Inland Empire Health Plan in Rancho Cucamonga, California, is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire, a metropolitan area in Southern California.

THE PROBLEM

Comprehensive medication reviews, a significant utilizer of trained clinical pharmacist resources, were not focused on plan members most in need, and the review process was manual and time-consuming. Moreover, it was unclear if member outcomes were improving because of this program.

PROPOSAL

Preveon is a specialty pharmacy focused on chronic disease management. Inland Empire Health Plan has outsourced its medication review process to Preveon for its MyMeds Program, and as such, purchased Surveyor Health licenses and allocated them to Preveon. The Preveon team members serve as the end users of the platform from Surveyor Health, an AI-enabled healthcare technology company.

“The Surveyor Health platform, which includes the MedRiskMaps and StratMaps applications, was proposed to make comprehensive medication reviews faster, better, more efficient and with full tracking, management and learning support,” said Edward Jai, senior director, pharmaceutical services and chief pharmacist, at Inland Empire Health Plan.

“It was to achieve this by more precisely targeting members, based on medication risk rather than a simple count of meds taken by the patient,” he said.

Once members in need are identified, they would then be reviewed using MedRiskMaps to help the clinical pharmacist reviewer better and more quickly understand the treatment trade-offs faced by the patient with their current drug regimen, he explained.

The tool’s support for multidimensional analysis, information fusion, visualization, simulation, probabilistic AI prediction and automatic generation of clinical documentation were aimed at the problem, he added.

MARKETPLACE

There are various medication management information systems being sold by health IT vendors today. Some of these companies include Cureatr, DrFirst, Genoa Healthcare, LogicStream Health, Medication Management Systems, Mediware Information Systems, Netsmart and Swisslog.

MEETING THE CHALLENGE

The health plan identified a clinical pharmacy call center, Preveon Health, through an RFP process. The call center would provide the clinical pharmacists to use the Surveyor Health platform in concert with health plan staff in reviewing health plan members.

“Surveyor Health integrated the platform with health plan claims processing systems and databases, the pharmacy benefits managers’ fill history, and time series labs and vitals data to provide a reasonably complete picture of patients and their care,” Jai said.

"Surveyor Health integrated the platform with health plan claims processing systems and databases, the pharmacy benefits managers’ fill history, and time series labs and vitals data to provide a reasonably complete picture of patients and their care."

Edward Jai, PharmD, Inland Empire Health Plan

“Preveon also uses Salesforce for the patient relationship management system, so some review data, reports and artifacts generated by the Surveyor Health platform are redundantly persisted in Salesforce” he said.

Once the integration and workflows were tested and validated, user training was conducted, and management of specific data elements and attributes was finalized. Surveyor Health’s stratification of the health plan’s membership then populated an encounters pool in MedRiskMaps, identifying key members to review, said Dennis Ho, PharmD, founder and CEO of San Bernadino, California-based Preveon.

“Preveon clinical pharmacists then accessed these members in the StratMaps pool, launched reviews for them in MedRiskMaps and completed said reviews, more often than not making changes to each patient’s drug regimen,” he explained.

RESULTS

First, Inland Empire Health Plan and Preveon clinical pharmacists can, at last, access a meaningful picture of membership data that is actionable, Jai said. Review times have been cut in half, a substantial savings of clinical pharmacists’ time, not only without a loss of review quality and comprehensiveness, but with significant, measured improvements to both, he added.

"Preveon clinical pharmacists then accessed these members in the StratMaps pool, launched reviews for them in MedRiskMaps and completed said reviews, more often than not making changes to each patient’s drug regimen."

Dennis Ho, PharmD, Preveon

Other end results included:

• A 50 percent drop in drug-drug interactions;
• A 50 percent drop in duplications;
• Two meds discontinued per patient, on average.

ADVICE FOR OTHERS

“I would recommend that payers carefully evaluate the entire comprehensive medication review workflow – people, process and technology – and identify key outcomes and process metrics – measures of success – and then develop a target state where technology can be an enabler of improvement,” Jai advised.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com