Today, prescription drugs are the first choice for medical intervention in treating 88 percent of patients suffering chronic conditions. The 50 percent of Americans treated for a chronic condition account for 96 percent of all prescription drug spending and 75 percent of all medical costs. A proprietary new pharmacy model developed over three years by Medco Health Solutions, Inc. significantly reduces critical gaps in care for patients with chronic and complex diseases and lowers overall medical costs, according to an independently validated set of analyses released today.
“The data could not be more compelling. In an era where we have seen huge increases in the number of patients with chronic disease, an evidence-based protocol model leveraging the Medco Therapeutic Resource Centers(R), has proven critical to improving the effectiveness of treatment and driving down the cost of health care. We’ve invented an end-to-end capability that yields better outcomes, both clinically and financially,” said Medco’s Chairman and Chief Executive Officer, David B. Snow Jr.
Rigorous large-scale analyses were conducted by Medco, and the associated clinical content and general analytical processes were independently reviewed and validated by the actuarial and consulting firm, Milliman Inc.
The first analysis evaluated 600,000 patients to identify gaps in care in their treatment of diabetes, and pulmonary and heart disease. The gaps in care ranged from deviations in nationally accepted clinical protocols, including incorrect and over-prescribing, to patients failing to appropriately follow their physician’s instructions.
Key findings over a 90-day study period:
- For hypertension, Medco closed 81 percent of the clinical gaps related to patients not adherent to diuretic medications.
- For hyperlipidemia, Medco closed 74 percent of the clinical gaps related to patients not adherent to statin medications to lower cholesterol.
- Medco closed 24 percent of the gaps related to diabetes patients under insulin treatment who were not monitoring their blood sugars.
- Medco closed 7 percent of the gaps related to diabetes patients who, contrary to evidence-based protocols, never had a statin prescribed.
The second analysis, which was a review of two years of pharmacy and medical data, concluded that using the Medco Therapeutic Resource Centers (TRC) substantially reduced overall health care costs for select patients with hypertension by improving adherence to evidence-based standards. Per patient health care costs for hypertensive patients who either were primarily or exclusively using the TRCs was $10,509 annually, a $700 per-patient reduction in health care costs compared to the traditional pharmacy care model.
“In addition to elevating clinical care to improve patient wellness, this reduction in overall health care costs represents a significant breakthrough, and serves as a baseline for driving further improvement through our Six Sigma quality protocol, which is a foundation in achieving the potential of evidence-based medicine,” said Kenneth O. Klepper, Medco president and chief operating officer.
The third analysis compared compliance with evidence-based diabetes quality-of-care metrics for patients enrolled in the TRCs compared with those patients obtaining standard pharmacy care services.
Key findings comparing TRCs to traditional pharmacy channels revealed:
- More than 78 percent of TRC patients were adherent to their diabetes medications, compared to only 56.5 percent.
- More than 83 percent of TRC patient with diabetes were adherent to antihypertensive medications compared with 65.4 percent.
- More than 80 percent of TRC patients with diabetes were adherent to cholesterol-lowering medications compared with 62.4 percent.
- Of patients with diabetes needing to be on a cholesterol medication 76.6 percent of TRC patients were on a cholesterol medication compared with 63 percent.
Separately, Medco also evaluated the over-use of short-acting rescue inhalers for patients with asthma. Using a protocol-driven approach, the percentage of patients obtaining more than the recommended single canister of the rescue inhaler was reduced from 22 percent to 7 percent. This demonstrates the ability of the TRCs to identify and institute protocols to reduce medication waste and, at the same time, improve patient outcomes.
“These results are great news for those treating patients with chronic illness; they show that barriers to adherence, which have been a persistent and difficult problem, can be overcome with the right therapeutic approach,” said Klepper. “Patient counseling by specialist pharmacists appears to have a high degree of success in closing many of the gaps in care that need to be eliminated in order to improve clinical outcomes and lower overall health care costs. This was key to establish high levels of transparency and accountability to our clients.”
The TRC approach enlists specialist pharmacists guided by nationally recognized protocols in specific chronic diseases, as well as access to integrated data systems that allow them to leverage both pharmacy and medical information to better assess the patient’s condition and recommended course of treatment. These specialist pharmacists are uniquely able to provide in-depth counseling to patients to close a range of clinical gaps in care and, when necessary, to inform their collaborative discussions with the patient’s physicians.
“The focus today in health care is on developing a fully-wired system. This system is already a reality at Medco,” said Snow. “Our TRC model allows us to aggregate, in real time, 100 percent of prescription drug data and complementary medical information to identify and close gaps in care, drive proactive improvements, and prevent harmful drug interactions that also add to our nation’s huge health care bill.”
Lower Costs; Better Outcomes
These TRC analyses add to the growing body of evidence that overall cost of caring for patients decreases as the gaps in pharmacy care are closed. A separate Medco study published in the journal Medical Care, found that average yearly combined pharmacy and medical costs for the patients who were not adhering to evidence-based treatment protocols was $8,867 compared to $4,570 for patients adherent to their treatment regimen. On average, each diabetes patient not properly adhering to recommended therapy increases health care costs by as much as $2,200 per year.
“There is no denying that the unnecessary costs created by clinical gaps in prescription drug care are huge — but human costs are even higher. When people with diabetes fail to follow their medication or monitor their blood sugar, they risk blindness, amputations, renal failure and other serious complications. People with high blood pressure risk heart attack or stroke if not properly controlled through drug therapy,” said Dr. Peter Juhn, president of Medco’s TRC pharmacy practice. “Developing a care model that identifies at-risk patients and effectively intervenes through counseling and education is critical for preventing these avoidable consequences.”
“These results validate our belief that an advanced pharmacy model drives superior financial and clinical benefits,” Snow said. “We have already begun evaluating ways in which we can work with community pharmacies to bring the benefits and solutions we have created in the TRCs to the patients they serve. We are also working with policymakers in Washington to share what we have learned in hopes that it can serve as a model contributing to the many health care reform efforts under consideration today.”
Medco
Medco Health Solutions, Inc. is the nation’s leading pharmacy benefit manager based on its 2007 total net revenues of more than $44 billion. Medco’s prescription drug benefit programs, covering approximately one-in-five Americans, are designed to drive down the cost of pharmacy health care for private and public employers, health plans, labor unions and government agencies of all sizes, for individuals served by the Medicare Part D Prescription Drug Program, and those served by Medco’s specialty pharmacy segment, Accredo Health Group. Medco, the world’s most advanced pharmacy(R), is positioned to serve the unique needs of patients with chronic and complex conditions through its Medco Therapeutic Resource Centers(R), including its enhanced diabetes pharmacy care practice through the Liberty acquisition. Medco is the highest-ranked independent pharmacy benefit manager on the 2008 Fortune 100 list. On the Net: http://www.medcohealth.com/.
Milliman
Milliman is among the world’s largest independent actuarial and consulting firms. Founded in Seattle in 1947 as Milliman & Robertson, the company currently has 49 offices in key locations worldwide. Milliman employs more than 2000 people, with a professional staff of more than 1000 qualified consultants and actuaries, including specialists ranging from clinicians to economists. The firm has consulting practices in healthcare, employee benefits, property and casualty insurance, life insurance, and financial services. Milliman serves the full spectrum of business, financial, government, union, education, and nonprofit organizations. For further information, visit www.milliman.com.