Value Propositions - December 2016

VBCR - December 2016, Vol 5, No 6 - Value Propositions

In This Article

Application and Population Management System Undergoing Testing for the Management of Flares in Patients with Rheumatoid Arthritis

Pfizer is collaborating with Brigham and Women’s Hospital, Boston, MA, in the testing of a new mobile application and population management system geared toward managing flares in patients with rheumatoid arthritis (RA).

Over a 6-month time frame, most patients with RA have ≥1 flares, and yet the majority of these occurrences are not reported to healthcare providers. This gap in communication between the patient and the provider hinders effective management of the condition.

In their proposed randomized controlled trial, Brigham and Women’s Hospital and Pfizer will assess the effect the application and population management system has on patients’ satisfaction with their treatment, patients’ perception of the patient–provider interaction, and disease activity in 190 patients with moderate-to-severe RA who are taking disease-modifying antirheumatic drugs. Patients involved in the trial will be randomized to the smartphone application and population management system that monitors RA disease activity between scheduled visits with their healthcare provider, or to a waitlist control.

According to the entry for this trial, patients who are randomized to the mobile application and population management system will be given the application after their first visit. The application will ask questions about their pain, function, and disease activity on a daily basis. The patients’ self-reported symptoms will be reviewed by a population manager through an Internet-based dashboard. The population manager will also facilitate contact between the patient and the provider, and reach out to the patient in accordance with prespecified guidelines. Patients who are randomized to the waitlist control arm will be provided with the contact details of a trial staff member, but will otherwise receive no active contact (unless the patients initiate it), and will not be given the mobile application.

“We believe that the smartphone app [application] + population management system has the potential to benefit all RA patients, seen not only at the BWH [Brigham and Women’s Hospital] Arthritis Center, but also at other rheumatology practices around the country,” Yvonne Lee, MD, Associate Physician, Brigham and Women’s Hospital, and principal investigator in the trial, and colleagues posited in their study proposal.

The primary outcome measures will comprise scores at 6 months from 3 questionnaires: Treatment Satisfaction Questionnaire for Medication, Patient-Physician Interactions Questionnaire, and Clinical Disease Activity Index. Treatment effects, which are mean differences between the outcomes of the 2 cohorts at 6 months, will be estimated via mixed models. Results of the trial are anticipated to positively affect patients by facilitating the real-time documentation of self-reported disease activity, securely transferring data to providers using an Internet-based dashboard, and combining concerning trends and letting providers know about them through the use of a population manager.

“We expect this model to be easily adaptable to other rheumatic conditions, as well as nonrheumatic chronic illnesses. We anticipate that it will have broad applicability in helping patients better understand their disease and symptoms, improving patient‐HCP [healthcare provider] communication and, ultimately, improving disease management,” Dr Lee and colleagues concluded in their proposal of the application and population system management trial.

Lee Y, et al. A Novel Mobile App & Population Management System to Manage Rheumatoid Arthritis Flares. January 19, 2016. Accessed December 2, 2016.

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Humana Adds MDLIVE Telemedicine Technology Benefit to Select Medicare Advantage Plans

Humana and MDLIVE are continuing to join forces in their bid to increase patient access to care by expanding their provision of telemedicine to select counties in Georgia, New Mexico, Oregon, and South Carolina.

The service, which provides virtual access to physicians 24 hours a day, was made available to certain Medicare beneficiaries in the Arizona counties of Maricopa, Pinal Pima, La Paz, Mohave, and Yavapai. According to Humana, the positive response rate was 90% among members who used the service in 2016 and who took the postcare survey.

“With on-demand services playing a big role in people’s lives today, it’s important that we offer our members access to on-demand care to help reduce some of the primary barriers that prevent people from getting medical care. Video and telephonic visits allow our members to receive healthcare when and where they need it so we can help them achieve their optimal health. For Medicare beneficiaries, getting care when it’s needed may be able to help reduce hospitalizations and emergency room visits,” said Jim Laughlin, President, Senior Products, Humana, Atlanta, GA, in a press statement released by the company.

Throughout the 2017 plan year, patients with certain Medicare Advantage plans may be eligible to use this service. Participants will be able to contact MDLIVE physicians about a variety of nonemergency medical conditions (eg, cold, flu, headaches, skin infections) using personal computers and smart-phones. Each telemedicine visit will require a copay not unlike the one the patient would pay for an in-person visit.

In addition to giving patients the opportunity to see their physicians outside of standard primary care office hours (eg, evenings or weekends, while traveling), telemedicine can benefit those who are unable to drive because of their condition, or who have no access to methods of transportation.

Under the consent of the patient, Humana ensures that electronic health records are available to MDLIVE’s network of board certified healthcare professionals so that the physicians can make notes based on the virtual visit. Humana also confirms that treatments prescribed by MDLIVE clinicians are shared with the respective patient’s primary care physician.

Patients are advised against using the telemedicine service for chronic conditions (eg, diabetes, heart disease), medical emergencies, or as a replacement for an in-person visit with a primary care physician or other healthcare provider. Depending on the state, there may be some limitations regarding the delivery of certain healthcare and prescription services via telemedicine.

Humana. Humana adds telemedicine technology benefit in Medicare Advantage plans available in Georgia and South Carolina. November 7, 2016. Accessed December 5, 2016.

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Applications Being Developed to Provide Patients with Timely Drug Cost Information

With the goal of decreasing cost-driven noncompliance with therapy, multiple insurers, pharmacy benefit managers, and technology companies are creating mobile and computer applications that will provide patients with information about their health insurance coverage, medication costs, and less expensive drug alternatives before they even get to the pharmacy.

According to the Centers for Disease Control and Prevention, data from a 2013 national health survey revealed that, as a result of drug costs, approximately 7.8% of adults in the United States did not take their medication as prescribed, 15.1% requested less expensive medication from their physician, 1.6% purchased their drugs overseas, and 4.2% used alternate therapies.

The developers of these applications seek to improve drug compliance by helping patients lower their out-of-pocket costs, as well as lessen the amount of time patients spend with their physicians, pharmacists, and insurance companies in an effort to get less expensive prescriptions.

UnitedHealthcare is already in the process of tackling this issue via a pilot project using its ScriptHub Plus application, which provides the location-specific price of a prescribed drug under the patient’s insurance plan, in addition to other options, such as potentially cost-effective therapy alternatives that the patient can discuss with their physician. ScriptHub Plus is still a work in progress, however, with UnitedHealthcare officials noting that, as of yet, it does not support stopping electronic orders from processing while patients consider their other options, and does not provide physicians with pricing data via electronic health records.

Some vendors are focusing primarily on providing this cost information to physicians. For example, CVS Health and Surescripts are working on a feature that will give patient-specific benefit and cost information to physicians at the point of care via electronic health records, with the aim of reducing the number of administrative callbacks that physicians and pharmacists typically encounter.

Rubenfire A. Apps for Rx sticker shock. Modern Healthcare. July 30, 2016. Accessed December 5, 2016.

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Last modified: February 1, 2017
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