Third-Party Payer Track: Proactive Identification and

Intervention Approaches

Presenters:

• Rochelle Henderson, PhD, Senior Director of Research, Express Scripts, Inc.

• Joseph Anderson, MBA, Director of Analytics, Helios

• Tron Emptage, RPh, Chief Clinical Officer, Helios

Moderator: J. Kevin Massey, MS, Program Administrator, Division of Public Health, Delaware Department of Health and Social Services, and Member, Rx Summit National Advisory Board

Disclosures

• Rochelle Henderson, PhD, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.

• Joe Anderson, MBA – Employment: Helios

• Tron Emptage, RPh – Employment/Stockholder: Helios

• J. Kevin Massey, MS, has disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.

Disclosures

• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

• The following planners/managers have the following to disclose:– Kelly Clark – Employment: Publicis Touchpoint Solutions;

Consultant: Grunenthal US– Robert DuPont – Employment: Bensinger, DuPont &

Associates-Prescription Drug Research Center– Carla Saunders – Speaker’s bureau: Abbott Nutrition

Learning Objectives

1. Explain the role of predictive analytics and statistical models to identify high-risk claims.

2. Describe strategies for intervening in high-risk claims to help injured workers and control costs.

3. Identify characteristics associated with chronic opioid use in a newly injured worker population.

4. Outline proactive strategies for curbing opioid abuse and misuse by chronic users.

Rx Drug SummitProactive Identification and

Intervention Approaches

Rochelle Henderson, PhDSenior Director of Research, Express Scripts

Disclosure Statement

• Rochelle Henderson, PhD has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.

Learning Objectives

1. Explain the role of predictive analytics and statistical models to identify high-risk claims.

2. Describe strategies for intervening in high-risk claims to help injured workers and control costs.

3. Identify characteristics associated with chronic opioid use in a newly injured worker population.

4. Outline proactive strategies for curbing opioid abuse and misuse by chronic users.

Pain Treatment in America

Challenges in the practice of pain care 1

Evolving evidence2

Approaches to better management for healthier outcomes3

Paying a High Price

259 million prescriptions for painkillers written in 2012

50 Americans die every day from prescription drug

poisoning

Using Data and Analytics to Dig Deeper

Prescribing Patterns Put Patients at Risk

Dangerous Combinations of Drugs

Dangerous Combinations of

Doctors

Rigorous Inferential Approach

Opioid Prescribing Physicians

Outlier Detection Method

Identification

Key Findings• Over 60% of WC uppermost

prescribers prescribe opioids to 2 or fewer patients

• On average, WC uppermost prescribers write: – more 30-day adjusted opioid

prescriptions per user

– longer days’ supply

– more than 7 times higher average cost for opioid prescription per user per day of therapy 0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

WC GH Mixed

% Uppermost Opioid Prescribers

We Need to Strike a Balance

Proactive Identification and Intervention Approaches

Presented by

Joe Anderson, MBA

Director of Analytical Services

Tron Emptage, M.A., R.Ph.

Chief Clinical Officer

Disclosure Statement

• Joe Anderson, MBA, Employment: Helios

• Tron Emptage, RPh, Employment/Stockholder: Helios

INDUSTRY TRENDS

Use of Narcotics and Other Medication ClassesFirst Year After Injury

22

59%

52%

30%

10%

57%55%

29%

10%

53%56%

30%

9%

0%

10%

20%

30%

40%

50%

60%

Narcotic Analgesics NSAIDS Skeletal Muscle Relaxants Dermatologics

2010 2011 2012

Medication Use Over Time

23

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10

Analgesics Narcotics Anti-inflammatory Skelatal Muscle Relaxers

Anti-Convulsant Dermatologic Antidepressant

Factors that Influence Outcomes

24

Number of Prescribers

Number of Pharmacies

PrescribingBehaviors

Medication Patterns

Body Part/Nature of Injury

Demographics of Prescriber

Medication Agreement

Drug Monitoring

SO WHAT ARE WE TO DO?

Predictive AnalyticsUsing a Multivariate Statistical Model to Predict High Pharmacy Cost Claimants

26

Correlate early data about an injured

worker…

… with resulting long-term spend of that

injured worker.

Workers injured in 2010 Resulting pharmacy costs in 2013

(DEPENDENT VARIABLE)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 4 6 9 12 18 24

Geographic and other Demographics Prescriber: Demographics of Treating Prescriber

Injury: Body Part, Nature of Injury Pharmacy Behavior

Pe

rcen

t o

f Si

gnif

ican

ce(A

ggre

gate

d A

cro

ss M

ult

iple

Var

iab

les)

Months Since Date of Injury

Predictors Change as Claims Age

Clinical AnalyticsIntervening on High-Cost Claims

Intervention Type Cost per Claim

Pharmaceutical Companies Use Network Analysis to Identify and Target Influential Doctors with Advertising

Source: ”Drug Marketers Use Social Network Diagrams to Help Locate Influential Doctors” May 16, 2013

http://www.nytimes.com/interactive/2013/05/16/business/PHARMA.html?ref=business

This Is Also an Effective Technique to Understand Injured Workers’ Risk for Long Term Prescription Drug Use

Long-Term Pharmacy Cost of Injured Worker, Based on Initial Prescriber’s Connectedness

Lon

g-Te

rm P

har

mac

y C

ost

of

Inju

red

Wo

rke

r

Initial Prescriber’s Connections with Other Prescribers

Science + Science = Outcomes

Data Analytics + Clinical Expertise = Better outcomes

Individualized Analysis + Clinical Review = Better Outcomes

Physician Letters

Pharmacist Medication Review

Physician Medication Review

Medication Monitoring

Declining Claim Duration

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48

2010 2011

2012 2013

Months since Date of Injury

Percent of Injured Workers Filling

Prescription Medications

35

A total program solution consisting of comprehensive data, risk analysis, and clinical tools will greatly decrease the likelihood of a long-term claim.

Thank You

Third-Party Payer Track: Proactive Identification and

Intervention Approaches

Presenters:

• Rochelle Henderson, PhD, Senior Director of Research, Express Scripts, Inc.

• Joseph Anderson, MBA, Director of Analytics, Helios

• Tron Emptage, RPh, Chief Clinical Officer, Helios

Moderator: J. Kevin Massey, MS, Program Administrator, Division of Public Health, Delaware Department of Health and Social Services, and Member, Rx Summit National Advisory Board