Partnering to Deliver Solutions: A forward thinking approach in addressing health disparities

Date: April 5, 2016

Lily Higgins, MD – Market Chief Medical Officer, Keystone First

Lavdena Orr, MD – Market Chief Medical Officer, AmeriHealth Caritas District of Columbia

Heather Ruszin – President and CEO, Stellar Pharmacy

Natashia Sanders – Regional Director, PerformRx

Table of Contents

• How Innovation Happens

• The B.E.S.T. Cabinet & Program Overview

• The B.E.S.T. Program in Pennsylvania

• The Care Now Cabinet – The Next Challenge & Solution

• Care Rewards Program

• Key Takeaways

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How Innovation Happens

1. Identify Need – A key business (Patient Care) need, challenge or

obstacle is recognized.

2. Identify Potential Solutions – Thought leaders brainstorm and identify

potential people, process and/or technology strategies and solutions.

3. Prioritize Patient Safety and Outcomes – Patient safety and improved

patient outcomes are prioritized as part of the solution development.

4. Collaborate & Integrate Partner Capabilities– Partnering organizations

collaborate and work to integrate their relevant core people, process

and/or technology capabilities and expertise to design viable solutions.

5. Team and Share Resources to Implement – The solution is implemented

using shared resources as appropriate.

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B.E.S.T. Asthma Program – Breathe Easy. Start Today.®

https://www.youtube.com/watch?v=nvwR74XpKUM

Asthma Facts

Asthma is one of the most common chronic disorders in childhood, currently

affecting an estimated 7.1 million children under 18 years.

Asthma is the third leading cause of hospitalization among children under the age

of 15.

In 2010, there were 500,000 asthma-related hospitalization and 2 million asthma-

related ER visits.

Throughout the year, 1 in 5 children with asthma went to an ED for care.

The annual direct health care cost of asthma is approximately $50.1 billion;

indirect costs (e.g. lost productivity) add another $5.9 billion, for a total of $56.0

billion dollars.

Asthma Facts-Pennsylvania

Multiracial children experience a higher prevalence of asthma at 20 percent

compared to Caucasian children with an eight percent rate

Recent publication (2012): Asthma Prevalence in Philadelphia

– 2, 368 children screened through door-to-door methodology

• 21.7 asthma prevalence

– 5,563 children screened in schools

• 27.5 asthma prevalence

Child Asthma Hospitalization Philadelphia

Asthma Facts

Asthma medication adherence is low

– Non-adherence rates range from 30 percent to 70 percent

Up to three-quarters of total asthma-associated costs may be due to poor asthma

control

Improper inhaler technique results in poor asthma control

B.E.S.T Program Overview Electronic Rx Dispensing at Point of Service

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2013: Paper processes and binders

2014: XpeDose process eliminates paper and moves to a secure electronic dispensing unit

2016: New XpeDose TT units broaden provider and patient access

The Evolution from Paper Binders to Direct Electronic Rx Dispensing

B.E.S.T Program Overview Providing Timely Care Directly to the Patient

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Physician Dispensing At Point of Service

Patient Therapy Starts Immediately

Patient leaves office with inhalers, spacers and masks

Refills of Medication and Supplies delivered to the patient’s home each month free of charge.

B.E.S.T Program Overview Results to Date

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-21.30%

-36.80%

17.20%

-40.00%

-30.00%

-20.00%

-10.00%

0.00%

10.00%

20.00%

Inpatient Admissions Inpatient Days Outpatient Visits

March 2013-March 2016 29 Sites in PA

5 Sites in DC

Total Members 7674

Total New Rx 18974

Total Refill Rx 5792

Total Fills 24766

2014 6-month Pre & Post Asthma Study of Participating Members

B.E.S.T.

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Expansion to Family Planning program

Improvement of pre-conception health

Includes medications and devices-LARC

CARE NOW

Care Rewards Program Another Innovation in Fulfillment

• AmeriHealth Caritas DC has partnered with Stellar Rx to implement our Care Rewards gift card incentive program to improve results for several HEDIS measures

• $20 Walmart Gift Cards will be awarded to all member completing the following eligible exams or screenings

o Diabetic Exams and Screenings

o Adolescent Well Child Exams

o Post Partum Visits

• Other popular gift cards, e.g. Chipotle and DTLR, are being contemplated to further motivate specific age groups to complete the prioritized HEDIS and EPSDT measures

• Stellar Rx provides the following services to help make the program a success o Member eligibility verification

o Member phone call handling (includes fielding member calls and answering questions related to the program)

o Mail request processing (includes reviewing and tracking mailed member incentive requests)

o Validation of exam (includes outbound calls to providers to verify exam completion)

o Incentive fulfillment and tracking (includes mailing of gift cards to those members meeting the requirements and tracking the fulfilment of the member request)

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Key Takeaways

• A holistic, low barrier approach is needed in serving populations

with high needs such as Medicaid

• Leveraging the provider’s office for one stop convenience

increases the likelihood of compliance

• Providers appreciate an easy to use tool such as the cabinet which

fits in easily with the flow of their office

• Member incentives are an effective motivator when they are

relevant to the intended participants and delivered in a timely

fashion

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