introducing valueoptions’ clinical care alerts

Copyright © 2012 ValueOptions, Inc. All Rights Reserved.

Introducing ValueOptions’ Clinical Care Alerts

January 2013


What are Clinical Care Alerts?

How does it work?

What are the benefits?

Questions and Answers

Agenda

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The Issue of PoorMedication Adherence

Unnecessary hospitalizations

Medication escalation

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Medication-related problems contribute up to 50% of behavioral health admissions, 20% of medical admissions, and increased morbidity and mortality.

Medication non-adherence is considered the single most important factor leading to relapse among patients with schizophrenia.

Risk of hospitalization for schizophrenia decreases by almost 20% for every 10% increase in medication compliance.

Patients with therapy gaps of 30 or more days per prescription have almost five times greater risk of being hospitalized compared with patients whose therapy gaps are 0 to 10 days.

The Impact of Non-Adherence

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American Health & Drug Benefits, August 2009


Most Interventions Today TargetPatients Directly

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Physician

PBM

Patient

Researchshows patient

self-reporting to be highly

unreliable.1

Pharmacy

Health Plan


Clinical Care Alerts

Our Clinical Care Alert automated system identifies and notifies physicians of potential behavioral health, physical health, and medication care gaps in a timely manner.

It re-engages physicians in what has become an increasingly member-centric world to close patient-specific care gaps in the entire population while improving quality.

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Clinical Care Alerts Help Close Care Gaps

Works through the patient’s trusted advisor – the physician – closing a key feedback loop

Most often closed care gap is Early Discontinuation of Medication

Enhances provider collaboration by notifying all physicians related to a specific issue

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BehavioralClaim Data

Patient

Physician

Automated Provider Engagement

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ValueOptions Clinical Care Alert


Concise Alerts that Support Collaborative Care

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Sample Medication Adherence Alert


Concise Alerts that Support Collaborative Care

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Sample Lab Monitoring Alert


Clinical Care Alert Technology

Analytical tools consisting of field-tested, validated rule sets for successful conversion that drives overall cost savings

Uses 11,000+ alert rules to screen the entire population and intervene earlier to reduce the chance of consumers becoming high-risk and high-cost

Alert rules updated manually on a bi-monthly basis or as needed

Enhances provider collaboration by notifying all physicians related to the specific issue in writing so they can work together to coordinate care for the consumer

Automated alert generation leads to successful intervention

Customized nimble, flexible data exchange structure

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Clinical Care Alert Automated Process

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Sub-Optimal Therapy

Monitoring

Missing Procedures

Poor Compliance Early Discontinuation

Alert Rules Cover All Chronic Conditions

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Duplicate Therapy

Polypharmacy

Drug-Drug Interactions

Overuse / Substance Abuse

Age-Inappropriate Therapy

Alerts


Behavioral Health Related Rules

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Alert Example

Depression Without Antidepressants

Diagnosed with depression but is not filling prescriptions for an anti-depressant.

Follow-Up After Hospitalization for Mental Illness

Consumers hospitalized for treatment of selected mental health disorders but not seen on an ambulatory basis or in intermediate treatment with a mental health provider.

Acute and Continuation Phase Depression Treatment

Consumers diagnosed with a new episode of depression were treated with antidepressant medication, but discontinued therapy prior to six months.

Optimal Practitioner Contacts for Medication Management of Depression

Consumers diagnosed with a new episode of depression and treated with antidepressant medication, but have not had at least three follow-up contacts with a practitioner during the 84-day (12-week) Acute Treatment Phase.

Medications that Aggravate Depression

Multiple drugs have been reported to cause depression in some consumers. Elderly people are particularly at risk.

Schizophrenia Without Antipsychotics

Consumer appears to have schizophrenia but is not filling prescriptions for an antipsychotic.

Antipsychotic medications & metabolic screening

Consumers treated with an atypical antipsychotic agent that have not had a diabetes screening.

Bupropion & Eating Disorders Combination bupropion and eating disorder increasing risk of seizures.

Bipolar Disorder Without Mood Stabilizers

Consumer appears to have a bipolar disorder, but is not filling prescriptions for a mood stabilizer.

ADHD Medication Management

Attention deficit hyperactivity disorder (ADHD) consumers on first-line medication that have less than one (1) follow-up visit per year.


Questions and Answers

introducing valueoptions’ clinical care alerts

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