The Quality Corner Show welcomes back Dr. Ben Urick, PharmD, PhD, Principal Health Outcomes Researcher at Prime Therapeutics and Adjunct Assistant Professor of Clinical Education at the UNC Eshelman School of Pharmacy, to talk about trends in medication adherence including creating value through medication adherence improvement.
Urick reviews a bit of existing literature on medication adherence and then explores the relationship between health expenditures and medication adherence. Other topics include social determinants of health and what disease states are currently popular for medication adherence research.
Ben Urick Referenced Materials:
PBMI National Conference Video with Managed Healthcare Executive
PQS Quality Corner Show Season 1 Episode 30
The Quality Corner Show welcomes back Dr. Ben Urick, PharmD, PhD, Principal Health Outcomes Researcher at Prime Therapeutics and Adjunct Assistant Professor of Clinical Education at the UNC Eshelman School of Pharmacy, to talk about trends in medication adherence including creating value through medication adherence improvement.
Urick reviews a bit of existing literature on medication adherence and then explores the relationship between health expenditures and medication adherence. Other topics include social determinants of health and what disease states are currently popular for medication adherence research.
Ben Urick Referenced Materials:
PBMI National Conference Video with Managed Healthcare Executive
PQS Quality Corner Show Season 1 Episode 30
00:00:02:21 - 00:00:24:22
Ben Urick
Beyond that. And in further contrast to the existing literature, the members that are using and the way we're defining adherence is the exact way in which the Pharmacy Quality Alliance defines adherence. And so when we have programs that are using things like the EQUIPP platform. What we are using within those with within those programs are the exact same measures, specifications as we use in our study.
00:00:24:24 - 00:00:41:09
Ben Urick
And so we know that for these members, with these measures specified this way, if we can improve their adherence, this is what we think the medical cost offsets are going to be. And that creates a much stronger argument then than simply basing estimates off of the existing literature.
00:00:41:11 - 00:01:06:12
Intro
Welcome to the Pharmacy Quality Solutions Quality corner show where quality measurement leads to better patient outcomes. This show will be your go to source for all things related to quality improvement and medication use and health care. We will hit on trending health topics as they relate to performance measurements and find common ground for payers and practitioners. We will discuss how the equip platform can help you with your performance goals.
00:01:06:14 - 00:01:43:23
Intro
We will also make sure to keep you up to date on pharmacy quality news. Please note that the topics discussed are based on the information available at the date and time of recording. Information or guidelines are updated periodically and we will always recommend that our listeners research and review any guidelines that are newly published. Buckle up and put your thinking cap on the quality Corner show starts now.
00:01:44:00 - 00:02:03:03
Nick Dorick
Hello Quality Corner Show listeners. Welcome to the PQS podcast, where we focus on medication, use, quality improvement and how we can utilize pharmacists to improve patient health outcomes. I'm your host, Nick Dorich. In this episode we are going back to what is one of my all time favorite topics and one that we have frequently discussed on the Quality Corner show.
00:02:03:05 - 00:02:25:03
Nick
Admittedly, it's been a little while. We've dabbled in some other topics because it turns out that pharmacist provided services covers a wide range of capabilities and training by the pharmacist and by the pharmacy technician team. But for this episode, we are going to focus on medication adherence, the role of the pharmacist, and maybe some new information as it relates to trends for medication adherence.
00:02:25:05 - 00:02:54:18
Nick
We'll cover some new ground and maybe just maybe take a little bit of a look back at why information and studies about adherence, why maybe they're getting to be a little bit outdated. So for today's guest, I'm going to go ahead and bring them in here early so we can start the discussion. Today's guest is Dr. Ben Urick and he's principal health outcomes researcher at Prime Therapeutics and adjunct assistant professor of clinical education at the University of North Carolina Eshelman School of Pharmacy.
00:02:54:24 - 00:03:01:10
Nick
I will also note that this is not Ben's first time on the podcast. So welcome back to the show. Ben And how are you doing today?
00:03:01:12 - 00:03:04:21
Ben
Thank you very much. Nick I am doing great. Appreciate it.
00:03:04:23 - 00:03:21:15
Nick
Excellent. So, Ben, folks may not have listened to the episode where you were on the show previously, and that's okay because they can go back and listen to it, of course, but they're going to get to hear from you now. But before we get into the topic of today's conversation, let's get a little bit of your background. So what's your career in health care?
00:03:21:15 - 00:03:24:22
Nick
And then what is it you do in your role at Prime Therapeutics today?
00:03:24:24 - 00:03:45:03
Ben
Yeah, Thanks, Nick. So I am a pharmacist by training. I went to Drake University. Go Bulldogs for my pharmacy. When I was pursuing my PharmD I realized I had a passion for research as well as a passion for teaching and that's what led me to pursue a Ph.D. in health services research at the University of Iowa.
00:03:45:05 - 00:04:08:11
Ben
Just following graduation, went just down the road to the Amherst of Iowa. There I pursued an interest in health policy and managed care and wanted to look at the intersection between health policy with the particular focus on payers and how that affected pharmacy practice. That's been an area of interest for mine really from the from the be from about my my P1 year in pharmacy school.
00:04:08:11 - 00:04:40:18
Ben
So for example like my dissertation topic was on assessing the relationship between pharmacy quality and total cost of care for a commercially insured population. So that's been a longstanding interest. And then with that, I actually went to university in North Carolina as I was completing my Ph.D. and pursued an opportunity there as a research track faculty in the Center for Medication Optimization, working with the Community Pharmacy Enhanced Services Network and Community Care in North Carolina on an internal program.
00:04:40:18 - 00:05:06:21
Ben
Evaluation of the impact of the payment model that Community Care in North Carolina had implemented on member outcomes within the Medicaid program. And so that was a great opportunity to work with that exciting initial development of CPC and that some of your listeners may be familiar with. After a couple of years, I had an opportunity to do some research that I had funded for myself in a variety of areas.
00:05:06:21 - 00:05:33:10
Ben
A lot of it was related to performance-based pharmacy payment models and sort of fast forwarded to it to a couple of years ago. The Center for Medication Optimization closed at UNC and I and I took that as an opportunity to pursue the pathways through pharmacy benefit managers. And so like I said, I've always been interested in this and there was an opportunity that came up in that Prime Therapeutics to do research in the Health Outcomes team with Pat Gleason and others.
00:05:33:12 - 00:06:08:23
Ben
And so I realized that using our combined administrative claims dataset for pharmacy and medical claims, we could do a lot of really interesting and relevant research that matched my interest. And I think could be a positive benefit for the pharmacy profession. So that's where I am today. And a Prime Therapeutics, the Principal Health outcomes researcher and have retained an adjunct title at UNC and have worked on the adherence work that we'll be discussing today as well of a variety of other topics, including GOP wide adherence and persistence, as well as some work related to medically integrated pharmacies, cancer and several different areas.
00:06:09:00 - 00:06:27:21
Nick
Excellent. I'm really looking forward to this. And Ben, you and I have known each other for a long time. And going back to I think when you were a Ph.D. student at University of Iowa, but always interested in this is really your focus point. And I think of you as one of the folks that's really at the forefront of some of the pharmacy service.
00:06:28:00 - 00:06:52:20
Nick
Pharmacy and service provided services research that's out there. And so I'm really excited to have this conversation and actually bring you back on. The show was prompted by a video that that I saw where you recently interviewed, I think it was with PMI or you talked about adherence and just kind of some of the new information and how the managed care side is looking at adherence and working with pharmacies here And here and now today.
00:06:53:01 - 00:07:05:23
Nick
So that prompted by my interest to have you back on the show. So with that, we're going to jump into the questions. But before we do, we're going to get a quick message from my teammates here at PQS.
00:07:06:00 - 00:07:30:13
Breakdown
Now it's time for the breakdown as quality corner show host little as three main topic questions. Our guests will have a chance to respond and there will be some discussion to summarize the key points This process will repeat for the second and third questions, which will wrap up the primary content. So that's the 14th. After that, expect to end on a closing summary, usually containing about this question. Now that we have the start of the process, let's jump into the questions.
00:07:36:22 - 00:08:14:17
Nick
All right then. Now that we've heard from the PQS team, we're going to jump into the question for today's show. And I want to start off first talking about medication adherence and effectively, what does the research say? So, you know, there are years and years going back 30 years of three decades of research related to medication adherence. But I think one of the key items that even I still see today is that there may be pharmacies, there may be folks in managed care, there may be folks in public in public health that are looking at and referencing medication adherence research that may be a few decades old and there are definitely some changes that have
00:08:14:17 - 00:08:38:23
Nick
occurred in the industry over the years that the challenges, the barriers that exist may be different, benefit design may be different. So what I'd like to start us off with is as for you as a researcher and for someone that looks in this area, what are your considerations for existing literature on medication adherence? And then how should folks that are in this area, how should they look to modernize available research and resources?
00:08:39:00 - 00:09:13:24
Ben
Yeah, thanks, Nick. That's a great question. And we get that all the time when I talk to people about work that I've done in adherence, a lot of times what I hear back is I think we've got that pretty much answered, don't we? And, you know, that's a common response. But if you really start looking at the literature, you would be surprised how little of the existing literature is relevant to a managed care organization today looking at quality measures as defined by the Pharmacy Quality Alliance and used within the party program and looking at medical cost offsets from that literature.
00:09:14:00 - 00:09:33:06
Ben
And there are several reasons why that's not true. So for one, the quality measures used by PQA were developed really within the last decade and a little bit of change. I mean, you know, they're they, they have some age to them. But if you're thinking about the age of the medical literature, particularly things like the there was a paper by Sokol that's gotten over 2000 citations.
00:09:33:06 - 00:10:12:16
Ben
That's from 20 years ago. That was from long before the Pharmacy Quality Alliance even existed. Nonetheless, had a well developed quality measure. So, you know, the age of some of this literature means that there is no way that that literature could have used PQA’s because quality measures, because, again, that was before peak to ever existed. And then in addition to that and I can I can speak to this as a former academic, if you're looking at this from an academic perspective, unless you are really tied to the idea of looking at quality measurement from the perspective of Medicare, the academics are free to define adherence however they want.
00:10:12:16 - 00:10:42:19
Ben
And you will find in the existing literature that academics have done that. So even when a quality measure calls itself, you know, a PDC type type measure which proportionate is covered, that uses a method to adjust, fills for overlap, truncates supply at the end of the period, therefore requiring that, you know, quality measurement cannot exceed 100% or proportion of one which again looks feels, smells like the existing PQA measure.
00:10:42:21 - 00:11:07:00
Ben
You would find that the literature oftentimes, for example, requires that the member have a corresponding medical diagnosis, which the PQA measure does not. You may find that there are some nuances around PDC where 80% for that PDC measure may not be that relevant to 80% around the PDC measure for PCA. Also, you oftentimes find with an epidemiological literature that what you're looking at is a cohort of members who were initially who initiated therapy.
00:11:07:02 - 00:11:31:09
Ben
There was a study by Bayer, for example, that looked at statin use and found that statins were highly protective and reduced total cost of care, which is great, but that's in a cohort of members who newly initiated therapy, which is very, very different than the two plus fill denominator requirement that PQA has, which includes those who are new to therapy as well as those who are continuing on therapy.
00:11:31:11 - 00:11:58:00
Ben
So for those reasons, there's some really meaningful technical differences in the measures. There's some differences in age with the measures and there's additional requirements, for example, around having medical diagnosis, which makes the existing literature not nearly as relevant as one might hope due to questions from managed care organizations, pharmacy benefit managers and others who are trying to answer questions around if I improve adherence according to a PQA specified measure, what is the resulting change in medical cost?
00:11:58:02 - 00:12:26:07
Nick
Yeah, and Ben I think one of the key items here is we're trying and when I say we, I mean the industry here, you know, groups like PQA, you know, like CMS measure developers, but trying to get everybody kind of singing off the same handbook, if you will, or trying to get everybody speaking the same language. And when we look back 20 years or prior to those measures, there's different ways that calculations were being done, different ways that they were look at different time periods as well.
00:12:26:09 - 00:12:44:11
For when is a patient being evaluated. As you mentioned, a patient newly initiated on therapy is going to be they're going to have different adherence strains in a patient then has perhaps been on the therapy for five plus years. So really, as it goes to the use of these measures, it becomes a very different, different, very different understanding.
00:12:44:13 - 00:13:12:03
Nick
I think even looking back and one item that had you had noted in the video I referenced previously was adherence scores and just what numbers are looking at, right. Where some of the adherence numbers may be in older research, may look at adherence scores or PTC scores for a population that is around the 50 or 60%, whereas now we see in Medicare, BSA, CMS data, which is publicly available, adherence, scores much higher at a population level, but even Medicaid and commercial populations.
00:13:12:09 - 00:13:20:22
Nick
So before we go on to the next question, Ben, anything else that you'd want to highlight is that may be different or may be a cause for kind of just differences in the environment?
00:13:21:02 - 00:13:42:18
Ben
Yeah, that's a great point. So, you know, again, when we're looking at data that's 15, 20 years old or again so called, so can we use data from the end of the nineties, and it can still get cited more than 100 times every year. And it gets cited because it looks really, really good, right? People like it. Well, you can say that there is a study that justifies over $1,000 in annual medical spending reduction from adherence improvement.
00:13:42:18 - 00:14:05:13
Ben
Right. Like that's that we want that to be true. But if you look at the average PDC within SOCOL, I don't have it up in front of me, but it's something like in the fifties, right? So PQS just released its summary of Medicare Technical notes that and, and in that it showed that the I think the top cutoff threshold for a 4 to 5 star plan is now at like 91%.
00:14:05:15 - 00:14:32:08
Ben
Right. But it's just a really, really different world. And those thresholds started off at 75% a decade ago. Right. Like there's been some really big changes. So if you're thinking about who is in that non adherent population, particularly within Medicare, those members just look very, very different than what they did even a decade ago when you had, you know, average PDC scores in the seventies versus average PDC score is in the upper eighties today.
00:14:32:10 - 00:15:05:19
Nick
Yeah. So then I'll move this to our next question. And this is something that's a we and I talked about at the beginning medication hearings being one of my favorite topics, but there's sort of a subset of medication adherence talk that gets even more excited and that's how we relate medication adherence to total health or medical expenditures. This is really, especially from a community pharmacy standpoint, this is where we think we can show the value, but that can be seen as or from the community pharmacy perspective, that can be seen kind of as a black box because we don't have that details.
00:15:05:19 - 00:15:34:20
Nick
We don't really have that information. So you know someone from yourself who's coming from the background and from the day to day work as a health, you know, as a as a health or public health researcher, you're really interested to see and from your consideration how our payers, you know, relating or how are they tying together, what are some of their current considerations for marrying up pharmacy claims to work by the pharmacy team and how that ties to medical claims and how that ties to total health or medical expenditures.
00:15:34:22 - 00:16:07:13
Ben
Great question. So there are a couple different ways that managed care organizations and pharmacy benefit managers can think of the relationship between improvements in medication adherence and Medicare cost offsets. So there are two broad approaches for calculating this relationship, even if you have the data. One is a decision analysis modeling approach that is similar. So there's some work by Jonathan Watanabe at all that have looked at a decision analysis modeling approach, and that says things like if you have an improvement in adherence, you would expect to see a reduction in hospitalizations.
00:16:07:15 - 00:16:32:23
Ben
If the average hospitalization costs $2,000, you can take that improvement in adherence, multiply that by your preceding, you know, percent reduction in hospitalizations. Do that for every measure and your and you do that for every outcome, like E.D. visits, for example, and everything else. And you eventually come up with a number that should represent the relationship between improvements in adherence and reductions in health care spending.
00:16:33:00 - 00:16:54:24
Ben
So that is a valid approach. But you don't actually have real health care dollars that are fitting into there. What you're looking at is sort of approximations based on changes in event rates. And those event rates can do things like double counting. You can have things like inflated medical spending estimates for those that you're just sort of it's not as accurate a version of reality as we would have liked to have seen it.
00:16:54:24 - 00:17:22:07
Ben
Prime Therapeutics And so instead of this decision analysis modeling approach, we chose a direct cost offset modeling approach where we say, let us look at improvements in medication adherence and measure the future reduction in health care spending directly using regression modeling approach. And in that way, we know that the health care dollars that we are including in our models, are actual health care dollars that our clients are spending on this care.
00:17:22:07 - 00:17:46:00
Ben
And it's not sort of approximations based on changes in event rates. And so that's why we chose that latter method. Now, among studies that have used this this method of direct cost offset modeling, there's a couple of different design considerations there. So the weakest design and this is actually what the social paper used, is if you look at adherence to day and medical spending today, and it's a pretty simple approach, right?
00:17:46:00 - 00:18:03:22
Ben
Like a like a first or second year biostatistician, you could do this because you're just looking at the the concurrent correlation between these two values. You say, okay, what is health care spending among those who are adherent and what is health care spending among those who are not adherent? What's the difference in those values? Voila, that's savings. And from a causal perspective, that's a really tough argument to make.
00:18:04:02 - 00:18:23:13
Ben
It likely overestimates savings because what you're doing is you're trying to what you're really doing there is saying, okay, how much less health care spending to those who are adherent tend to create compared to those who are not adherent. And there's a lot packed into there when you're looking at that difference. It's hard to say that that difference in adherence is really causing those differences.
00:18:23:13 - 00:18:42:10
Ben
Right. And that's what we want to see from the PBM perspective is trying to get at what is this as close we can from an observational perspective, What is this causal difference? So what we've chosen is we've chosen a lagged model, which is to say we're looking at adherence today and medical spending tomorrow or adherence this year, Medicare spending next year.
00:18:42:12 - 00:19:00:12
Ben
And we're also looking at these changes over time. And so the exact model we're using looks at, if you can think about this in three year periods. So we're looking at changes in adherence from year one to year two and how that correlates to changes in medical spending from year to year three. There's a couple of events doing this.
00:19:00:12 - 00:19:21:21
Ben
One, we can say who is not adherent in year one, and among those who are non-adherent in year one, if they become adherent in year two, right now, we're getting sort of at this causal relationship, right? What is their future change in health care spending from year to year to year three? And so we're not looking at health care spending concurrent with changes in adherence.
00:19:21:23 - 00:19:47:17
Ben
And so this design helps us solve this observation, those challenges that we've seen, and we think it provides more accurate estimates of the relationship between improvements, adherence improvements in adherence America, cost offsets than is existent in the current literature. Beyond that, and then and further contrast the existing literature, the members that are using and the way we're defining adherence is the exact way in which the Pharmacy Quality Alliance defines adherence.
00:19:47:19 - 00:20:06:10
Ben
And so when we have programs that are using things like the EQUIPP platform, what we are using within those with within those programs are the exact same measure specifications as we use in our study. And so we know that for these members with these measures specified this way, if we can improve their adherence, this is what we think the Medicare cost offsets are going to be.
00:20:06:12 - 00:20:12:03
Ben
And that creates a much stronger argument then than simply basing estimates off of the existing literature.
00:20:12:05 - 00:20:42:14
Nick
Ben, quick follow up question for you. As I think about this and as you're talking about the different models and ways that you're looking at prescription use, medical information, medical claims, there's also a big push now and in the current environment around social determinants of health and how that plays into a patient's overall health spend. What they're kind of, we'll say reaction, how they're going to be as it relates to use of medication or receiving services.
00:20:42:16 - 00:21:06:24
Nick
This is I understand this may be a too much of a new topic, but it is something that is certainly prioritized that CMS has called out, that groups like PQA that they're considering in their measures. But from your standpoint as a researcher, you know, more information and maybe those social determinants maybe that's coming at from screenings from a pharmacy, but I would have to imagine that that's also a consideration or perhaps a growing consideration in your model for these purposes.
00:21:07:01 - 00:21:29:10
Ben
Yeah. Thank you, Nick. So when it comes to social determinants of health and adherence, I think there are a couple of different ways you can consider this. So one, if we're looking at this from the Medicare perspective, Medicare changes to the risk adjustment factor as well as to risk adjusting quality measures means that clients really do need to pay a lot more Medicare Part D plan.
00:21:29:10 - 00:21:54:16
Ben
Sponsors need to pay a lot more attention to performance on the adherence measures, particularly within those who are have a lower subsidy or dual disability as well as disability status. And so splitting off those members, identifying opportunities for adherence improvement within those members and then focusing on that to close gaps within that strata will become very important. Now there are a couple of different ways that you can think of identifying these members.
00:21:54:16 - 00:22:15:14
Ben
We have data to do that through. I think C codes, there's a lot of concern around data completeness with the ZIP codes, but I have found in my work that I've done looking at our clients data that zip codes are highly predictable, nonadherence and actually independent of low income subsidy status, which is interesting. And so you could use that to identify members who have an opportunity for gaps closures.
00:22:15:16 - 00:22:36:05
Ben
If you're looking at this from a targeting perspective, we would love to work more closely with pharmacies that that have, you know, the ability to capture SDOH data. I can't I can't speak to any existing programs, but I know that there is some interest around there. And then when it comes to the cost offsets piece, that is something where I think additional work can be done, right?
00:22:36:05 - 00:22:51:17
Ben
So if you can, for example, make an argument, particularly in the commercial space where Medicare doesn't really drive these incentives right? You sort of have to make an argument to an employer group like this is why this is important. And that's just a lot harder than it is within Medicare because there's no quality bonus payment around it within the commercial setting.
00:22:51:17 - 00:23:10:02
Ben
We haven't done this yet, but I wouldn't like to look at the differences in Medicaid costs, offset from adherence improvement from members who have a social determinant health concern. Because if you can identify a greater r y for those populations, then that fits more into your targeting. We've looked at targeting from a health perspective, so trying to find members who have a more severe version of a disease.
00:23:10:02 - 00:23:35:18
Ben
And we have seen that members, for example, who have diabetes as well as other cardiovascular concerns, improving adherence. But then those members on their diabetes medications does have a greater medical cost offset. If we run the numbers and it shows that there are similar relationships, members who have higher social determinants of health concerns, then that, you know, again further justifies our why when we're trying to sell this to to a commercial client.
00:23:35:20 - 00:23:38:02
Ben
But I think that's a bit more speculative.
00:23:38:04 - 00:24:04:13
Nick
Got it. Ben, thanks for that further description and definitely an area that I'm continuing to keep my eye on. As I note, both payors and pharmacies are as well. Final question or final topic for for us today that I want to cover. When pharmacists think about medication adherence, it may be seen as, hey, we're working to keep all of our patients adherent or, you know, hey, when patients are schedule what patients really want to be outreaching more for that personalized management of the medication.
00:24:04:18 - 00:24:25:22
Nick
It's a bit different from the payer side of things. And as we talk about managing the patients or the members, there's an element of very much that comes into cost and what considerations have to be taken into consideration. So, you know, from the from from that perspective, what are some of that will make will say, hotspots for medication adherence efforts?
00:24:25:24 - 00:24:55:00
Nick
Because when I think about it from a health plan perspective or from a PBM perspective, they want to focus on medication adherence. Yes, but there may be an interest to focus on certain disease states or patients that are in different steps or stages of modifying a therapy. So, you know, when it comes to research on medication adherence, are there certain topics, certain disease states, certain classes of therapy that are perhaps more prioritized or that should be perhaps on the radar more for community pharmacy considerations?
00:24:55:02 - 00:25:19:02
Ben
Yeah. So there's two pieces of that. One is sort of payers perspective, particularly within commercial. I mean, Medicare, it's it's pretty straightforward, right? It's the big three, you know, statins, diabetes and hypertension, which is just Rosa for commercial thing. You know, there's more diversity there and that's and that's driven by by population as well as, you know, incentives or lack thereof.
00:25:19:04 - 00:25:36:10
Ben
From the payer perspective, there are some incentives that are sort of trade related that we can't really that out there aren't super relevant to to to pharmacies. But when we're thinking and this is this is part of the PBM, my presentation that I had an opportunity to give, we had somebody from our commercial team talk about sort of what our commercial plans elect.
00:25:36:12 - 00:26:15:00
Ben
And so, you know, there are some some trade related incentives. But beyond that, if we're looking at things that have an R y hypertension, so we have a hypertension all class measure, which is similar to diabetes, all class measure, it's not a PCA defined measure, it something we've done in-house, but we've shown that if you broaden out your hypertension category to look at a broader set of classes that are probably being used for things like heart failure in addition to your renin angiotensin two antagonist, which are oftentimes with blood pressure specifically, you do actually see greater medical cost offsets from hypertension all class measure than you do with renin angiotensin system antagonists, which is pretty
00:26:15:00 - 00:26:59:05
Ben
interesting. You also have a broader catchment of patients where you can get more people into that measure, which is beneficial from a population health perspective as well as a cost offsets perspective when we're thinking about additional classes of medication. One thing that doesn't get as nearly as much focus is mental health. And so we've shown that our antipsychotic and antidepressant PDC measures, which are using the PQA approach but are not PQA endorsed measures, do show that there is an improvement in health care spending, which is to say a reduction if the if a person can achieve PDC 80.
00:26:59:05 - 00:27:20:16
Ben
Now there are some real challenges with saying that a person antidepressant is supposed to be 80% adherence to their medication. But for those who do achieve that threshold, we do see that there is a lower cost offset and antipsychotics kind of as a as a separate class of medications. We do see that there is a substantial reduction health care spending for members who can achieve PDC 80 with an antipsychotic class as well.
00:27:20:16 - 00:27:37:04
Ben
So that doesn't receive nearly as much attention, but that is is nonetheless quite important. So I would say think about this in terms of hypertension as well as, you know, broadening this out for for mental health medication classes can can be impactful and can show our why.
00:27:37:06 - 00:27:55:17
Nick
Yeah the mental health is a great call up and I've through the years heard that from a number of folks that work in the managed care space because even when we do look at research for medication adherence and what are the causes, we know there's no one single cause why patients are medication are not adherent excuse me to their medications.
00:27:55:17 - 00:28:19:13
Nick
It's often cost, it's often burden either of the disease or the number of medications that they may be taking. But there's also a pretty strong research background that mental health or in years past, it was more often noted simply as depression. But we know mental health is more broad than that, right? That that can be an underlying cause in many cases for for medication adherence.
00:28:19:13 - 00:28:42:22
Nick
And we also know that mental health issues are not beholden to just one single population or one age group, that it really fits the entire spectrum. We also see that that matches along when we're talking a medicare population for health, for a plan, sponsor Medicare that mental health screening, screenings for for depression, screenings for loneliness, things of that nature also are becoming more of an important play.
00:28:42:24 - 00:29:05:11
Nick
The final item that I'll ask about Ben here before we wrap up this. Hey, whereas there are why you mentioned some of the classes medication this in the introduction, I'll call this one out because another popular area is patients with diabetes. It's overall a smaller group of patients and perhaps a mental health or for those that are taking a hypertensive medication.
00:29:05:13 - 00:29:21:24
Nick
But often those are patients that can be taking a myriad of medications and that where that exacerbation of that disease can manifest itself in a number of different ways. So anything before we close, before we wrap up, anything else that you would note as it relates to diabetes management in the current environment?
00:29:22:01 - 00:29:45:16
Ben
Yeah, we certainly do see meaningful medical cost offsets within members with diabetes. I mean, using the non incident diabetes medication measure as specified by PCA and used it in Part D stars, we can see that even for the commercial population there is a there's a meaningful reduction with about $650 worth of savings for members who can have an improvement in adherence to the diabetes medications.
00:29:45:16 - 00:30:10:17
Ben
And as you mentioned, sort of with the progression of metabolic syndrome syndrome, and you can see this with the number of denominator qualifying patients, you do see the smallest number within not into some diabetes medications. You see sort of a person gets hypertension, then they get high cholesterol that eventually you get diabetes. And so you sort of see the biggest ends within hypertension and then statins and then diabetes.
00:30:10:17 - 00:30:27:12
Ben
But by the time you get to diabetes, very few people have diabetes and diabetes alone. And if you're looking at this and you only see a member qualifying for the diabetes denominator, it might just be because they decided to stop. There's that medication and therefore they're not even qualified for that denominator, which is an entirely separate conversation. Right.
00:30:27:12 - 00:30:47:13
Ben
I think it's important for us to consider within any of this that what we're what we're really looking at is secondary non adherence among those who are at least reasonably persistent. Right? It's those who have decided to fill their medication and to take it at least twice, which is a probably, I don't know, half of people who I think or less of people who actually have the disease.
00:30:47:13 - 00:31:05:01
Ben
And so, you know, we're thinking about this from the broadest possible perspective. You know, that's that's an important thing to to to consider. And and your members of diabetes are more complicated than what you might even, you know, might they might even appear in the claims stream that you have access to.
00:31:05:03 - 00:31:24:04
Nick
Yeah. Well, thank you, Ben. Appreciate your your time are taking the time out with us today to help explain some of these these topics and to give just a real quick summary before we wrap up and get to our final questions that are more personal in nature for you then what we really discussed for today was really looking at the basis of medication adherence research.
00:31:24:08 - 00:31:48:04
Nick
What has changed now over 20 plus or 30, 30 years and really looking to make foundational changes into what information we have or consider with adherence programs. We talked about how payers in the managed care space are looking at pharmacy and prescription claims and medication adherence and tying that as well into medical spend, a topic that I think is very much of interest for everybody involved in the environment.
00:31:48:04 - 00:32:10:02
Nick
And then we finished off talking about where we really see the ROI. So when folks if you're you know, those three topics, if if you want to go back and re listen to those, any of those parts of the podcast, you're definitely recommended. Ben's got a lot of great information. And then as well we'll include in the show notes the video from the series Where Were Ben was featured not that long ago.
00:32:10:08 - 00:32:24:21
Nick
That covers a little bit of kind of different but is pretty complementary to what we discussed here today. So Ben, really appreciate you having you on the show and to talk medication adherence, but are you ready to talk about things that are not medication related for a couple of minutes?
00:32:24:23 - 00:32:25:23
Ben
You bet.
00:32:26:00 - 00:32:35:17
Nick
All right. So these are going to be our rapid fire questions comes to state. What's what's top of mind. So first question for you. Are you a morning person or a night owl?
00:32:35:19 - 00:32:43:06
Ben
You're a night owl. Absolutely. Yeah. I think of it as good as they are. People are good people. I am a stay up person 100%.
00:32:43:08 - 00:32:50:21
Nick
Okay, so what? When you say night owl, like, what does that mean as far as, like, approximate bedtime or like average bedtime?
00:32:50:23 - 00:33:00:22
Ben
So it's changed with kids, of course, but we're usually where you stay in bed by 11 or 12. But if I've got to get something done, I can be up until two or three.
00:33:00:24 - 00:33:10:08
Nick
Okay. Next question here. And feel free to give a particular example if one comes to mind. Do you prefer to read the book or watch the movie?
00:33:10:10 - 00:33:32:08
Ben
Oh man. So again, this is also change for kids. If I have the time, I absolutely prefer to read the book. So I am one of the people who, when Game of Thrones is coming out before we got an HBO subscription, I was like, I got to go. I got to read this. I went over to the library and read everything that was available and have been eagerly awaiting, you know, anything else that can come out of that.
00:33:32:10 - 00:33:37:00
Ben
So if I have the time and I can make it, then read the book.
00:33:37:02 - 00:33:47:04
Nick
Okay, excellent. That's generally where where I fall as well on it. What is your what is your personal recommendation for living a healthy life?
00:33:47:06 - 00:34:08:15
BEn
Oh, that's a great question. I mean, for me, it comes down to to balance, right? I mean, I enjoy the work that I do. I'm pretty serious about the work that I do. And I'm also pretty serious about taking time away from it. I'm the dance director of a local traditional Bavarian folk dance group. And so this is we're just wrapping up October 1st season, so that keeps me quite busy with that.
00:34:08:17 - 00:34:30:00
Ben
And it's great to do something that is completely unrelated to work but is also something fun to work towards and try to improve upon and is just is just a great way to provide balance. And also, you know, having, you know, a strong, strong family life is something that's important to me and and something that I think is, you know, grounding, centering and rewarding.
00:34:30:02 - 00:34:48:17
Nick
And quick editorial as it goes has been I know that you still work with student pharmacist in residence, fellows, that sort of thing. That's always one of my personal recommendations for folks that are either graduating from pharmacy school or from a residency or fellowship is to make sure you have a hobby that is not pharmacy or medical related.
00:34:48:17 - 00:35:07:18
Nick
And it's I think a lot of it is just having that experience and working with people that aren't in the same field. That's a great way to really kind of learn, grow and to not burn yourself out with the same conversations at the same time as well. Just last question here, Ben. What is one goal that you are currently working towards?
00:35:07:20 - 00:35:30:20
Ben
And that's great. Honestly, the first goal that comes to mind and that's just because Saturday is the last October festival season where we're where you have a traditional Bavarian folk dance. It's this bench dance that we do and we're working out all season. I've got another guy who's been working on it with me, so we'll be getting this traditional Bavarian folk dance.
00:35:30:20 - 00:35:53:11
Ben
We choreographed to cut the audio for it, and I think we're going to have it. It'll be the premiere performance of this coming up. So that's that's the biggest that's the biggest, you know, personal goal, professional goals. We do intend to publish a lot of the work that we're doing here at Prime. That is very important to us to to again, kind of be that rising tide that raises all ships.
00:35:53:13 - 00:36:14:00
Ben
And so we have several pieces of work that we've done that we look forward to seeing published here in 2024. So the professional goal is, is getting those those pieces of work submitted to journals published. And, you know, again, continuing that academic pursuit as a part of this position that contributes excellent.
00:36:14:00 - 00:36:37:17
Ben
What could have been in the prior answer you talked about balance being important and you gave a personal and professional. So keeping to your word and having a balance there with the goals that are set and best wishes on both of those goals. I'll look forward to seeing the results for both of them then. We appreciate having you on the show, having you back on the show, and something in the back of my head back, my mind is saying not the last time that we'll have you on the Quality corner show.
00:36:37:19 - 00:36:58:12
Nick
You're always a welcome guest here and will hopefully get to have you on again soon maybe as it relates to some of your 2020, some of that research you're aiming to have published in 2024. But before we wrap up here, Ben, if anyone has a question for you about your work at Prime, about the topics that you talked about today, where can folks contact you?
00:36:58:14 - 00:37:05:01
Ben
Yeah, it's a great question. So I think LinkedIn is always a good option. Send me a message through LinkedIn. I've gotten much better at checking those.
00:37:05:03 - 00:37:26:12
Nick
Excellent. Well, Ben, thank you again for your participation with today's episode and for your great thoughts on medication adherence and our pathway moving forward. But for our listening audience, we have now wrapped up this episode and we thank you for joining us today. We hope you listen to our next episode of The Quality CORNISH Show. And before we go, we have one final message from the PQS team.
00:37:26:14 - 00:37:48:02
Nick
The Pharmacy Quality Solutions. Polly Morning Show has a request for you. Our goal is to spread the word about how quality measurement can help improve health outcomes. And we need your help in sharing this podcast to friends and colleagues in the healthcare industry. We also want you to provide feedback, ask those questions and suggest health topics you'd like to see covered.
00:37:48:04 - 00:38:10:08
Nick
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