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Building a High-Tech, High-Touch Model for Drug Management

Caroline Carney, MD, MSc, is the chief medical officer for Magellan Rx Management, the pharmacy benefit management division of Magellan Health. She joined Magellan Health in 2016 and previously served as the chief medical officer for Magellan Healthcare. In her current role, Carney is broadly responsible for supporting Magellan Rx in building differentiated, industry-leading clinical programs and services. Prior to joining Magellan, Carney served in chief medical officer roles, working with Medicare, Medicaid, commercial, and exchange populations. She was trained in and practiced psychiatry, internal medicine, and psychosomatic medicine. Carney has a Master’s degree in preventive medicine, focusing on health services research and epidemiology. She also brings strong public sector expertise having served as medical director for Indiana’s Office of Medicaid Policy and Planning where she oversaw quality, pay for performance, and initiatives for behavioral and physical health.
As consumer preference continues to help shape the way in which care is delivered, the need for patient-focused innovation is critical. One key area where this approach can result in improved quality of care and reduced costs is drug management.

While the industry has made significant progress in recent years, there is still much we can do to drive a better patient experience around pharmaceuticals, starting from the point a drug is prescribed to when it is received and ultimately taken or administered. With the opportunity to leverage data in real time, we can more effectively prescribe medications, predict the likelihood of medication adherence, and design appropriate strategies to support adherence. We can even predict which medications a patient may require in the future based on factors such as drug history, health history, drug metabolism, and age. Further, we can design ways to more effectively work with physicians at the point of prescribing to ensure the decisions made are right for the patient and for the circumstance.

At Magellan Rx Management, we’ve taken a high-tech, high-touch approach to drug management that has significantly impacted behavior change in both patients and providers, supporting improved outcomes and a better overall experience. It’s a model that leverages data-driven solutions to deliver highly personalized services and higher-quality care at lower cost. We do not take a one-size-fits-all approach and are keenly aware that prescribing and interventions need to be individualized. 

The following are ways this unique model is redefining pharmacy benefit management and enhancing the experience for patients and providers alike.

High-Touch Decision Support Tools Aid Physicians in Ordering Complicated Drug Regimens

Today, roughly half of total pharmacy spend is driven by specialty drugs, with half of that specialty spend covered under the medical benefit. This portion of specialty spend is typically unmanaged by pharmacy benefit managers and health plans. Decision support tools we’ve built for specialty physicians ensure drugs are being administered at the most clinically appropriate site of service and are appropriately utilized.

Oncology drug regimens, for example, are very complicated. There are a number of individual factors that can determine success, such as the type of cancer the patient has, the patient’s genetic markers and medical history, and social determinants of health, along with many different drug combinations that have been used over time. The shifting regulatory landscape around guidelines for these regimens adds an additional layer of complexity. In instances where more information is needed to make a coverage decision, scheduling a high-touch peer-to-peer discussion with the prescribing physician to explain why the regimen requested may not be the appropriate regimen and working with the oncologist to determine the right approach for the patient is key. During these discussions, physicians are paired with an expert from their specialty. This model eliminates the frustration that accompanies a simple denial of coverage and provides the education and support needed to both improve outcomes and lower costs.

Innovation With the Patient in Mind

Accounting for up to 50% of treatment failures and more than 100,000 deaths per year, medication nonadherence can have a significant impact on patient outcomes. To improve the outlook, we’re exploring unique ways to improve medication adherence through patient rewards. For example, in collaboration with AiCure, we are piloting an artificial intelligence platform that captures and understands video, audio, and behavioral data to maximize clinical outcomes. The Virtual Rx Assistant engages patients and visually confirms they take their prescription. For instance, patients with hepatitis C take expensive medication for 8 to 12 weeks, costing approximately $24,000 total. If the medication is not taken correctly, there are significant health impacts and risk of not reaching the desired clinical response. Patients download the application onto their smartphone. The application uses computer vision and neural networks to visually ensure the correct patient is taking the correct medication. The automated system takes 5 to 10 seconds to use.

In addition to dosing data, other behavioral and physiological characteristics can also be analyzed to further analyze treatment response. The early results are outstanding: 96% of patients in the pilot have adhered to their treatment regimen. It’s one way in which innovation is driving improved outcomes and patient satisfaction while reducing healthcare costs.

Additionally, digital therapeutic apps are beginning to be approved by the FDA for treating conditions such as substance abuse, insomnia, depression, anxiety and more. With strong data demonstrating the success of such programs, digital therapeutics offer the potential to improve the impact of medications, avoid medication side effects, and curb the inappropriate use of pharmaceuticals for certain health conditions.

We also recognize that the way in which patients consume information is rapidly changing, requiring new approaches to communicating with them about their care plans and medications. Last year, Magellan partnered with VUCA Health to create educational videos presented by pharmacists, with a focus on helping patients understand:
  • The importance of medication adherence
  • The benefits of medication therapy management
  • How to use opioid medications safely
  • Key aspects of prescription drug coverage
This initiative helps ensure patients are informed about complex concepts like prior authorizations and medication safety in a nontraditional format that’s convenient for them. It’s an approach designed to boost medication adherence by increasing health literacy.

A Value-Centered Approach

While rapidly changing, it is an exciting time to be in healthcare. We’re seeing enormous advancements being made in the areas of precision medicine, pharmaceuticals and digital therapeutics that are changing lives by improving not only outcomes, but also access to care. But there is still a long way to go toward applying technology and innovation to the consumer pharmaceutical experience. Committing toward high-tech, high-touch pharmaceutical innovation is one way to bend the value curve in healthcare while improving health and the patient experience.

Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
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