PITTSBURGH — Highmark is reducing preventable adverse medication events, improving patient safety and reducing costs for patients who have diabetes through an innovative process that identifies opportunities to discontinue clinically ineffective prescriptions and flags dangerous medication combinations.
Highmark’s population health pharmacy team will showcase how it combines medical and pharmacy data and partners with primary care physicians to improve diabetes medication management during the Academy of Managed Care Pharmacy (AMCP) Nexus 2020 Virtual Conference on Monday, October 19 from 1:00-2:30 pm EST. The AMCP Conference is a premier national event for pharmacists, providers, biopharmaceutical and life science industry professionals, and digital health innovators to learn about innovations in managed care pharmacy.
“Our new approach is based on strong collaboration with our primary care partners,” says
Kelsey Moss, PharmD, a population health pharmacist for Highmark Health who will present at the AMCP Conference. “Highmark’s population health pharmacists work with primary care physicians, pharmacists and other population health leaders to ensure patients are receiving high-value care. We provide actionable reporting and insights to practices to identify opportunities to change prescriptions, and explain the clinical rationale and potential cost savings associated with those changes. We also support practices with additional education, toolkits and guidance to act on the data. Together, we try to ensure that patients are on the right medications, at the right time, at an affordable cost.”
Highmark’s population health pharmacy and healthcare analytics teams have established an innovative process to improve diabetes medication management for primary care practices that participate in Highmark’s True Performance, one of the largest value-based reimbursement programs in the U.S. More than 2,000 primary care practices covering nearly 2 million Highmark members participate in True Performance, which was has produced more than $1 billion in cost savings since its launch in 2017.
There are major opportunities to lower costs and improve patient health outcomes through improved medication management. For example, Highmark’s new process identified a de-prescribing opportunity for a patient who was prescribed multiple diabetes medications. The patient was taking both Trulicity (GLP-1 RA) and Januvia (DPP-4 inhibitor), which is considered to be an ineffective and duplicative combination. Highmark recommended that the primary care physician discontinue the patient’s prescription for Januvia. The change lowered the patient’s yearly co-pay by $520, and reduced the patient’s yearly total drug spending cost attributed to the provider by more than $4,600.
“As we learn best practices, we will be expanding this new medication management process to more of our provider partners and potentially identifying these opportunities on a larger scale in the future,” Moss says.
Adverse drug events cost the U.S. health system an estimated $30 billion annually, according to research published in the Journal of Pharmacology and Pharmacotherapeutics. Up to 60 percent of older adults are exposed to inappropriate medication use, according to a study published in the Research in Social and Administrative Pharmacy journal.
“We discovered that de-prescribing reporting that includes actionable patient opportunities, the clinical rationale for stopping the prescription and best practices produces the best outcomes for the provider and the patient,” Moss says. “Primary care practices that have more clinical resources, including pharmacists, are best positioned to take advantage of these medication management opportunities.”
For more information on the AMCP Nexus 2020 Virtual Conference, please visit: https://2020.amcpnexus.org/
About Highmark Inc.
One of America's leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Highmark Inc. (the Health Plan) and its affiliated health plans (collectively, the Health Plans) work passionately to deliver high-quality, accessible, understandable, and affordable experiences, outcomes, and solutions to customers. As the fourth-largest overall Blue Cross Blue Shield-affiliated organization, Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of more than 5.6 million members in Pennsylvania, Delaware, and West Virginia. Its diversified businesses serve group customer and individual needs across the United States through dental insurance and other related businesses. For more information, visit www.highmark.com.