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6th Annual Patient Adherence Congress

Interactive Discussion HC Reform,

Govt Policy Changes

Connected Health

Technology Scales Up 1:1

Contact

Feedback Tools That Drive AdherencePredictive

Diagnostic Tools

Compliance Packaging

Retail Pharmacy Interactions

Behavioral Economics &

Motivation

Social Media, and Online Engagement

Successful Patient

Adherence Programs

A Well-Rounded Day, A Variety of Insights, An Expert on Each Side of You*

*…in a very cool place

The Impact of Government Policy Directions on Medication Adherence

Greg CaressiSenior Vice President, Healthcare

March 10, 2011

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Key Take-Aways

Event Title:

Speaker/Facilitator:

Session Title:

6th Annual Patient Adherence Congress

Greg Caressi

The Impact of Government Policy Directions on Medication Adherence

Top 3 Take-Aways for Participants

Insight on how Healthcare Reform and policy shifts will drive medication adherence efforts

New thinking on the changing interactions of stakeholders in the system

New opportunities to engage with partners to increase adherence

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Future of Healthcare

What Will the Future Look Like?

Healthcare increasingly data driven and customized

Healthcare more like other service industries

Greater collaboration and information sharing across value chain

Greater transparency of prices/costs and outcomes

Increased development of standards of care and incentives to adopt them

Increasingly challenging market for new technologies. Demonstrating value will be essential.

Focus on economics

Longer time to market for new technologies

Increasing two-way interaction with patients

More “generics” – technologies providing same value at lower price, stripped down feature sets

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Common Forces Impacting All Healthcare Stakeholders

Patients Physicians Hospitals Pharma/Biotech Devices Health IT Payers

Economic Constraints - The Great Recession, Credit Crunch, Unemployment, Rising Deficits

Regulatory Changes - ARRA/HITECH, PPACA, HIPAA 5010, ICD-10, FDA

Political & Social Change - Partisan Politics, Empowered Consumers

Increased Use of IT - Internet, Mobile Devices, EHR/PHR, Social Media, Analytics

Demographics/Epidemiology - More chronic illness, poor nutrition, obesity, aging population, poverty

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Obama Administration Goals Accelerating Many Trends

The Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009 (ARRA) included >$35 B in incentives to help healthcare organizations modernize operations through the use of health information technology

HITECH specifically allocates $19.2 B in the form of direct payments to increase the use of EHRs by physicians and hospitals

CBO estimates that HITECH incentives will boost physician EHR adoption rates to 90% by 2019

Two key pieces of legislation will dramatically accelerate the pace of changeHITECH

(February 2009)PPACA

(March 2010)

The dual passage of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010, puts into place a series of changes in the way providers are compensated and expands access to health insurance to 32 million Americans who currently are without coverage

Primarily, PPACA is health insurance legislation. Secondarily, it addresses reimbursement and physician payment for services

More emphasis on diagnosis, monitoring, preventive care leading to increased collaboration with other providers

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Shifting the Financial Gravity of the SystemIn

vest

men

t

Continuum of Care

“At Risk” Undiagnosed Chronically IllManaged

Chronically IllUnmanaged

Endof Life

Healthy

$

$$$

$$$$

$$

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Shifting the Health Focus of the System

Prevention/Wellness

Disease/Care Management

Healthy/“Worried Well”

“At Risk” Undiagnosed Chronically IllManaged

Chronically IllUnmanaged

Endof Life

Continuum of Care

Siz

e o

f Im

pa

cted

Po

pu

lati

on Goal:

Keep People Healthy Longer

Goal:Keep

People Healthy Longer Goal:

Manage or Mitigate

Risk

Goal:Manage

or Mitigate Risk Goal:

Diagnose and

Reduce Treatment

Delay

Goal:Diagnose

and Reduce

Treatment Delay

Goal:Manage

Goal:Manage

Goal:Move to

More Interaction and Self-

Mgmt

Goal:Move to

More Interaction and Self-

Mgmt

Goal:Informed Decisions

Goal:Informed Decisions

ü Early identification and prevention

ü Access to new forms of care delivery to improve patient knowledge, self-help and health

ü Connection to benefits design to increase coverage for those services which prevent disease and improve health over long term

ü Reducing administrative and clinical waste

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Technology To Monitor and Achieve Better Outcomes

Remote Patient Monitoring

Remote Patient Monitoring

Hospital-based Systems

Hospital-based Systems

Consumer HealthConsumer Health

TelehealthTelehealth

Connected Health

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• Communication among the care teams is essential requiring an extensive use of health IT, including EHRs, e-Rx, clinical decision support, secure messaging and patient/provider Web portals

• Communication among the care teams is essential requiring an extensive use of health IT, including EHRs, e-Rx, clinical decision support, secure messaging and patient/provider Web portals

• Physician practice designated as a patient's "medical home" to coordinate the continuum of care and improve qualityand outcomes

• Physician practice designated as a patient's "medical home" to coordinate the continuum of care and improve qualityand outcomes

• The medical home model promotes a team based approach = increased collaboration and communication among stakeholders

• The medical home model promotes a team based approach = increased collaboration and communication among stakeholders

New Care Delivery Models – Patient Centered Medical Home

• Increased interaction among care team of the variety of meds being taken

• Increased patient empowerment focuses on understanding of disease and medications

• Increased interaction among care team of the variety of meds being taken

• Increased patient empowerment focuses on understanding of disease and medications

Existing Medical Home pilots have focused on medication adherence as key to goals of patient empowerment and reducing hospital readmissions

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ACO models:• require tracking of info

and outcomes• focus on chronic disease

management to improve outcomes

• Increase patient engagement, activation and accountability

• Utilize monitoring and analytics to achieve health outcomes

Groups of providers or practices under the umbrella of one organizing entity with responsibility to improve health, care efficiency + experience and outcomes for a defined population

New Care Delivery Models – Accountable Care Organizations

Engage in joint decision-making to manage the full continuum of care

The efficient operation of ACOs will be highly dependent on a solid information infrastructure, including health information exchange

ACOs must meet certain criteria including quality measurements and share in the cost savings for Medicare and Medicaid programs

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Summary of Impact of Policy and Market TrendsP

rese

nt M

arke

t C

ondi

tions

Fut

ure

Mar

ket

Con

ditio

ns

Health IT cost subsidies by government and commercial payers; increased focus on prevention and reduced hospital admissions

ACOs and Medical Home accelerating focus on medication adherence to reduce hospital admissions, achieve health outcomes, especially with chronic disease care

Greater need to document process of care and document outcomes. Increased physician interaction and awareness of variety of meds one patient is taking

Increased patient empowerment to understand and manage disease. Patient interacts directly with caregivers via remote monitoring and mobile apps (including re adherence)

Move away from fee-for-service to bundled payments based on quality of care (volume to value). Med adherence has high ROI in achieving outcomes, reducing hospitalizations

MEDIUMTERM

SHORTTERM

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Coming to Media Near You in 2011: Smoky the Bear says, “Only you can improve medication adherence”

• The Agency for Healthcare Research and Quality (AHRQ, part of HHS) asked the National Consumers League to lead a national public education campaign to improve medication adherence

• PSAs via TV, Radio, Print, Outdoor, Internet, plus social media• Recognition as a public health problem - “America’s other drug

problem” • Elevate adherence to a national health priority• Educate consumers on the importance of taking medication as

directed• Target those with chronic conditions • 100+ stakeholders• Three-year campaign

Govt agencies, Health plans, HCPs, PBMs, Pharma, IT firms, Employers, Unions, Patient groups, Consumer groups, Quality & Safety groups, etc.