Costs Avoided by Network 8 PBM

FY99 FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 est

$4,033,789

$18,129,848

$34,484,025

$58,866,612

$79,640,676

$102,317,644

$129,110,473

$142,128,045

$167,544,442

$206,415,470

$224,466,137

$245,656,605

1999-2000STORM/FORMRECYCLEDDATA MARTDEVELOPED,

PRINCIPLES &RULES PACTINITIATES COLLABORATION

BEST CONTRACT COMPLIANCE

MED SAFETY: NARCOTICSDRUG DRUGINTERACTIONS

MONITOR LABS: SPLIT TABLETSGLUCOSE STRIPSNOT ON INSULIN

1999-2005NORMING:SELF BENCHMARK:LAST YEAR'S AVG ACHIEVEMENTINDICATORS FOR ACCOUNTABILITY TO EACH OTHER:LOW HANGING FRUIT AND WINDFALLS--eg AB RATEDNITRO SL GENERIC PARETO CHARTS UNIQUE TO SITEONE "BYE"per SITEUNIFORM DATAPRECISE DEFINITION

PERFORMING 1999-2000 -2001- 2002- 2003-2004-2005--------------------------------------2006-2007-2008-2009-2010

2006-2010 NORMING: NATIONAL BENCHMARK: LAST YEARS BEST 3 VISNS

PERFORMING 2000- MED SAFETY SPIN OFF 2001-DATAMART -VISN 4,7,82001- TECHNOLOGY FINALIST2001- First VISN 8 MAP Mbr 2004-Award winning STATIN SPLIT TAB Paper at Am Heart Asso2005 Am J Cardiology Publication2005 Copay Revenue Accuracy 2009 5 VISN 8 MAP Mbrs 2010 Orlando Drug File Collabora-tion

Additional slides about

Collaborative Data Mining in Rapidly Changing Environments

Robert Goodhope, MD, MBA

CMO Tallahassee VA Outpatient Clinic

Chair Network 8 Pharmacy Utilization Committee

Summary in Non-technical termsSynergy from Melding Business Principles, Clinical

Knowledge and Data TechnologyNetwork 8 Pharmacy Benefits Collaboration

Desperately Needed a Low Cost Centralized Pharmacy Information Support System. Completed-1999

Struggled with Many PBM Processes and Discovered Stark, Wheatley, Snowantle & others --1999-Present

FOR MORE INFO...

Look at the VISN 8 Home Page (http://vaww.visn8.med.va.gov)

Data Recycled for Data Mining

Raw Outpatient Pharmacy Data Emailed to National for One VA formulary Copy Emailed to Server for Network 8 DataMart

Operational Transactions become Uniform Archival Data when transformed to Thirty Day Equivalent Rx * in Server Query Language *Allows accurate Financial Metric comparisons * Sine qua None Innovation by VISN 8 PBM Accessible to Trained Searchers at each Facility

Data Mining Evolution & BenefitsData Mining Operations:

Prospecting, Nuggets Test Holes Mining Veins of Data Refining “Mother Lode” into Beneficial Information

Data Mining Benefits: Review: Outcomes Oriented Resource Utilization Monitor: Effectiveness of Formulary decisions Practice Trending: Drug Use and Lab Results

Test Hole: Top 25 Drugs=45% of Drug Cost

Veins of Data: Cost Position by QuarterQ1FY01 Total Cost Q2FY01 Total Cost Q3FY01 Total Cost Q4FY01 Total Cost

SIMVASTATIN # SIMVASTATIN # SIMVASTATIN # SIMVASTATIN #LANSOPRAZOLE # LANSOPRAZOLE # LANSOPRAZOLE # OLANZAPINE #OLANZAPINE # OLANZAPINE # OLANZAPINE # GABAPENTIN #METFORMIN # METFORMIN # METFORMIN # METFORMIN #GABAPENTIN # GABAPENTIN # GABAPENTIN # EPOETIN #FELODIPINE # FELODIPINE # FELODIPINE # FELODIPINE #EPOETIN # EPOETIN # EPOETIN # CLOPIDOGREL #SERTRALINE # SERTRALINE # CLOPIDOGREL # ALBUTEROL #ALBUTEROL # CLOPIDOGREL # SERTRALINE # SERTRALINE #FLUOXETINE # ALBUTEROL # ALBUTEROL # FLUOXETINE #CLOPIDOGREL # FLUOXETINE # FLUOXETINE # LANSOPRAZOLE #GOSERELIN # GOSERELIN # GOSERELIN # RISPERIDONE #LAMIVUDINE # LAMIVUDINE # LAMIVUDINE # ROSIGLITAZONE #TERAZOSIN # RISPERIDONE # RISPERIDONE # LAMIVUDINE #RISPERIDONE # PAROXETINE # ROSIGLITAZONE # GOSERELIN #REBETRON # IPRATROPIUM # PAROXETINE # REBETRON #IPRATROPIUM # SURE STEP # SURE STEP # PAROXETINE #PAROXETINE # INSULIN # INSULIN # SURE STEP #INSULIN # ROSIGLITAZONE # IPRATROPIUM # FOSINOPRIL #SURE STEP # FOSINOPRIL # FOSINOPRIL # INSULIN #FOSINOPRIL # REBETRON # REBETRON # DONEPEZIL #BECLOMETHASONE # FEXOFENADINE # DONEPEZIL # IPRATROPIUM #ROSIGLITAZONE # LISINOPRIL # LISINOPRIL # RABEPRAZOLE #LISINOPRIL # DONEPEZIL # TERAZOSIN # LATANOPROST #DONEPEZIL # BECLOMETHASONE # FEXOFENADINE # CITALOPRAM #

“Well begun is Half done . . . 49.7% of Benefit comes from 1% of effort.”

1%

50%

19%

30% 30%

19%

50%

1%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1% : 50% 20% : 80% 50% : 99% WASTED

LAW OF EVENTUALLY DIMINISHING RETURNS

EFFORT

BENEFIT

VISN 8 Lost Opportunity CostAnnualized based on Q3FY01

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

Olan

zapine

Citalop

ram

SimvT

S

Strips

/Day

Oxy

SA

Divalp

roex

Amlo

dipin

e

Fexof

enad

ine

COX-2

Parox

TS

Carved

ilol

SertT

S

Tamsu

losin

CitaloT

S

Olan

zTS

Cilost

azol

Risper

TS

Irbesa

rtan

Pareto Line

Having Picked the Low Hanging Fruit

And Having Shaken Tree --The Pony

Waits For Windfalls-- Hoping for Branch Lowering Technology or Something New to stand upon

The Soft Stuff of Managing Innovations

Paradox: Innovations Require Conventions

Most Important Where Change Most Rapid--

Margaret Wheatley

He leads best who leads least, so in the end, they know they did it themselves- Lao Tse

And form a Social Network which Outlives the Initial Collaboration –David Stark www.santafe.edu

$ 1/4 Billion Cost Avoided & A Seminal Publication

Parra D, Beckey N, Raval H, Schnacky K, Calabrese V, Coakley R, Goodhope R

Effects of Splitting Simvastatin Tablets for Control of Low Density Lipoprotein Cholesterol

American Journal of Cardiology 2005

95(12):1481-83. Cited 12 times (in addition to the Popular Press) theledger.com