Satisfaction & Reduce Uncompensated and Charity Care Costs - - PowerPoint PPT Presentation

Creating a Viable Prescription Assistance Program to Improve Patient Satisfaction & Reduce Uncompensated and Charity Care Costs

Prescription assistance

Presenter Chastity Werner, CEO|President cwerner@npc-meds.com

Learning Objectives

• Our current state
• The why?
• Identifying patients in need?
• Creating a medication assistance program
• Identifying results

Where do patients go when they cannot afford their medications? ED & Readmissions Uncompensated & Charity Care Costs

Patients are faced with daily difficult choices, such as paying for their electricity, food

• r their

healthcare.

• r their

healthcare.

Behavioral vs. cost-related nonadherence (CRN)

How is your organization tracking medication adherence?

The cost to stay alive

• 1 in 3 chronically ill adults report that they are unable to afford food, medication or

both, and CRN is more common among those with food insecurity.

• It was found that half of adults with diabetes perceived financial stress, and one-fifth

reported financial insecurity with healthcare and food insecurity.

• Fewer than half of patients with diabetes report discussing the cost of medications

with their physicians, although over 75% express that such communications were important.

Source: Social determinants of health, cost-related non-adherence, and cost-reducing behaviors among adults with diabetes: findings from the National Health Interview Survey (HHS Public Access)

Did you know?

• 60% of Americans live with a chronic condition
• 40% have two or more
• 70% of Americans are on at least 1 prescription
• More than ½ are on two
• 20% are on 5 or more

The why

Uninsured & Underinsured High out-of- pocket expenses Organizations lack resources & access to solutions 2.1 Billion Rx are NEVER FILLED 68% Readmissions

• avoidable

adverse events related to medication non- adherence 72% Post- Discharge adverse events are related to medication adherence

Lack of Resources & & Access to Solutions

Case Study

• 70% reported difficulty paying for medicine
• 45% reported at least one form of cost-related nonadherence
• 40% engaged in more than one cost-related nonadherence practice
• 37.5% Skipped doses
• 12.5% Took less medication than prescribed
• 42.5% Delayed medication refills due to cost
• “Sometimes I cannot pick up from the pharmacy on time because I don’t have

money”

• Only 25% of these patients had a conversation with their providers

Source: Identifying and Understanding Barriers and Facilitators to Medication Adherence Among Marshallese Adults in Arkansas. (Journal of Pharmacy Technology 2018)

Case Study

• Over half the patients who experienced CRN had not asked

healthcare providers for help in reducing their costs.

• Patients may be embarrassed to tell their physicians when they

cannot afford their medications or believe that it is not the doctor’s job to deal with cost issues.

• Physicians tend to lack knowledge about drug costs and may

not be adequately trained to inquire about a patient’s financial situation.

Source: A Pilot Study on Cost-Related Medication Nonadherence in Ontario

The cost to stay alive

• Cost Related Medication Underuse (CRMU) (also referred to a

Cost Related Nonadherence-CRN)

• Circumstance that arise when a patient takes less medication than

prescribed or does not take it at all due to cost.

• This includes behaviors such as:
• Reducing dosage
• Skipping dosage
• Delaying dosage
• Sharing medications
• Reducing the cost barrier would lead to better chronic disease

management, reduced incidence of hospitalization, and reduced healthcare costs in the long term.3

Source: Cost-related medication underuse: Strategies to improve medication adherence at care transition (Am J Health Syst Phar 2019)

The why

• It is estimated that $100 to $300 billion
• f annual avoidable health care costs

are attributed to medication nonadherence in the US.

• Accounting for three to 13 percent of
• verall healthcare spending.
• The costs of prescription drugs in the

US are among the highest in the world and continue to rise – there is no regulatory body that controls pharmaceutical rate hikes.

How does your

• rganization

identify if your patients can afford the medications that have been prescribed?

The why

• Lack of insurance and high out-of-pocket costs
• Organizations have lack of resources and access to solutions
• Per Kaiser Family Foundation when the uninsured are diagnosed with an

illness, they are more likely to forego healthcare services including medications.

• Not take the medication as prescribed
• Skip doses
• Share prescriptions
• Cut medications in half
• 30 million uninsured (Before Pandemic)

Impacts of COVID19

• Loss of employment = loss of insurance
• Cobra Insurance
• Hospitality workers, Self Employed, & Others = $0 Income
• Average American household has $1,000 savings
• Elderly instructed to stay home – many are technically

challenged.

• Before the outbreak it was estimated that 1-in-3 were impacted

by Cost-Related Medication Nonadherence (CRMN)

• 30 Over million uninsured

<10% 10-12% 13-14% 15-19% 20%+

Uninsured as of May 2020

Approximate increase in uninsured adults above 2018 levels

Michigan - 46% Iowa - 29% Minnesota - 28% Illinois - 23% Wisconsin - 22% Ohio - 21% Kansas - 20% Missouri - 19%

In May, the Census Bureau estimated that 26 million families did not have enough food to eat, and 38 million adults had little or no confidence in their ability to pay the next month’s mortgage or rent.

COVID-19 CRN preparedness

We are focused on treating and preventing COVID-19 cases, but are we thinking about what we should be doing now to prevent negative quality and financial tertiary impacts of COVID-19?

• Medication adherence struggles will only be exasperated by the COVID-19

pandemic (primarily driven by ability to afford meds).

• The Annals of Internal Medicine estimates that a lack of adherence causes

nearly 125,000 deaths and is associated with 10% of hospitalizations.4

• 3 months from now, will your patients prioritize paying for:
• A medication necessary to manage their chronic disease?
• Living expenses and debts (credit cards) incurred during their furlough?
• A hospital bill?

$600 x 12 months = $7,200 $100 copayment assistance card = $100 they could pay your

• rganization

1 less ED visit or Readmission saves your organization?

What is your ROI?

Case study

• $650,000 per 1,000 patients ($250,000 cost)
• 3:1 ROI
• Inpatient utilization decreased by 50%
• ED utilization decreased by 35%
• Cost per case decreased by 40%
• Cost per case decreased by 15%

Reduction in year-over-year “high utilizers” 66-80% decrease in number of high utilizers after Year 1 Additional 50-75% decrease between Year 1 & 2

https://www.dispensaryofhope.org/

Does your organization do meds to beds?

• pportunities
• Increasingly, health systems are providing discharge

medications at low or no cost to decrease 30-day readmission rates. Due to potential limitations, medication adherence requires a reliable, chronic supply of medications.

• Available programs:
• 340B
• Traditional PAPs (Patient Assistance Programs)
• Co-Pay Assistance Cards
• Investigate generic options
• Educate the patient on shopping for the best price

Creating a medication assistance program

• Identify stakeholders
• Pharmacy
• Case Management
• Care Coordinators
• Nursing staff
• Providers
• Clinical teams
• Financial Assitance
• Medicaid Eligibility
• Create a committee to build the infrastructure
• Who is going to be responsible?
• Software or spreadsheets?
• Identify and create processes for each

program

• Create a process
• Facilitate internal meetings to

explain the why

• Ask their experiences
• How often do we have patients that

express they are having difficulty paying for their medications?

• Do we see patients skipping doses
• r not getting their scripts

consistently filled?

• Market internally
• Share results with your team –

make them proud!

• Market externally
• Press releases
• Commercials

Identify if the process will be outsourced or facilitated internally

Obstacles

• Identifying patients
• Lack of cost knowledge at the time or prescribing
• Lack of internal communication and tracking
• Obtaining patient financial records
• Patient Unresponsiveness

Pharmacists & medication assistance programs

Pharmacists are often the first ears to hear "My medication is too expensive" or "I can't afford that". Besides Care Management/Care Coordination, Pharmacists are also often the first individuals to help patients navigate to lower-cost

• ptions such as medication assistance programs,

prescription alternatives, community resources, and financial counseling.

• Do you know what the Pharmacists who work

with your patients rely on to provide lower cost

• ptions?
• Do Pharmacists you partner with offer

Medication Assistance solutions to your patients?

Pharmacist led medication reconciliation & other services

Order Verification: Prevent prescription errors through Pharmacist verification of all medication orders. Medication Reconciliation: Prevent adverse drug events during admission, transfer, and discharge. Transitional Care Management: Ensure medication plan adherence and provide medication management services that creates a smooth exchange from one care environment to the next.

Uniquely positioned pharmacist led programs

• In a study published in the American Journal of Health-System

Pharmacy, an AMC that implemented Pharmacist led discharge education and medication reconciliation for high-risk patients translated into a significant reduction in 30-day rate of hospital readmissions, declining from 17.8% to 12.3% with estimated cost savings of $780,000 annually.9

• According to a meta-analysis study published by the Journal of

Clinical Pharmacy and Therapeutics, Pharmacy led Medication Reconciliation interventions were an effective strategy to reduce medication discrepancies during admission or discharge.10

• Reduction of adverse drug event related hospital revisits, all-cause

readmissions, and ED visits through Pharmacist led Medication Reconciliation during transitions of care have been successfully demonstrated through a variety of models and studies.11

There is a misperception that Medicare patients do not qualify for programs.

Measuring success

There is a large selection of direct and indirect reporting measures to gauge the effectiveness of a Medication Assistance Programs. The measures selected must always strive to align with:

• Business case
• Services provided
• Population selected
• Capabilities of EHR & business

intelligence solutions

Measuring success

Utilization & Quality

• ED Visits
• All Hospital Re-Visits Related to

Adverse Drug Events

• 30-Day Readmissions
• Adverse Drug Events %
• Medication Order Errors (by type
• f error)

Pharmacy

• Substitution %
• Medication Assistance

Program Referrals

• Refill Frequency
• Medication % Picked Up

Medication Assistance Program

• Medication Savings

Selected Measures commonly focused on are:

Measuring success

• Track progress
• Approvals
• Total savings
• High utilizers – track progress
• Discharge medication savings
• Testimonies
• Unresponsive patients
• Identify savings
• Press release
• Savings on 30-day discharge

medications

• Share your story
• Social Media
• Patient Testimonies
• Commercials

Tell Your Story!

Monitoring results

The cost to stay alive

It is reported that only 20% of physicians are aware of what the patient’s OOPC (Out-Of-Pocket-Cost) will be when prescribing. More than 20% of prescriptions are not picked up at the first fill with higher abandonment rates for high-copay medications. In order to reduce CRMU we must have cost conversations

Identifying patients in need

Patients under the age of 65 with high disease burden without health insurance and having a lower household income. Accurately assessing a patient’s risk of CRMU requires a conversation regarding cost. More than 1/3 of patients who experience CRMU never disclose their nonadherence. #1 reason patients do not discuss the fact that they cannot afford their medications is because they are not asked. Cost Related Medication Underuse

Help your patients get the medication they need but cannot afford!

“Ultimately, the most expensive medicine is the one not purchased, not taken, or not used correctly by the patients.”

• Tom Menighan, Executive VP and CEO of the American Pharmacists Association

Commit to making a change today!

At 211 degrees, water is hot. At 212 degrees, it boils. And with boiling water, comes steam. And steam can power a locomotive. Source: 212 the extra degree; Sam parker & Mac Anders

Thank You

Presenter Chastity Werner, CEO cwerner@npc-meds.com (314)920-7938