One patient, one pharmacist, big results. Part 3.

Blue Cross & Blue Shield of Rhode Island: $720,000 in savings for one patient

April 30, 2018

Consider one patient at a physician practice in Rhode Island struggling with hereditary angioedema (HAE), a challenging specialty condition. Let’s call her Helen. Stress, life events, even just getting a tooth pulled can trigger a flare. Helen’s medical and pharmacy spend was more than 3x that of others with HAE.

Add one on-site pharmacist in an innovative embedded pharmacist program to advocate for Helen and provide guidance and education. other patients with HAE.

The result: Over a two-year period, the program significantly improved the patient’s quality of life and reduced her use of medications. Helen’s annual costs dropped from $1.7 million down to $980,000.¹

Patient-centered pharmacist programs in action

HAE is a rare and potentially life-threatening genetic condition that occurs in about 1 in 10,000 to 1 in 50,000 people. It causes swelling in various parts of the body, including the hands, feet, face and throat. Patients can suffer excruciating abdominal pain, nausea and vomiting caused by swelling in the intestinal wall. Swelling of the airway or throat is particularly dangerous—it can cause death by asphyxiation.²

Prime research on HAE

Prime researched members with HAE and presented the study results at the Academy of Managed Care this month. Across 15 million commercial members, Prime found only 226 members with HAE. Across both medical and pharmacy claims, the average 12-month total cost of care was $409,925.³ The average 12-month drug cost was $395,507, or 97 percent of the total cost of care.

Just 111 of that group of 226 were continuously enrolled, allowing for further study. Ten of those 111 members had more than $1 million in HAE drug spend. None of these members were new starts.³ With costs this far outside the norm, did the members of this million-dollar club need a different kind of care than they were getting?

Yes. One pharmacist can change a life

Because stress can trigger an attack, having the right balance of prophylactic and on-demand medicine helps many patients treat their attacks at home.

Helen’s primary care physician asked MaryAnn, an on-site pharmacist, to attend an appointment with Helen and help collaborate on her care. MaryAnn worked with Helen for over two years. MaryAnn became Helen’s personal subject matter expert and coach in a complicated health care system.

MaryAnn went with Helen to all her physician appointments to help keep track of treatment changes and doctor’s counsel. She patiently answered questions and was often able to keep stress and fears from escalating. MaryAnn talked to Helen about all medication changes to monitor for reactions or concerns. And over time, MaryAnn was able to help Helen identify triggers for attacks. This made Helen’s HAE much more manageable.

The doctor also benefited from MaryAnn’s involvement. MaryAnn provided suggestions for new pharmacologic treatment plans that might better manage Helen’s HAE. MaryAnn also assisted with the paperwork for prior authorizations and refills, so prescription deliveries were timely.

From high cost to high quality

“Helen now has her HAE under better control and is living a better quality of life,” said Donna Paine, PharmD, RPh, MBA, BCBSRI specialty program manager. “She has fewer attacks and is able to manage most of them at home. Helen has reduced her use of emergency care.”

Helen reduced her utilization of Cinryze® and Berinert®. This generated an annualized savings of $720,000.¹

“With MaryAnn as part of my care team, I can take the everyday stresses of a 50+ hour workweek while managing my health. With MaryAnn, I could bounce ideas back and forth about new medications, treatment ideas and what else we can try. [She is:]

  • An extra set of ears at all doctor appointments
  • Someone to] reach out to on medication questions
  • A sense of assurance, knowing I am not alone
  • A local sense of comfort!”

–Patient with HAE

One patient. One pharmacist. An annualized savings of $720,000.

Managing big costs requires new strategies that look at the entire care spectrum. BCBSRI’s Patient-Centered Pharmacy Program is an example of a creative and effective way to manage pharmacy costs with an integrated approach.

How can a pharmacist-driven program improve health outcomes and reduce cost of care at your organization? Prime will work with plan sponsors to help identify opportunities for successful program development.

Drug names are the property of their respective owners.

Names of the patient and the pharmacist have been changed for privacy purposes.


References

  1. Blue Cross and Blue Shield of Rhode Island internal performance report on Patient-Centered Pharmacy Program 2014-2017.
  2. “What is HAE?” The US Hereditary Angioedema Association. Accessed at: https://www.haea.org/HAEdisease.php
  3. VandeWaller SE, Starner CI, Gleason PP. Hereditary Angioedema: A Comprehensive Integrated Medical and Pharmacy Claims Analysis of Utilization and Costs among 15 Million Commercial Insured. AMCP Poster Presentation April 2018 Boston, MA.
Hereditary Angioedema: A Comprehensive Integrated Medical and Pharmacy Claims Analysis of Utilization and Costs Among 15 Million Commercially Insured Members (Spring 2018)

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