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Medication Adherence, Cost and Access Kimberly Jinnett, PhD Research Director Integrated Benefits Institute brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Jefferson Digital Commons

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Page 1: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

Medication Adherence, Cost and Access

Kimberly Jinnett, PhDResearch DirectorIntegrated Benefits Institute

brought to you by C

OR

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iew m

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provided by Jefferson Digital C

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Page 2: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 3: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

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Up the Organization

The View from the C-Suite

Page 5: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

On the Brink of Change

How CFOs View Investments in Health and Productivity

IBI Research, 2002

Page 6: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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.

Page 7: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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.

Page 8: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

The Business Value of Health

Linking CFOs to Health and Productivity

IBI Research, 2006

Page 9: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

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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

Page 11: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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).

Page 12: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 13: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 14: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 15: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 16: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 17: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

The Impact of Pharmaceutical Plan Design

IBI Research

2007

Page 18: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 19: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 20: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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%

Page 21: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

What can we learn about Diabetes from the HPQ/HPQ-

Select Database?

Preliminary Analysis

2010

Page 22: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 23: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re 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

Page 24: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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%

Page 25: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 26: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 27: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

What can we learn about Diabetes from the IBI

Benchmarking Database?

Preliminary Analysis

2010

Page 28: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 29: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

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

Page 30: Medication Adherence, Cost and AccessFull Costs – Medical, Pharmacy, Absence and Presenteeism $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 D e p re s

Contact IBI

Kimberly Jinnett, PhDResearch [email protected]

www.ibiweb.orgwww.benefitsintelligence.org

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