Week 11 – R X S T E W A R D S H I P
Moving Toward STRATEGIC RX STEWARDSHIP™
Have you ever been surprised when looking at an itemized bill from your phone carrier? In a recent review of my own bill, I counted nine separate costs in addition to the charge for the actual service. Some of the line items, including the 9-1-1 Service Fee, are easily understood. Other items, including a nebulous “Administrative Fee”, are not as clear. What is included in this amount? What value am I receiving?
Unfortunately, this phenomenon is fairly common. Think about your last hotel bill. Or your most recent vehicle purchase. Title costs, dealer prep, documentation fees….even a wheel tax! However, while these costs may not have been included in the advertised price, they were likely clearly articulated on your bill. When it comes to pharmacy benefits, that isn’t always the case. Some costs are harder to discern for all but the most savvy.
A trusted advisor can be very helpful in trying to find and quantify these hidden costs. To assist you in this effort, please find below areas where hidden costs can typically be found.
Classification of medications as brand, generic or specialty –
On the surface it may seem as though this is a simple determination but when a generic medication is categorized as a specialty medication, the result is a dramatic increase in cost for you and your members.
Formulary –
Your formulary should favor medications that provide the best value for your organization as opposed to being set up to maximize value for others through spread pricing, rebates, and commissions.
Maximum Allowable Cost (MAC) list –
Ideally your MAC list should be transparent and updated on a regular basis.
Rebates –
Your organization should understand the methodology utilized to calculate rebates earned and should have the ability to be audited. If your organization does not receive rebates, there should be quantifiable cost offsets in place.
Administrative Fees –
There should be clarity on exactly what services your organization is receiving in return for administrative fees.
Prior Authorization Management –
You should understand the value your organization is deriving from the prior authorization process including metrics for the volume of reviews conducted, denial and appeals rates and adherence to medication regimens that are suggested as part of the prior authorization process.
Pricing –
Your organization should have a good understanding of how ingredient cost reimbursement is determined, as well as the total cost of providing a medication to a patient. This includes administrative fees, dispensing fees,
Pricing is an area that we would like to expound upon as it is often a treasure trove for hidden costs. It is common to simply examine the ingredient cost of a medication when completing an analysis of costs. However, a more accurate review would also examine pharmacy dispensing fees and administrative fees including those assessed by your PBM, TPA or others.
The information included in the graphic below was pulled from Northwind’s claims repository and depicts differences in ingredient costs, administrative fees and dispensing fees using a traditional PBM model as compared to Northwind’s transparent cost-plus model.
If you would like to learn more about helping your organization understand hidden costs, maximize financial efficiency and avoid fees that do not provide value – let’s have a conversation!
Week 10 – R X S T E W A R D S H I P
Moving Toward STRATEGIC RX STEWARDSHIP™
Charles Duell, who served as the Commissioner of the US Patent Office from 1898 to 1901, is often mistakenly attributed as saying something along the lines of “Everything that can be invented has been invented.” Over time, this has been proven to be an ‘urban legend’; however, later in life, he did remark:
“ In my opinion, all previous advances in the various lines of invention will appear totally insignificant when compared with those which the present century will witness. I almost wish that I might live my life over again to see the wonders which are at the threshold.“
Although Duell made this statement in 1902, it rings true even 119 years later. Perhaps nowhere is his comment more relevant than in the pharmaceutical industry – especially in the area of specialty medications. Developments in technology and an understanding of the human body at unprecedented levels of detail have led to amazing advances in medication therapy. Newer treatment options for diabetes, cancer, cardiovascular conditions and autoimmune diseases abound. Additional treatments for cancer, diabetes and Alzheimer’s disease are on the horizon as are truly novel treatments using gene therapy. Those who have previously struggled with a lifelong condition, those whose disease has progressed beyond traditional medications and those who have faced an ‘incurable’ malady have been given newfound hope for relief.
Unfortunately, the financial implications of these advances are both substantial and well documented. While this issue is not new for employers, the future size and scope of these challenges continues to be realized.
TRENDS OF NOTE
Although specialty medications typically account for less than two percent of all prescriptions, it is not unusual for them to account for 45% – 55% of an employer’s entire pharmacy benefit spend. It is anticipated that specialty pharmacy spend will exceed $360 billion in 2021, with 9 of the top 10 best-selling medications (by revenue) being classified as specialty drugs. This compares to 7 of the top 10 in 2014 and 3 in 2010. In 2020, 83% of medication approvals were for specialty pharmaceuticals, an increase from 66% in 2019. Specialty pharmacy prices are likely to increase by 11.5% in 2021 as compared to a 2.8% price increase for non-specialty pharmaceuticals. Furthermore, prescription volume for specialty medications increased 6% in 2020 as compared to flat utilization for non-specialty medications.
In their 2021 Drugs to Watch report, Clarivate™ identified four medications which they believe will produce more than $1 billion each in annual sales within five years. While less than half-dozen gene therapies are currently FDA-approved (at an average cost exceeding $1 million each), over 900 clinical trials are currently in progress to evaluate future gene therapies.
MOVING TOWARDS THE FUTURE
These trends point to employers facing further specialty medication-related cost pressure. The most common cost containment approaches implemented to date have involved increasing copayments and deductibles, instituting prior authorization and step therapy programs, narrowing the specialty medication formulary list and using patient assistance programs. Some employers have chosen to simply exclude specialty medications altogether. It is certainly understandable that employers will need to take the steps necessary to protect the viability of their benefit plan and the company at large and Northwind can help provide options and solutions; however, one wonders if there are steps that can be taken to attenuate costs while maintaining plan access to specialty medications for employees.
- Ensure the patient is taking the medication properly. Having a pharmacy team available to provide customized 1:1 education and to answer questions that come up over time is a key component for long-term patient success. Many specialty medications require more diligence than simply taking a tablet or capsule. Regimens can be complicated. They can be time sensitive. They can have specific storage requirements. Proper use often requires a guiding hand and consistent support.
- Ensure medication adherence. The most expensive medication is the one that isn’t taken. Employers need programs in place to ensure patient adherence with their medication regimen. Patients who need specialty medications often have complex diseases, cognitive challenges or extensive medications lists. Over a period of time, it is easier to lose track of whether a medication was taken than one would think.
- Have a plan to measure overall outcomes. It is easy to focus solely on the cost of the medication, but it is important for employers to take a broader view. Metrics such as overall benefit costs (medical and pharmacy), absenteeism and productivity trends can all be important components of measuring the overall investment that has been made in specialty medications.
- And last, but certainly not least – focus on prevention. This post started with a quote from Charles Duell and will end with one from Benjamin Franklin – “An ounce of prevention is worth a pound of cure.” Any effort employers can make to help prevent or control disease will pay dividends. Regular health education, benefit plan design that emphasizes preventive measures and employer-sponsored biometric checks and health screenings can be of tremendous value. Clinical programs that help employees with tobacco cessation, weight management, pulmonary disease, cardiac disease, diabetes etc. can not only provide short-term savings, but can prevent disease progression leading to a need for certain specialty medications.
The financial implications of specialty medication use is understandably a cause for concern but if you would like to explore ways to continue to provide a robust, meaningful benefit plan for your employees while protecting your organization, please reach out. Let’s have a conversation!
Week 9 – R X S T E W A R D S H I P
Moving Toward STRATEGIC RX STEWARDSHIP™
During last week’s “R is for Results” post, we made the case that while simple metrics are a good starting point for measuring outcomes, it is important to try to move toward a longer-term goal of measuring impact. We also teased this week’s installment of our Rx Stewardship blog series and our exploration of the positive financial and clinical outcomes achieved as the result of implementing a Northwind diabetes clinical blueprint.
BACKGROUND
It would be hard to overstate the impact diabetes has had on patient lives or overall healthcare trends. As seen in the graphic below, the prevalence of diabetes continues to increase at a disturbing rate. Perhaps even more concerning is data that indicates a significant driver of this increase is the incidence of diabetes in adolescents.
Source: CDC. National Diabetes Statistics Report; 2020.
The cost of treating a patient with diabetes is ~ 2.3 times the cost of treating a patient without the disease. According to the most recent data available, $327 billion is spent annually to provide diabetes-related care throughout the United States. This accounts for 1 out of every 4 dollars spent on healthcare! And yet for all the resources devoted to this effort, diabetes remains a leading cause of blindness, chronic kidney disease, non-traumatic amputations and cardiovascular mortality. As prevalence increases, addressing this disease may require new or additional resources and planning.
CLINICAL BLUEPRINTS
As employers grapple with the impact of diabetes, they have become ever more interested in seeking solutions that mitigate the human and financial resource toll this disease imparts. This need was a major driver in the development Northwind’s chronic disease clinical blueprints – a road map that patients, employers and health services providers can follow to achieve more efficient medical and pharmacy resource utilization and better outcomes.
All thirteen of Northwind’s clinical blueprints, including diabetes, provide a mechanism for removing the medical, pharmaceutical, educational and financial challenges patients face in managing a chronic disease. One important feature of the clinical blueprints is that for employers who offer a health center for their employees – the programs are designed to further incent patients to utilize the health center offering by making it a true nexus of care. In this way there is maximization of the value of the investment already being made by an employer.
Northwind has partnered with a variety of health center providers and employers to implement our clinical blueprint for diabetes. While the size of the employer, the geographic location of the employees and the work they do is highly varied, the need to support the healthcare journey for those with diabetes is very consistent. Northwind is proud to work with our employer and health center partners in supplying subject matter expertise and additional resources to supplement their efforts. We are inspired by their commitment to better health and their willingness to try innovative approaches to care management.
RESULTS
One of the most common metrics for measuring diabetes control is Hemoglobin A1c (A1c). Not only does this lab test measure longer-term blood glucose control, it is also an indicator of the level of risk for future complications including stroke and heart attack. From the pre-program baseline through the first six months of program participation, we are seeing an average 1% reduction (12% relative reduction) in A1c. Patients who had good control of their disease have stayed in control, while those who had struggled are now experiencing remarkable results. As an example, we have seen patients lower A1c values as much as 4 percent. One longer term program patient lowered their A1c from 14.3% to 7.4%. As a point of reference – a decrease of 0.5% is typically considered clinically relevant.
The program has resulted in increases in compliance with routine foot exams and annual eye exams. Improvements in blood pressure and cholesterol control have also been noted. Emergency Department visits and inpatient hospital admissions for a diabetes-related condition are dropping. Pharmacy and medical benefit costs have been reduced.
While this success has been tremendous, perhaps the most important outcome has been the impact on the lives of the participants. Multiple program enrollees have come forward to thank their employers for providing this level of support. They have relayed how the program has provided benefit not only to them but to their family members. As witnessed by the quote below, that impact has been substantial.
“This removed a big worry. I am able to stay healthy and pay rent.”
VP, Compensation and Benefits describing the reaction of an employee enrolled in their Diabetes Management Program
Are you ready to take the next step to drive results for your organization and your employees? Are you interested in learning more about Northwind’s clinical blueprints? If so, let’s have a conversation!
Week 8 – R X S T E W A R D S H I P
Moving Toward STRATEGIC RX STEWARDSHIP™
R is for Results
Seeing or hearing advertisements proclaiming results is commonplace for most of us. Promotions frequently tout the biggest sale of the season, unsurpassed warranties or life-altering results. My new personal favorite is an ad proclaiming that a particular product is guaranteed to last a full 24 hours but quickly reminds consumers that they need to use said product twice daily!
This bravado has carried over into the health care industry and more specifically pharmacy services. Claims of being the one and only provider of certain services, decrees of maximum cost savings and promises of full transparency are becoming the norm. And while this may reflect an industry that continues to evolve product and service delivery, it does beg the question – outside of all of the hype – do you understand the result of the investment your organization is making in your pharmacy benefit program?
Truly understanding results requires a working knowledge of at least foundational terms and concepts within the industry. A few examples include average wholesale price (AWP), average cost index (ACI) and maximum allowable cost (MAC). Even terms that are believed to be simple and commonly understood may need to be double-checked as working definitions have evolved over the past few years. Beyond simply understanding terms, do you understand how fees, cost sharing and rebates are actually calculated? If your organization is told it is receiving 100% of earned rebates, is there clarity for how that is measured? Is there visibility into the impact on overall costs? From a clinical perspective, is there agreement on which metrics are being measured? Perhaps most importantly, is there a quantifiable positive impact on real life health outcomes?
Receiving results even as independent points of data can be a step forward in the quest to craft a high value benefit plan. However, if that information is disconnected, not placed into the proper context or distracts attention from the overall picture, the information may not be as helpful as perceived. As an example, when exploring the use of migraine medications, a report may show high generic, formulary and medication adherence percentages. At first glance, all three of those metrics are positive. However, they may obscure insight into members who are using migraine rescue medications week after week or month after month without using any medications for preventing the migraine in the first place. If this is the case, not only are those members not receiving the best care or outcomes, it is likely that absenteeism, productivity and overall benefit dollars have been negatively impacted – clearly not the desired result.
As you contemplate designing your organization’s plan to measure data and gain better insight into the true outcome impact of those metrics, you will likely find value in incorporating a few Lean Six Sigma (LSS) concepts into your planning and execution. The use of A3’s and smart goals can help create a road map for program implementation, data collection and impact measurement. Having these quality improvement tools in place can be of tremendous benefit for organizations seeking to maximize the value of their investment.
Northwind is committed to helping your organization achieve its outcomes and impact goals. We can provide LSS Black Belt support throughout your journey and our advanced analytics, data reporting and clinical blueprints are all designed to help you gain insight into your data, influence trends and behavior and impact health outcomes for those you serve.
Next week’s blog is entitled D for Diabetes and will explore the positive financial and clinical outcomes achieved as the result of implementation of a clinical blueprint as part of a collaborative effort between an employer, a health center provider and Northwind. We are very excited to share these results with you. In the interim, if you would like to explore ways to help your organization achieve the results you desire – true measurable and impactful outcomes, please reach out. Let’s have a conversation!
Week 7 – R X S T E W A R D S H I P
Moving Toward STRATEGIC RX STEWARDSHIP™
A is for Analytics
“Things get done only if the data we gather can inform and inspire those in a position to make [a] difference.” – Mike Schmoker
If you are a self-funded employer, a benefits advisor, or a provider of employer-based healthcare – you are in a position to make a difference. You have the ability to make healthcare more accessible, more affordable, more efficient and easier to navigate. Your ability to influence change confers upon you a great responsibility. A responsibility to be a good steward of your resources, to be bold, to seek out solutions to complex problems, and to advocate for those you serve or represent. At Northwind, we are privileged to work with individuals and groups who actively engage in this pursuit and we salute your efforts. However, we believe there is more to be done!
Throughout the duration of this blog series, we have made multiple references to our Framework for Strategic Rx Stewardship and its core elements – Insight, Influence and Impact. This week’s blog focuses on Insight, particularly our work with Advanced Analytics and Actionable Insights.
The objective is to convert data into information that will drive the ability to influence wellness behavior through programs and services with the ultimate goal to have a positive impact on overall health outcomes. In fact, we are so committed to this effort that we have made our analytics services cost-free and commitment-free!
ADVANCED ANALYTICS
Leveraging robust data mining capability and expert guidance, Northwind Advanced Analytics utilizes your pharmacy claims file as the basis for providing visibility and understanding of opportunities for increasing the value of your pharmacy investment.
We help you uncover opportunities for savings on direct costs, enhanced rebate procurement, and implementation of clinical programs. Projections for on-site dispensing optimization and/or home delivery are included with the analysis, as is a review of specialty medications – the fastest area of growth within pharmacy spending. Each report provides practical, actionable recommendations for your consideration. With our Lean Six Sigma expertise we can even help you design a road map for implementing and then monitoring the progress of the programs you choose to embark upon.
ADVANCED INSIGHTS
Our Advanced Insights program offers an ongoing review of your pharmacy benefit program. Dashboards are available allowing you to track a variety of metrics to help improve the overall efficiency of your program. Information is provided about hidden trends within segments of your membership. As an example, gaps in preventive care, populations at-risk for poor outcomes, and members likely to be non-compliant with their medications can all be identified so that strategies can be implemented to obtain the best results possible. Should an employer provide access to an employer health center for their membership, our Advanced Insights program is intended to work in collaboration with the medical team to enable the health center to be a true nexus of care for your organization.
Do you want to make a difference but aren’t sure where to start? Do feel like you don’t have the data you need to make an informed decision about next steps? Are you looking for a collaborative partner in your quest to implement and monitor patient care programs? If so, let’s have a conversation and get things done together!
Week 6 – R X S T E W A R D S H I P
Moving Toward STRATEGIC RX STEWARDSHIP™
W is for Webinar
Last month, in collaboration with the Wellness Council of Indiana, we kicked off our three-part webinar series entitled Strategic Rx Stewardship. We are now eagerly counting down the days until our second installment – Diabetes Care Re-imagined: Leveraging your health center to manage diabetes – and thought we would share the 5 W’s of the event.
WHAT: This webinar focuses on a case-study of Mountain American Credit Union’s success in leveraging their health center to provide enhanced care navigation support for their members who have diabetes.
WHO: Betsy Bigler, President and COO for Northwind Pharmaceuticals will moderate the session and we are thrilled that she will be joined by Dr. Jeffrey Ayers, a regional medical director for CareATC, and Keith Grames, the AVP, Compensation and Benefits for Mountain American Credit Union.
WHEN: Tuesday, April 27th from 2:00 – 3:00 EDT
WHERE: Anywhere it is convenient for you to log in!
WHY: There are many reasons why you should consider participating in this event including the following:
- Over 23 million people in the United States have been diagnosed as having diabetes with an additional 7 million being undiagnosed. It is estimated that 80 million Americans have at least one risk factor for developing diabetes.
- Diabetes is one of the leading causes of blindness, non-traumatic amputation and kidney disease and is the seventh leading cause of death.
- The cost of medical care for a patient with diabetes is approximately 2.5 times the cost of care for a similarly situated patient without diabetes.
There are also several reasons that Northwind is committed to providing this webinar. Not the least of those reasons is that one of our core values is to leave things better than we found them. We know that by working with our employer and health center partners we can maximize the value of the pharmacy investment that employers are making. Furthermore, we believe that utilization of our clinical blueprint framework creates additional opportunities for providers to have the tools necessary to help patients successfully navigate their path to good health.
We hope you can join us on April 27th and have included a registration link below. If you cannot attend the webinar but would like to learn more, please reach out – let’s have a conversation!
Week 5 – R X S T E W A R D S H I P
Moving Toward STRATEGIC RX STEWARDSHIP™
E is for Engagement
Health care terminology has always been interesting to me. Borborygmus (stomach growling) is one of my favorite unique sounding words that is just fun to say. Most proper medical terms are precise and refer to very specific pathology, symptoms, procedures or medications. However, this preciseness has not translated to healthcare administration where many phrases are commonly used but lack concise or even agreed upon definitions. Terms such as “wellness”, “population health” or even “compliance” tend to fall into this category. Another term that has eluded a standardized definition is “engagement”. At Northwind, we talk a lot about engagement so we thought it might be helpful to put additional context behind our use of the word.
A BRIEF HISTORY
The current concept of patient engagement can likely be traced back to the 2001 Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century. The purpose of the report was to address challenges many patients faced when trying to navigate a complicated health system that often valued a one size fits all approach over patient buy-in, understanding or convenience. The report envisioned a ‘patient-centered’ system that provided care that was ‘respectful of and responsive to individual patient preferences’ and resulted in patients understanding their care plan in an effort to increase their ability to follow treatment regimens.
In the intervening years engagement has been the topic of countless presentations, articles, conferences, books and panel discussions. Companies have been created to assist organizations with tactics such as patient portals, social media campaigns, wearable health devices and program development. Engagement has even served as its own outcome metric. The National Committee for Quality Assurance, among other organizations, has deemed a variety of assessments measuring patient engagement as a requirement for certification. Medical providers, benefits directors and IT executives all claim a certain level of ownership in creating ‘engaged patients’ even if they do not agree on what that means.
From our perspective, the conceptual framework of patient engagement that was put forward in a Health Affairs Policy Brief seems particularly poignant. The authors first outlined “patient activation” as the patient’s knowledge, skills, ability and willingness to manage their own health care. They then defined “patient engagement” as a broader concept that combines patient activation with interventions designed to promote positive patient behavior. As Michelle Noteboom summarized in a subsequent Healthcare IT News article, “In other words, the patient is willing and able to participate in [their] care and someone is providing ‘interventions’ to promote that participation.”
WHY ENGAGEMENT IS IMPORTANT
With so much mindshare devoted to characterizing patient engagement, it is logical to ask the question – is engagement all that important? In a word, yes. Using the concepts of patient activation and engagement as defined above, a randomized, year-long study of over 60,000 patients demonstrated that those with the highest activation scores, even after adjusting for health status and other health-related factors, had 21% lower medical costs as compared to a peer group with the lowest activation scores. In addition, patients who were provided enhanced programmatic support experienced 12.5% less inpatient admissions, 2.6% less emergency department visits and 9.9% fewer surgeries.
THE NORTHWIND APPROACH
At Northwind, we have a variety of programs and services available to assist our partners in providing patients with the knowledge and skills needed to create activation. These include resource guides, medication education, compliance packaging, patient care apps and a team of pharmacists available for personal consultation as needed. We also offer patient engagement opportunities through our chronic disease clinical blueprints which provide care navigation assistance for patients and providers alike. These blueprints cover everything from program development and patient enrollment through outcomes measurements.
If you want to learn more about driving outcomes through our patient engagement strategies – let’s have a conversation!
Week 3 – R X S T E W A R D S H I P
Moving Toward STRATEGIC RX STEWARDSHIP™
It is an honor to be able to write the blog post for this week as I come from a family of teachers. My wife, both parents, mother-in-law, grandmother and great-grandfather all devoted their professional lives to education and to nurturing students of all ages. I have seen first-hand the countless hours of preparation that were dedicated to providing a learning experience that not only helped create opportunities for students but inspired them to be life-long learners and to use their education to benefit others.
THE VICIOUS CYCLE
Schools face a multitude of challenges. Society has continually asked more and more of our educators but has not provided a commensurate level of resources. Financial constraints that have plagued school systems for quite some time have worsened in recent years as security measures, additional safety net programs and pandemic-related expenses have all created additional resource needs.
While these challenges are significant, one of the greatest difficulties facing schools is maintaining the health and well-being of their staff. Emphasis on the outcomes of standardized testing, student and parent pressure for grade inflation, reduced teaching autonomy, school shootings and e-learning have all placed additional burdens on teachers resulting in job dissatisfaction, burnout and some of the highest turnover rates in recent history. Unfortunately, as teachers juggle the demands associated with caring for their students and their own families, caring for themselves is often an afterthought. Medical appointments are delayed, medications are skipped, and health screenings are avoided.
Teacher selfcare as an afterthought has a two-fold effect. First, studies have demonstrated that students of healthy teachers are able to achieve better academic outcomes than students with unhealthy teachers. Second, gaps in preventive or routine medical care typically result in the need for expensive ‘rescue’ care which often leads to sub-optimal outcomes and increased costs for both the individual and the school system. These increased medical costs put further financial pressure on school systems resulting in less funds being available for student programming, teacher resources or contributions to the medical/pharmacy benefit plan. A vicious cycle is created that can be difficult to break.
INSIGHT, INFLUENCE, IMPACT – THE SCIENTIFIC METHOD OF Rx BENEFITS
We are taught that the Scientific Method is based upon the following components:
- Conduct observation and complete background research to describe a problem
- Create a hypothesis
- Test the hypothesis
- Draw conclusions and make improvements to refine the hypothesis
Northwind has created a framework for Strategic Rx Stewardship™ that follows the same basic components.
We provide the insight, influence and measures of impact required for self-funded employers to:
- understand and articulate current pharmacy concerns
- create customized programs to address those concerns
- measure program results and design future interventions using quality improvement principles
THE $100 MILLION STRATEGIC RX STEWARDSHIP™ CHALLENGE
As a pharmaceutical services company genuinely interested in ensuring that our patients have the resources and education needed to maximize their care, we feel a deep connection to school systems and their mission. In fact, Northwind is so committed to assisting school systems that we are engaging in a $100 Million Strategic Rx Stewardship™ Challenge. Between now and the end of 2021, we are working to identify a combined $100 million in pharmacy benefit savings opportunities for school systems and their insured members. Our goal is to assist schools in improving the health of teachers and staff while maximizing the efficiency of their pharmacy benefit so that precious financial resources can be used to further student education.
Will you join us in meeting the $100 Million Challenge? If you are a school system administrator or advisor and are interested in learning more – let’s have a conversation!
Week 2 – R X S T E W A R D S H I P
Moving Toward Strategic Rx Stewardship
Northwind Pharmaceuticals is headquartered in Indianapolis and along with our fellow Hoosiers, we are thrilled to host the 2021 NCAA Men’s Division I Basketball Tournament. As the tournament progresses over the next three weeks, there will be a lot of talk about strategy and specifically X’s and O’s – the representation of choreographed movement between teammates to accomplish a goal that individuals could not achieve on their own.
While we certainly enjoy discussing the intricacies of basketball, when we think of strategic planning and X’s and O’s, we tend to think about employer on-site and near-site health centers and the opportunity to use those as a nexus of care to benefit self-funded employers and their insured membership. Employer-sponsored health centers can be a lever to drive improved outcomes through implementation and integration of targeted programs. As part of our 14-week series on Strategic Rx Stewardship™, this blog post will explore the concept of the nexus of care and its impact.
Merriam-Webster provides a short list of definitions for nexus including: ‘casual link’, ‘center’ and, our favorite, ‘connected group’. Using a health center as a nexus of care, a place where purposeful connections are made between patients, care providers and pharmacy services, can be a powerful tool in achieving integrated health and improved outcomes. At Northwind, we strive to provide insight, influence and impact as our contribution to this nexus of care model.
INSIGHT
Leveraging dynamic pharmacy analytics tools and expert guidance, we provide visibility, understanding and direction for employers and their health center partners. Detailed information about pharmacy spending, ‘high risk’ patients, formulary efficiency opportunities and medication adherence patterns can all be utilized to maximize the outreach efforts of health center providers. Imagine the efficiency employers gain by moving away from using a non-specific, blanket-type approach to member engagement with the hope of reaching the correct members in favor of utilizing specifically targeted programs and communication strategies crafted with insights gained through pharmacist-reviewed analytics.
INFLUENCE
Empowering an employer’s membership with facilitated access to medications, home testing, supplies and education assists the employer in gaining greater influence over pharmacy costs and health outcomes. Last week’s blog provided an overview of our Rx@Work, Rx@Home and RxAdministration products, including Clinical Blueprints. These programs can be utilized as part of a coordinated effort to give health center medical providers additional tools they can implement to engage patients. Clinical Blueprints, in particular, are a perfect way to deliver on a nexus of care philosophy as they provide health center staff and ancillary care providers with a complete toolkit of resources to assist with outreach, disease education, self-monitoring tools, chronic care medications and monitoring parameters for quality improvement efforts.
IMPACT
At Northwind, our approach to creating improvement is built upon three pillars:
- Engage – We engage the employer, the health center and the patient in the Strategic Rx Stewardship™ process.
- Enhance – We enhance employer and health center partners’ ability to leverage pharmacy spend to deliver better health outcomes.
- Empower – We empower the employer, the health center and the patient with the guidance and tools necessary to provide value to each stakeholder.
This work is documented on customized dashboards that capture the outcomes of a variety of employer and health center guided metrics, as well as, those derived from medical standards of care and published HEDIS measures. For us, the true measure of impact is determined by whether we have facilitated converting an employer’s Rx spend into an Rx investment that returns value through improvement in cost containment and clinical outcomes.
Employer-sponsored health centers are perfectly positioned to be a nexus of care that delivers impactful and measurable outcomes through strategically targeted medical and pharmaceutical interventions. If you would like to learn more about the X’s and O’s of the Strategic Rx Stewardship™ playbook and how we can win together, please contact us. Let’s have a conversation!