health management will become a required

core competency in a post-[reform] environment- Institute for Health Technology Transformation

Automated & Ongoing

‐ Data integration‐ Analytics‐ Reporting‐ Communication‐ Engagement

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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 CardiologyNew England Healthcare Institute. ‘Thinking outside the pillbox via Healthcare insights; Express Scripts Lab;

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“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

Medication AdherenceBig Opportunity in Population Health Management

Poor Adherence and the Risk of Bad Outcomes

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

< 5% 5-10% 10-25% > 25%

% o

f P

op

ula

tio

n T

akin

g D

OIs

Risk of Event in Next 12 Months

Percent At-Risk For Medication-Related Admission / ER Visit

People have very different risks of medication-related events

Knowing this risk helps identify where improving adherence can reduce it

The relationship between adherence (PDC) and future events isn’t merely two groups of ‘Adherent’ vs. ‘Not’ separated at 80% PDC

Poor Adherence and the Risk of Bad Outcomes

Medication Adherence Decile

Futu

re E

ven

t R

ate

3 Mo PDC

6 Mo PDC

12 Mo PDC

Cardiovascular medications

Adherence and Future Events

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Impact of Poor Medication AdherenceExample population-1 year experience on cardiovascular, oral diab and resp meds

Total individuals

Individuals on Drugs of

Interest

Total Rx costs on Drugs of Interest

Medication-Related

Admissions

Medication-Related ER

Visits

Costs of Medication-

RelatedAdverse Events

Costs of AdverseEvents Caused

by Non-Adherence

1,000,000 104,521 $40.4M 4,092 9,043 $86.3M $28.8M

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?

Why can’t we eliminate these?

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• Maximizes the ROI of interventions by precisely matching individuals to specific interventions using value-based selection

Implement

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

How to Optimize: Meaningful Adherence™Maximizes intervention ROI

• Increases intervention effectiveness by exploiting proprietary data on engagement and feedback loops

• Drives continuous improvement: monitoring, measurement and continuous evaluation of interventions and the individuals in them

• Enhances value-based initiatives

Plan OptimizeImplement

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

0-10% 10-20% 20-30% 30-40% 40-50% 50-60% 60-70% 70-80% 80-90% 90-100%

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

Value-based Selection finds42,856 individuals where increasing adherence yields positive intervention ROI

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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

#In

div

idu

als

Value and rules-based agree on these individuals

Rules-based selection misses 18,486 individuals who could benefit

PDC

Total Value-based

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

0-10% 10-20% 20-30% 30-40% 40-50% 50-60% 60-70% 70-80% 80-90% 90-100%

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Value-Based vs. Rules-Based Selection

Bottom-line impact of optimizing interventions

#In

div

idu

als

PDC

Total Value-based

Rules-based Value-based

41,114 Selected individuals 42,856

$ 2.3M Eliminated events $ 3.1M

$ 1.6 M Additional Rx costs $ 0.5M

$ -13.03 Net savings/participant $ 96.75

(0.7) ROI 2.7

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Lucy

• PDC: 44%

• Rules-based selection

picked Lucy

• Improving Lucy’s

adherence 25% would

have reduced expected

costs by >$14,000

Value-Based vs. Rules-Based Selection

3 Example individuals

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Total Value-Based

The Lucys

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Nora

• PDC: 29%

• Rules-based selection picked

Nora

• Improving Nora’s adherence

45% would have reduced

expected costs by <$200.

Value-Based vs. Rules-Based Selection

3 Example individuals

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Total Value-Based

The Noras

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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

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Total Value-Based

The Ethels

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Matching individuals to appropriate intervention requires analytical precision

Value-Based vs. Rules-Based Selection

Adherence alone doesn’t reveal potential savings

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 Avoided with Increase in PCD

> $14,00025% Increase

< $20045% Increase

> $10,00010% Increase

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Designed for a quick start by optimizing your current interventions

Maximize speed to value

How to OptimizeMeaningful Adherence™

Plan OptimizeImplement

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

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Risk

GNS Modeling & Analytics

Medical claimsEligibilityRx claimsOther data as available (Labs, Survey, EHR, Demographics, etc.)

Engagement

Efficacy

ROI

1. Scope the opportunity2. 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/BTesting

Intervention

Getting startedOptimize your current interventions

Op

tim

ize o

perati

on

s

Op

tim

ize s

trate

gy

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

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Modeling & Analytics Suite for Meaningful Adherence™

Meaningful Actions Accelerator (MAX)

Analytics &Models

Risk

MeasureBase

Plan Implement Optimize

Engagement

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

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A solution

platform for

optimizing

population

health

management

processes

ROI

GNS Population Health SolutionsAccelerate intelligent interventions

REFSTM Machine

Learning Platform

“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

We Have Reached a Janus Moment

Data-Intensive Discovery

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

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.”

- Robert Laughlin, Different Universe