Three Minutes with Patrick Gleason

Patrick Gleason, PharmD, Prime’s assistant vice president, Health Outcomes, has a passion for helping to ensure medications are affordable and accessible to the people who need them. His team turns integrated medical and pharmacy claims data into actionable insights that help Prime’s clients improve health outcomes and manage spend.

What’s your role at Prime?
I lead a team of 12 within the Health Outcomes department; we have a mix of skills, including data scientists, PhD epidemiologist, PhD pharmacist researchers, biostatistician, senior clinical analysts, and more. We mine the medical and pharmacy claims data of members, across all lines of business, for insights to shape care management programs and clinical program service offerings. We play a role in demonstrating Prime’s clinical programs impact, as well as creating and fulfilling value-based contracts reporting with pharmaceutical manufacturers. We fulfill pharmacy benefit manager required clinical compliance reporting, like URAC. Finally, we help construct some of Prime’s products, like HighTouchRx®.

Describe HighTouchRx.
This product is unique in the marketplace. HighTouchRx uses Prime’s integrated medical and pharmacy claims data to optimize drug therapy regimens and identify significant cost-savings opportunities, especially in high-cost, specialty drugs. Using that data, pharmacists reach out to prescribers, and they work together to help ensure cost-effective medication therapy optimization; realize savings for both the member and the plan. There are two client options for HighTouchRx. Clients can choose a full-service option, where Prime-employed pharmacists handle analysis and outreach. Clients can also tap into a web-based portal and rules engine for data and analytics. Then, pharmacists employed by the health plan conduct their own prescriber outreach. Both options include Prime data scientists who perform continuous savings opportunity quality improvement and prioritize outreach opportunities.

Before formally launching HighTouchRx™, Prime piloted this approach with three clients. What did you learn?
We learned we can certainly save dollars for health plans. We proved that our data analysis delivers results. We demonstrated that outreach – to providers, pharmacies and members – can be extremely effective. Finally, we showed that our drug therapy optimization rules and predictive model identifying members who are likely to generate $250,000 or more annually in drug spend work to provide pharmacists with actionable information. Prime won an award of excellence from the Pharmacy Benefit Management Institute based on the results of our pilots.

You’re on the board of directors for the Academy of Managed Care Pharmacy (AMCP) and serve on the methods advisory board for the Institute for Clinical and Economic Review (ICER) – why is it important that Prime holds a seat at those tables?
AMCP’s overarching goal aligns well with Prime’s – helping health care work better by finding ways to get people the medications they need at a more affordable cost. Among many other things we do, the AMCP board works to help ensure fair pricing of drugs. On the ICER methods advisory board, I help advise ICER on methodology for measuring the medications cost-effectiveness. In both roles, I represent Prime’s opinion as a payer in these discussions.

How does Prime’s work differ from what other pharmacy benefit managers (PBMs) are doing?
One big difference is Prime’s collaboration with the Blue plan sharing medical and pharmacy data and sharing a member centric quality care vision; that is the carve-in PBM value. When an employer opts for a carve-out PBM, they don’t have access to integrated medical and pharmacy data in the same way Prime does and there is not integration of care services, like the HighTouchRx product example.

Because our clinical programs, product development and health services research involve both pharmacy and medical data, we have a good perspective. Our Blue plan plus Prime insights have inspired some of Prime’s newer products, including HighTouchRx and MedDrive™. Prime is proud of the variety and quality of research we do – we look at medical and pharmacy data, find the savings, proof it out, and publish it.