Third-Party Payer: Teaming with Clinicians in the Intervention Process - Patrick Burns, Tron Emptage, Dr. Lawrence Feinstein and Dr. Robert Hall

1. Teaming
with
Clinicians
in
the
Interven3on
Process
Clinical
Collabora3on
Achieves
Be9er
Outcomes
Principled
Strategies,
Inc.
Patrick
J.
Burns,
President
Lawrence
Feinstein,
Ph.D.,
Vice
President,
Clinical
Programs
Progressive
Medical,
Inc.
Tron
Emptage,
R.Ph.,
Chief
Clinical
Officer
Robert
Hall,
MD,
Corporate
Medical
Director
Presenters

2. Disclosure
Statements
Patrick
J.
Burns
has
no
financial
rela3onships
with
proprietary
en33es
that
produce
health
care
goods
and
services.
Lawrence
Feinstein
has
no
financial
rela3onships
with
proprietary
en33es
that
produce
health
care
goods
and
services.
Tron
Emptage
has
no
financial
rela3onships
with
proprietary
en33es
that
produce
health
care
goods
and
services.
Robert
Hall
has
no
financial
rela3onships
with
proprietary
en33es
that
produce
health
care
goods
and
services.
2
Progressive
Medical,
Inc.
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2014
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3. Learning
Objec3ves
1. Differen3ate
between
threatening
and
collabora3ve
outreach.
2. Assemble
a
list
of
words
and
phrases
that
reduce
fric3on
and
foster
partnership
between
payors
and
the
physician.
3. Iden3fy
tools
that
demonstrate
effec3ve
outcomes.
3
Progressive
Medical,
Inc.
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2014
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Rights
Reserved

4. Discussion
Points
Factors
that
Influence
Outcomes
Risk
Iden3fica3on
&
Interven3on
Tools
Lessons
Learned
Clinical
Collabora3on
Q&A
4
Progressive
Medical,
Inc.
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2014
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Reserved

5. Workers’
Compensa3on
vs.
Group
Health
Suburban
Home
Custom
Log
Cabin

6. The
Tale
of
Two
Doctors
6
Doctor
A
Doctor
B
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Medical,
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7. Factors
that
Influence
Outcomes
7
Number
of
Prescribers
Number
of
Pharmacies
Prescribing
Behaviors
Medica3on
Pa9erns
Body
Part/
Nature
of
Injury
Demographics
of
Prescriber
Medica3on
Agreement
Drug
Monitoring
Progressive
Medical,
Inc.
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2014
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8. Number
of
Prescribers
• West
Virginia
• Evalua3on
for
doctor
shopping
– Doctor
shoppers:
Four
or
more
prescribers
in
last
six
months
–
%
of
deceased
pa3ents
–
%
of
living
pa3ents
8
Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500.
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2014
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9. Number
of
Prescribers
• West
Virginia
• Evalua3on
for
doctor
shopping
– Doctor
shoppers:
Four
or
more
prescribers
in
last
six
months
– 25
%
of
deceased
pa3ents
– 3.5%
of
living
pa3ents
9
Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500.
Progressive
Medical,
Inc.
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2014
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10. Number
of
Pharmacies
• West
Virginia
• Evalua3on
for
pharmacy
shopping
– Pharmacy
shoppers:
Four
or
more
pharmacies
in
last
six
months
–
%
of
deceased
pa3ents
–
%
of
living
pa3ents
10
Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500.
Progressive
Medical,
Inc.
-­‐
Copyright
2014
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Rights
Reserved

11. Number
of
Pharmacies
• West
Virginia
• Evalua3on
for
pharmacy
shopping
– Pharmacy
shoppers:
Four
or
more
pharmacies
in
last
six
months
– 17%
of
deceased
pa3ents
– 1%
of
living
pa3ents
• 55%
of
pharmacy
shoppers
were
also
doctor
shoppers
11
Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500.
Progressive
Medical,
Inc.
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2014
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12. Number
of
Prescribers
and
Pharmacies
12
Uncoordinated
Care
Progressive
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Inc.
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13. Prescribing
Behaviors
• Opioids
prescribed
early
in
the
claim
• Days
supply
of
opioids
• Number
of
fills
• Morphine
equivalent
dose
(MED)
– Washington
State
– 120
MED
threshold
13
http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf
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14. Medica3on
Pa9erns
• Type
of
opioids
and
claim
cost
• Michigan
– Final
claim
cost
≥
$100,000
– Short
ac3ng
opioids
→
1.76
more
likely
– Long
ac3ng
opioids
→
3.94
more
likely
14
White JA, Tao X, Talreja M, Tower J, Bernacki E. The effect of opioid use on workers' compensation claim cost in the State of Michigan. J Occup Environ
Med. 2012 Aug;54(8):948-53.
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15. Medica3on
Pa9erns
• Mul3ple
short-­‐ac3ng
and
long
ac3ng
opioids?
• Poten3al
drug-­‐drug
interac3ons
– West
Virginia
– Opioids
and
benzodiazepines
15
Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012 Jun;50(6):494-500.
Progressive
Medical,
Inc.
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2014
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Rights
Reserved

16. Body
Part/Nature
of
Injury
• Ohio
• Highest
costs
per
claim
by
body
part
– Lumbar
spine
– Shoulder
– Cervical
spine
• Industries
with
highest
average
costs
per
claim
– Transporta3on
– Warehouse
– U3li3es
and
Construc3on
16
Dunning
KK,
Davis
KG,
Cook
C,
Kotowski
SE,
Hamrick
C,
Jewell
G,
Lockey
J.
Costs
by
industry
and
diagnosis
among
musculoskeletal
claims
in
a
state
workers
compensa3on
system:
1999-­‐2004.
Am
J
Ind
Med.
2010
Mar;53(3):276-­‐84.
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17. Demographics
of
Prescriber
Geographical
varia3on
of
opioid
prescribing
• Acute,
work-­‐related
low
back
pain
• Decision
to
use
opioids
related
to
social
condi3ons
• Massachuse9s
5.7%
vs.
South
Carolina
52.9%
• 79%
of
state
varia3on
explained
by
3
factors
1. State
household
income
inequality
2. Number
of
physicians
per
capita
3. Workers’
compensa3on
cost
containment
effort
score
17
Webster
BS,
Cifuentes
M,
Verma
S,
Pransky
G.
Geographic
varia3on
in
opioid
prescribing
for
acute,
work-­‐related,
low
back
pain
and
associated
factors:
a
mul3level
analysis.
Am
J
Ind
Med.
2009
Feb;52(2):162-­‐71.
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Medical,
Inc.
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18. Demographics
of
Prescriber
Geographical
varia3on
of
opioid
prescribing
• 135
million
opioid
prescrip3ons
in
2008
• 37,000
retail
pharmacies
• Large
varia3on
in
opioids
prescribed
• Coun3es
having
the
highest
prescribing
rates
‒ Appalachia
‒ Southern
and
western
states
 Strongest
predictor
of
amounts
prescribed
 Number
of
available
physicians…”by
far”
18
McDonald
DC,
Carlson
K,
Izrael
D.
Geographic
varia3on
in
opioid
prescribing
in
the
U.S.
J
Pain.
2012
Oct;13(10):988-­‐96.
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Inc.
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19. Demographics
of
Prescriber
19
McDonald
DC,
Carlson
K,
Izrael
D.
Geographic
varia3on
in
opioid
prescribing
in
the
U.S.
J
Pain.
2012
Oct;13(10):988-­‐96.
Progressive
Medical,
Inc.
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2014
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20. Medica3on
Agreement
• Also
know
as
a
“pain
contract”
• Recommended
by
– U.S.
Department
of
Health
and
Human
Services
– American
Academy
of
Pain
Medicine
– Veterans
Health
Administra3on
– American
College
of
Occupa3onal
and
Environmental
Medicine
(ACOEM)
– Official
Disability
Guidelines
(ODG)
20
Payne, R, E Anderson, R Arnold, L Duensing, A Gilson, C Green, C J. Haywood, S Passik, B Rich, L Robin, N Shuler, and M Christopher. "A Rose by Any
Other Name: Pain Contracts/agreements." The American Journal of Bioethics : Ajob. 10.11 (2010): 5-12. ACOEM 2011; ODG 2012
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21. Medica3on
Agreement
• Informed
consent
• Promotes
educa3on
• Improves
compliance
• Components
– Informed
consent
for
treatment
with
medica3on(s)
– Acceptable
and
unacceptable
behaviors
– Consequences
for
failure
to
adhere
to
agreement
21
Payne, R, E Anderson, R Arnold, L Duensing, A Gilson, C Green, C J. Haywood, S Passik, B Rich, L Robin, N Shuler, and M Christopher. "A Rose by Any
Other Name: Pain Contracts/agreements." The American Journal of Bioethics : Ajob. 10.11 (2010): 5-12. ACOEM 2011 ODG
2012
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Medical,
Inc.
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22. Medica3on
Agreement
Sample
22
Progressive
Medical,
Inc.
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2014
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23. Drug
Monitoring
• Urine
drug
screen
– U.S.
Department
of
Health
and
Human
Services
– ACOEM
– ODG
• Iden3fy
possible
drug
misuse
and
abuse
23
Gilbert
et
al.
"Importance
of
Urine
Drug
Tes3ng
in
the
Treatment
of
Chronic
Noncancer
Pain:
Implica3ons
of
Recent
Medicare
Policy
Changes
in
Kentucky."
Pain
Physician
13.2
(2010):
167-­‐86.
Progressive
Medical,
Inc.
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2014
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24. Effects
on
Behavior
PaCent
• “My
prescrip3ons
are
being
monitored”
• “I
may
be
drug
tested”
• “I
signed
an
agreement”
• “I
could
lose
my
pain
meds”
24
• Physician
Physician
• “My
prescribing
habits
are
being
monitored”
• “I
could
lose
my
license
to
prescribe”
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25. Why
Some
Physicians
Don’t
Follow
Guidelines
25
KNOWLEDGE
ATTITUDES
BEHAVIORAL
FACTORS
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Medical,
Inc.
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26. RISK
IDENTIFICATION
&
INTERVENTION
TOOLS

27. Risk
Iden3fica3on
and
Interven3on
27
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.
Rx
Data
Analysis
1:1
Individualized
ConsultaCon
via
Telephone
or
In
person
Prescriber
PSI
Score™
and
Scores
for
Top
Three
Risk
Factors
(out
of
17
total
factors)
#1
Early
Refills
#2
Excessive
Use
#3
Dosage
and
Volume
of
Opioids
Risk
Scoring
of
Prescribers
Monthly
CommunicaCon;
Quarterly
Score
Updates
Prescriber
Resources
Toolkit
Engagement
via
Personalized
Outreach
49
PredicCve
Metrics
Pharmacy
Metrics
Prescriber
Metrics
PSI
Score™
17
Behavioral
Risk
Factors
PaCent
Metrics
Opioid-­‐specific
Metrics

28. Iden3fy
Prescriber
“Risk”
• Concept
of
“risk
factors”
borrowed
from
disease
management
• At
what
point
would
you
allocate
resources
to
intervene
with
the
following
prescriber?
– Starts
most
pa3ents
on
highest
dosage
– Frequently
prescribes
excess
days
supply
– Is
located
50+
miles
from
many
of
his
pa3ents
– High
pa3ent
volume
compared
to
specialty
peers
28
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

29. The
PSI
Score™
• Iden3fy/Stra3fy
̶̶
Popula3on
and
Specialty
Peers
• Predict
risky
prescribers
by
iden3fying
trends
• Individualize
the
interven3on
effort
by
iden3fying
each
prescriber’s
top
three
risk
behaviors
• Monitor
prescriber
behavior
change
over
3me
• CQI
̶̶
Measure
interven3on
effec3veness,
and
improve
• Comply
with
treatment
direc3ve
to
iden3fy
prescribers
and
members
for
review
of
appropriateness
of
opioid
therapy
29
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

30. Prescriber
Risk
Score
Distribu3on
30
High
Risk
Moderate
Risk
Low
Risk
©
2014
by
Principled
Strategies,
Inc.
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rights
reserved.

31. Predic3ve
Risk
Iden3fica3on
31
Which
prescribers
not
currently
in
the
high
risk
group
will,
in
six
months,
have
a
PSI
Score™
equal
to
or
greater
than
the
cutoff
value
that
defines
“high
risk”,
with
a
90%
confidence
level?
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

32. Prescriber
Interven3on
IdenCficaCon
• Risk
scored
and
rank
ordered
the
prescriber
popula3on
• Iden3fied
1,200
prescribers,
along
with
the
top
3
risk
factors
for
each
Engagement
• 250
prescribers
per
week
for
four
weeks
• Addi3onal
prescribers
for
two
more
weeks
to
reach
goal
of
1,000
ConsultaCon
• 20-­‐minute
telephone
call
or
office
visit
consulta3on
with
PharmD
• Printed
materials
including
instruc3ons
to
refer
to
behavioral
health
Follow-­‐up
• Six
months
follow-­‐up
communica3on
post-­‐appointment
• Three-­‐month
and
six-­‐month
update
on
PSI
Score™
and
risk
factor
scores
32
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

33. Iden3fica3on
• 1,200
prescribers
iden3fied
for
engagement
• ≥
98th
%ile
of
the
PSI
Score™
distribu3on
33
High-­‐risk
Prescriber
DistribuCon
by
Specialty
Family
Medicine
23%
Internal
Medicine
22%
Psychiatry
9%
Pain
Management
7%
Surgery
7%
Physical
Medicine
&
Rehab
7%
Anesthesiology
6%
Physician
Assistant
4%
Nursing
4%
Other
12%
©
2014
by
Principled
Strategies,
Inc.
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rights
reserved.

34. Iden3fica3on
Top
Risk
Factors
Occurring
most
frequently
among
prescribers’
top
three
risk
factors
34
PaCent-­‐focused
Risk
Factors
Mul3ple
Prescribers
Mul3ple
Pharmacies
Mul3ple
Family
Members
Prescriber-­‐focused
Risk
Factors
Early
Refills
of
Similar
Products
Dosage
and
Volume
of
Opioids
Opioid
with
benzodiazepine
or
carisoprodol
Concomitance
Excessive
Use
of
Controlled
Substances
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2014
by
Principled
Strategies,
Inc.
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rights
reserved.

35. Engagement
Packet
• Welcome
Le9er
̶̶
Personalized
and
Tailored
• Risk
Factor
Worksheets
̶̶
Each
prescriber’s
top
three
risk
factors
• Clinical
Advisories
specific
to
each
prescriber’s
risk
factors
• Pa3ent
Informa3on
Report
̶̶
List
of
each
prescriber’s
pa3ents
contribu3ng
to
his/her
top
three
risk
factor
scores,
and
their
prescrip3on
informa3on
• Prescriber
Resources
and
Recommenda3ons
̶̶
Guides;
assessments;
services
to
refer
to
for
psych
evalua3ons,
rehab,
consulta3on,
and
coordina3on
of
care
35
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

36. Engagement
• Outbound
scheduling
calls
– Call
prescriber’s
office
to
schedule
a
20-­‐minute
telephone
call
or
office
visit
with
a
licensed
PharmD
– Confirm
receipt
of
the
engagement
packet
• Confirm
the
appointment
72
hours
prior,
by
call
or
email
36
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2014
by
Principled
Strategies,
Inc.
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rights
reserved.

37. Consulta3on
• 20
to
30-­‐minute
1:1
consulta3on
with
a
PharmD
trained
in
the
program
protocol
– Telephone
call
– Office
visit
• In
the
first
four
minutes:
Assess
prescriber’s
level
of
mo3va3on
versus
resistance,
and
adjust
objec3ves,
tac3cs,
|and
3ming
accordingly
37
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2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

38. The
Tale
of
Two
Doctors
38
Doctor
A
Doctor
B
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2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

39. A
Tale
of
Two
Doctors
39
Scheduling
Call
Refuse
Schedule
Release
Office
Visit
Telephone
Call
MoCvated
/
CooperaCve
• Review
the
engagement
packet
materials
• Explain
the
purpose
of
the
program,
themes,
the
PSI
Score™,
risk
factors,
clinical
recommenda3ons,
Pa3ent
Informa3on
Report
• Explain
the
program
follow-­‐up,
score
updates,
and
invite
further
discussion
Resistant
/
UncooperaCve
• Explain
the
purpose
of
the
program,
themes
• Focus
on
the
resources
to
help
the
prescriber
• Shorten
appointment;
schedule
follow-­‐up
• Track
PSI
Score™
over
3me
and
have
Regional
Medical
Director
follow-­‐up
if
necessary
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

40. Follow
Up
• Sa3sfac3on
Survey
sent
within
two
weeks
of
appointment
• Monthly
Communica3ons
– By
email
unless
prescriber
requests
fax
– Links
to
short
video
vigne9es
and
addi3onal
materials
on
the
Web
– Brief
survey
ques3ons
• Quarterly
Score
Updates
• Relapse
Monitoring
Based
on
Updated
Scores
and
Trends
40
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

41. Program
Resources
• Service
Center
– Staffed
by
four
administrators
and
six
PharmDs
– Outbound
and
inbound
telephone
calls,
email
and
fax;
dedicated
lines
and
auto-­‐a9endant
• CRM
System
– Tracks
all
outbound
and
inbound
communica3ons
– Collects
data
on
all
aspects
of
the
program
– Repository
of
all
prescriber
informa3on
– Automated
opera3onal
and
clinical
reports
41
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

42. Measuring
Clinical
Outcomes
• Monthly
updates
to
the
PSI
Score™
and
risk
factor
scores
enable
us
to:
– Measure
change
across
the
prescriber
popula3on
and
within
each
specialty
group
– Indirectly
measure
adop3on
of
clinical
recommenda3ons
– Iden3fy
prescriber
trends
as
they
develop,
permizng
early-­‐stage
interven3on
per
prescriber
and
the
popula3on
– Have
a
con3nuous
feedback
look
to
evaluate
program
impact
and
improve
effec3veness
• Currently
we
measure
– Risk
– U3liza3on
(pharmacy
only)
– Benefit-­‐to-­‐Cost
(pharmacy
only)
• In
the
future
we
will
measure
the
aforemen3oned
for
both
pharmacy
and
medical
42
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

43. Post-­‐interven3on
Outcomes
(12
mo)
Endpoint
Model
Significance
P
PSI
Score™
R
Yes
<
0.001
Mul3ple
HCPs
R
Yes
<
0.001
Mul3ple
Pharmacies
R
Yes
<
0.001
Concomitance
R
Yes
<
0.002
Opioid
Prescrip3on
Claims
U
No
Morphine
Equivalent
Dose
(mg)
U
Yes
=
0.020
43
Legend:
R
=
Risk
Factor,
U
=
U5liza5on
Factor
Cost
Model
Significance
P
Savings
Opioid
Rx
Claims
Yes
=
0.041
$2,596,189
Non-­‐opioid
Rx
Claims
Yes
=
0.045
$461,731
Benefit-­‐to-­‐Cost
4.4
:
1
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

44. CLINICAL
COLLABORATION
FOR
BETTER
OUTCOMES
IN
WORKERS’
COMPENSATION

45. Clinical
Collabora3on
for
Be9er
Outcomes
Early
capture
of
prescripCons
leads
to
greater
control
through
connected
programs.
45
Progressive
Medical,
Inc.
-­‐
Copyright
2014
-­‐
All
Rights
Reserved

46. Clinical
Collabora3on
for
Be9er
Outcomes
Quicker
access
to
informaCon
be9er
equips
claims
professionals
and
clinicians
to
make
decisions.
46
Early
capture
of
prescrip3ons
Progressive
Medical,
Inc.
-­‐
Copyright
2014
-­‐
All
Rights
Reserved

47. Clinical
Collabora3on
for
Be9er
Outcomes
Quicker
access
to
informa3on
47
Early
capture
of
prescrip3ons
MulC-­‐factor
risk
analysis
based
on
pharmacy
behavior,
the
injury
and
overall
demographics
should
be
applied
to
be9er
predict
the
path
of
a
claim.
Progressive
Medical,
Inc.
-­‐
Copyright
2014
-­‐
All
Rights
Reserved

48. Analyze
Risk
Predic3ve
power
of
variables
change
over
Cme
48
Percent
of
Significance
(aggregated
across
mul3ple
variables)
Progressive
Medical,
Inc.
-­‐
Copyright
2014
-­‐
All
Rights
Reserved

49. Clinical
Collabora3on
for
Be9er
Outcomes
Quicker
access
to
informa3on
49
Early
capture
of
prescrip3ons
MulC-­‐factor
risk
analysis
based
on
pharmacy
behavior,
the
injury
and
overall
demographics
should
be
applied
to
be9er
predict
the
path
of
a
claim.
There
will
always
be
claims
that
mature
into
complicated
situa3ons;
having
the
right
tools
to
apply
at
the
right
Cme
is
essen3al.
Progressive
Medical,
Inc.
-­‐
Copyright
2014
-­‐
All
Rights
Reserved

50. • Claims
Professional
Outreach
• Physician
Outreach
• U3liza3on
Reviews
• Interven3on
Reports
• Peer-­‐to-­‐Peer
Review
Clinical
Tools
and
Exper3se
50
Progressive
Medical,
Inc.
-­‐
Copyright
2014
-­‐
All
Rights
Reserved

51. Commentary
Change
in
Opioid
Use
Post
DTM
DTM
Results
MedicaCon
Spend
per
Claimant
48
(9.3%)
detected
an
illicit
substance
250
(48.6%)
detected
a
Non-­‐Prescribed
Drug
284
(55.3%)
did
not
detect
the
prescribed
medica3on(s)
64%
of
iden3fied
claimants
that
were
tested
had
a
result
inconsistent
with
the
prescriber
therapy
Changes
in
UClizaCon
(based
on
days
supply)
Changes
in
Spend
All
Medica3ons
↓
21%
↓
20%
All
Opioids
↓
24%
↓
28%
All
Benzodiazepines
↓
28%
↑
6%
360
Days
Post
Enrollment
Compared
to
90
Days
Pre-­‐Enrollment
Urine
Drug
Monitoring
Drug
Tes3ng
and
Monitoring
Outcomes
show
significant
decrease
in
u3liza3on
60%
61%
64%
66%
70%
51
Progressive
Medical,
Inc.
-­‐
Copyright
2014
-­‐
All
Rights
Reserved

52. Commentary
Change
in
Opioid
Use
Post
Review
Success
Rate
by
MedicaCon
Class
MedicaCon
Savings
per
Claimant
$-­‐
$200.00
$400.00
$600.00
$800.00
$1,000.00
$1,200.00
$1,400.00
$1,600.00
91-­‐180
days
181-­‐270
days
271-­‐360
days
Overall
success
rate
70%
Average
decrease
in
opioid
use
8.4%
Average
savings
per
injured
party
$3,586.93
Return
on
investment
(ROI)
8:1
Medica3on
Class
Average
Success
Rate
Average
Savings
per
Successful
Interven3on
Muscle
Relaxants
76%
$
302.78
Dermatologics
73%
$
1,794.08
Seda3ves
65%
$
1,257.18
Opioid
Analgesics
57%
$
2,711.91
NSAIDs
52%
$
563.91
Gastrointes3nal
50%
$
1,014.86
An3convulsants
46%
$
1,630.16
Anxioly3cs
38%
$
244.58
Respiratory
33%
$
1,555.03
An3depressants
31%
$
316.17
Medica3on
Reviews
with
addi3onal
interven3on
via
Peer
to
Peer
Outreach
outcomes
are
measured
separately
Medica3on
Reviews
Medica3on
Reviews
result
in
an
average
$3,500
savings
per
injured
party
52
Progressive
Medical,
Inc.
-­‐
Copyright
2014
-­‐
All
Rights
Reserved

53. Commentary
Change
in
Opioid
Use
Post
Review
Success
Rate
by
MedicaCon
Class
MedicaCon
Savings
per
Claimant
Overall
success
rate
62%
Average
decrease
in
opioid
use
25.6%
Average
savings
per
injured
party
$5102
Rate
of
achieving
contact
with
prescriber
79%
Return
on
investment
(ROI)
4:1
Medica3on
Class
Average
Success
Rate
Average
Savings
per
Successful
Interven3on
An3-­‐migraine
agents
82%
$
6,662.66
NSAIDs
77%
$
524.23
Laxa3ves
69%
$
131.67
Muscle
Relaxants
65%
$
422.69
Dermatologics
63%
$
1,587.41
Opioid
Analgesics
62%
$
2,995.51
An3convulsants
61%
$
1,077.05
An3depressants
60%
$
723.16
Seda3ves
57%
$
884.56
Anxioly3cs
50%
$
1,290.77
$-­‐
$200.00
$400.00
$600.00
$800.00
$1,000.00
$1,200.00
$1,400.00
91-­‐180
days
181-­‐270
days
271-­‐360
days
Peer
Outreach
Combining
Medica3on
Reviews
with
Peer
Outreach
results
in
an
overall
4:1
ROI
53
Progressive
Medical,
Inc.
-­‐
Copyright
2014
-­‐
All
Rights
Reserved

54. The
Tale
of
Two
Doctors
54
Doctor
A
Doctor
B
Both
trea3ng
doctors
ul3mately
made
medica3on
changes
based
on
recommenda3ons
from
the
reviewing
physician.
Doctor
B
was
willing
to
partly
compromise.
Progressive
Medical,
Inc.
-­‐
Copyright
2014
-­‐
All
Rights
Reserved

55. LESSONS
LEARNED

56. Lesson
Learned
Carefully
cra<ed
outreach
fosters
engagement
• More
recep3ve
when
it
is
clearly
understood
that
– We
are
NOT
claiming
prescriber
is
engaging
in
inappropriate
behavior
– Our
emphasis
is
on
making
certain
the
injured
party
receives
the
right
medica3on
at
the
right
3me
• Inclusion
of
detailed
prescrip3on
informa3on
for
the
prescriber’s
own
pa3ents
was
a
major
contributor
to
prescribers’
willingness
to
par3cipate
• Calls
to
schedule
appointments
must
occur
within
one
week
of
receipt
of
engagement
packets
• Design
the
Engagement
Packet
mailing
envelope
so
office
staff
can
easily
iden3fy
that
it
contains
pa3ent
PHI
and
must
be
delivered
only
to
the
prescriber
• Review
of
the
themes
of
the
program
by
PharmD
increased
comfort
and
collabora3on
• Most
appointments
were
completed
within
20
minutes
• Member
and
claim
level
informa3on
was
very
useful
in
reconciling
charts
and
taking
ac3on
as
appropriate
56
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

57. Lesson
Learned
Collabora5on
can
drive
posi5ve
change
• Most
prescribers
– are
unaware
their
pa3ents
are
engaging
in
aberrant
behavior,
such
as
“doctor
shopping”,
drug
seeking,
or
diversion
– preferred
an
appointment
by
telephone
call
– had
read
the
engagement
materials
prior
to
the
appointment
– believed
that
they
were
already
implemen3ng
adequate
steps/precau3ons
in
their
prac3ce
• Although
most
prescribers
expressed
concern
about
being
“monitored”
by
the
payor,
by
the
end
of
the
call,
addi3onal
resources
and
tools
were
iden3fied
that
would
help
improve
the
safe
use
of
control
substances
– Locking
members
into
a
single
pharmacy
– Specific
lab
tests
including
“no
threshold
tes3ng”
and
“adultera3on
panel”
– Referrals
for
addic3on
specialists
and
psychological
counseling
services
• Many
providers
were
not
aware
of
these
addi3onal
resources
57
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

58. Lesson
Learned
Addi5onal
Challenges
of
Pain
Management
Clinics
• Members
are
sent
back
to
the
PCP
for
‘follow-­‐up’,
refills
on
controlled
substances,
and
long-­‐term
pain
management
• PCPs
expressed
a
low
comfort
level
with
managing
chronic
pain
pa3ents
but
felt
they
were
‘le•
with
no
choice’
58
©
2014
by
Principled
Strategies,
Inc.
All
rights
reserved.

59. Thank
you!
Ques3ons?

60. Contact
Us
Lawrence
Feinstein,
Ph.D.
Office:
(760)
230-­‐6326
Email:
lawrence.feinstein@safeusenow.com
Patrick
J.
Burns
Office:
(760)
230-­‐6323
Email:
patrick.burns@safeusenow.com
60

61. Contact
Us
Tron
Emptage,
R.Ph.,
Chief
Clinical
Officer
Tron.Emptage@progressive-­‐medical.com
Robert
Hall,
MD,
Medical
Director
Robert.Hall@progressive-­‐medical.com
61