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Medication Adherence, Cost and Access
Kimberly Jinnett, PhDResearch DirectorIntegrated Benefits Institute
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About IBI
• National, not-for-profit membership organization
• 550+ corporate sponsors
• Employers: 85% of IBI’s members
• IBI’s mission: Demonstrate the business value of
a healthy workforce through independent HPM research to point the way, measurement and modeling tools to help get there, and a forum for sharing ideas and experience.
• Visit www.ibiweb.org
New Employer Realities• Show the C-suite the value of improved
workforce health
• Healthcare reform: the value of a healthy workforce or the cost of healthcare?
• Dead end: attempting to control claims costs in separate program silos
• Looking for best strategies to improve workforce health, reduce lost time, and enhance productivity
• Limited data, time, and dollars
Up the Organization
The View from the C-Suite
On the Brink of Change
How CFOs View Investments in Health and Productivity
IBI Research, 2002
Linking Health, Productivity and the Bottom Line
Strong link
61%
Weak link
7%
Moderate link
32%
Source: On the Brink of Change – How CFOs View Investments in Health and Productivity. Integrated Benefits Institute. 2002.
Critical
Factor
4%
Moderate
Degree
54%
Great Degree
21%
Slight Degree
18%
Not At All
3%
Effect of Benefits Programs on Financial Performance
A big deal for only 25%
Source: On the Brink of Change – How CFOs View Investments in Health and Productivity. Integrated Benefits Institute. 2002.
The Business Value of Health
Linking CFOs to Health and Productivity
IBI Research, 2006
The Impact of Ill-Health
0%
25%
50%
75%
100%
Higher medical Trouble focusing
on job
More absence Affects bottom
line beyond
healthcare
Adversely affects
other benefits
costs
Agree Strongly agree
96%90%
86% 84%
71%
Source: The Business Value of Health: Linking CFOs to Health and Productivity, IBI, 2006
Are CFOs Getting Information?
• Absence– 51% ever get reports on occurrence
– 22% get reports on financial impact
• Presenteeism– 22% ever get reports on occurrence
– 8% get reports on financial impact
Source: The Business Value of Health: Linking CFOs to Health and Productivity, IBI, 2006
Lost Productivity Costs a Function of ….
• Ability to replace workers
• Time value of output
• Degree of team work
Source: Sean Nicholson, Mark Pauly, et al., "Measuring the Effects of Work Loss on Productivity with Team Production," Health Economics 15: 111-123 (2006).
How CFOs Would Use Lost-productivity Information
65%70%73%75%75%
0%
20%
40%
60%
80%
Consider
against health
plan costs
Reduce
Absence
Manage all
health-related
costs more
closely
Examine
business
benefits of
health plans
Reduce
presenteeism
Source: The Business Value of Health: Linking CFOs to Health and Productivity, IBI, 2006
New Research
Health and Productivity as a Business
Strategy: A Multiemployer Study*
* Source: Journal of Occupational and Environmental Medicine. Vol. 51, No. 4, April 2009
Database Structure – Phase II
• Three unique databases– 1,045,552 medical claims
– 413,110 pharmacy claims
– 34,622 employee self reports
• Creating an integrated database
– Mapping pharmacy claims to medical claims
– Mapping self reports to medical/pharmacy claims
Full Costs – Medical, Pharmacy, Absence and Presenteeism
$0
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
Depression
Obesity
Arthritis
Back/Neck Pain
Anxiety
GERDAllergy
Other cancer
Other chronic pain
Hypertension
Co
st
per
1000 E
Es
Medical Pharmacy Absence lost prod Presenteeism lost prod
Co-Morbidity and Lost Time
0
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 10+
# of chronic conditions
Lo
st
da
ys
Absence lost time Presenteeism lost time
The Impact of Pharmaceutical Plan Design
IBI Research
2007
Ave. Medication Adherence
64%
32%
45%
28%
0%
20%
40%
60%
80%
FILLING: % EEs filling at leastone script
REFILLING: % time inpossession of drug
Symptom Relieving Disease Modifying
Impact of Out-of-Pocket Cost
0%
20%
40%
60%
80%
Baseline plus $5 plus $10 plus $15 plus $20
Increase in copay
% E
Es
fill
ing
at
lea
st o
ne
scri
pt
Disease Modifying Symptom Relieving
Impact on Lost Productivity Costs-- No Script Group --
$12.8$14.0
$17.2
$0
$5
$10
$15
$20
Baseline Reduced
incidence
Reduced incidence
+ duration
Lo
st P
rod
uct
ivit
y C
ost
s ($
Mil
lio
ns)
-19% -26%
What can we learn about Diabetes from the HPQ/HPQ-
Select Database?
Preliminary Analysis
2010
Persons with Diabetes have more Chronic Conditions (Self-reported Diabetes 4% Prevalence)
2.1
5.1
0.0
2.0
4.0
6.0
With Diabetes (n=4955) Without Diabetes (n=121053)
Av
erage
Nu
mb
er o
f C
hro
nic
Con
dit
ion
s
Top Ten Chronic Conditions Among Persons with Diabetes
24.5%
24.2%
22.5%
22.4%
20.7%
30.2%
42.4%
46.2%
46.4%
51.1%
0.0% 20.0% 40.0% 60.0%
Hypertension
Obesity
High Cholesterol
Allergy
Arthritis
Depression
Fatigue
Sleeping Problems
GERD
Chronic Pain
Percent with Only Diabetes vs. Other Conditions in addition to Diabetes
Diabetes plus
other conditions
(n=4432), 89.4%
Only Diabetes
(n=523), 10.6%
Percent in Current Treatment among those with only Diabetes vs. with other conditions
88%92%
0%
50%
100%
With Only Diabetes With Diabetes and other
Conditions
Effects of Treatment and Comorbidities on Work Outcomes among those with Diabetes
Those in treatment have higher job performance
No significant effectIn Current Treatment
As comorbidity increases, job performance declines
As comorbidity increases, absence increases
Number of Illnesses
Job Performance
Absence
What can we learn about Diabetes from the IBI
Benchmarking Database?
Preliminary Analysis
2010
CY Lost Workdays per Active STD Claim(IBI Benchmarking Data, 2008)
45
25
16
0
10
20
30
40
50
Diabetes without
complications
With Renal
Manifestations
With Neurological
Manifestations
Med
ian
Da
ys
CY Median Costs per Active STD Claim(IBI Benchmarking Data, 2008)
$3,214
$2,791
$1,153
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
Diabetes without
complications
With Renal
Manifestations
With Neurological
Manifestations
Med
ian
Co
sts
Contact IBI
Kimberly Jinnett, PhDResearch Directorkjinnett@ibiweb.org
www.ibiweb.orgwww.benefitsintelligence.org
30
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