introducing valueoptions’ clinical care alerts
TRANSCRIPT
Copyright © 2012 ValueOptions, Inc. All Rights Reserved.
Introducing ValueOptions’ Clinical Care Alerts
January 2013
Copyright © 2012 ValueOptions, Inc. All Rights Reserved.
What are Clinical Care Alerts?
How does it work?
What are the benefits?
Questions and Answers
Agenda
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The Issue of PoorMedication Adherence
Unnecessary hospitalizations
Medication escalation
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Medication-related problems contribute up to 50% of behavioral health admissions, 20% of medical admissions, and increased morbidity and mortality.
Medication non-adherence is considered the single most important factor leading to relapse among patients with schizophrenia.
Risk of hospitalization for schizophrenia decreases by almost 20% for every 10% increase in medication compliance.
Patients with therapy gaps of 30 or more days per prescription have almost five times greater risk of being hospitalized compared with patients whose therapy gaps are 0 to 10 days.
The Impact of Non-Adherence
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American Health & Drug Benefits, August 2009
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Most Interventions Today TargetPatients Directly
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Physician
PBM
Patient
Researchshows patient
self-reporting to be highly
unreliable.1
Pharmacy
Health Plan
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Clinical Care Alerts
Our Clinical Care Alert automated system identifies and notifies physicians of potential behavioral health, physical health, and medication care gaps in a timely manner.
It re-engages physicians in what has become an increasingly member-centric world to close patient-specific care gaps in the entire population while improving quality.
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Clinical Care Alerts Help Close Care Gaps
Works through the patient’s trusted advisor – the physician – closing a key feedback loop
Most often closed care gap is Early Discontinuation of Medication
Enhances provider collaboration by notifying all physicians related to a specific issue
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BehavioralClaim Data
Patient
Physician
Automated Provider Engagement
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ValueOptions Clinical Care Alert
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Concise Alerts that Support Collaborative Care
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Sample Medication Adherence Alert
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Concise Alerts that Support Collaborative Care
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Sample Lab Monitoring Alert
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Clinical Care Alert Technology
Analytical tools consisting of field-tested, validated rule sets for successful conversion that drives overall cost savings
Uses 11,000+ alert rules to screen the entire population and intervene earlier to reduce the chance of consumers becoming high-risk and high-cost
Alert rules updated manually on a bi-monthly basis or as needed
Enhances provider collaboration by notifying all physicians related to the specific issue in writing so they can work together to coordinate care for the consumer
Automated alert generation leads to successful intervention
Customized nimble, flexible data exchange structure
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Clinical Care Alert Automated Process
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Sub-Optimal Therapy
Monitoring
Missing Procedures
Poor Compliance Early Discontinuation
Alert Rules Cover All Chronic Conditions
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Duplicate Therapy
Polypharmacy
Drug-Drug Interactions
Overuse / Substance Abuse
Age-Inappropriate Therapy
Alerts
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Behavioral Health Related Rules
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Alert Example
Depression Without Antidepressants
Diagnosed with depression but is not filling prescriptions for an anti-depressant.
Follow-Up After Hospitalization for Mental Illness
Consumers hospitalized for treatment of selected mental health disorders but not seen on an ambulatory basis or in intermediate treatment with a mental health provider.
Acute and Continuation Phase Depression Treatment
Consumers diagnosed with a new episode of depression were treated with antidepressant medication, but discontinued therapy prior to six months.
Optimal Practitioner Contacts for Medication Management of Depression
Consumers diagnosed with a new episode of depression and treated with antidepressant medication, but have not had at least three follow-up contacts with a practitioner during the 84-day (12-week) Acute Treatment Phase.
Medications that Aggravate Depression
Multiple drugs have been reported to cause depression in some consumers. Elderly people are particularly at risk.
Schizophrenia Without Antipsychotics
Consumer appears to have schizophrenia but is not filling prescriptions for an antipsychotic.
Antipsychotic medications & metabolic screening
Consumers treated with an atypical antipsychotic agent that have not had a diabetes screening.
Bupropion & Eating Disorders Combination bupropion and eating disorder increasing risk of seizures.
Bipolar Disorder Without Mood Stabilizers
Consumer appears to have a bipolar disorder, but is not filling prescriptions for a mood stabilizer.
ADHD Medication Management
Attention deficit hyperactivity disorder (ADHD) consumers on first-line medication that have less than one (1) follow-up visit per year.
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Questions and Answers