Highmark's population health pharmacy and its health analytics experts are teaming up to improve medication management for diabetes patients.
The new initiative focuses on members with diabetes who are enrolled in the insurers' True Performance value-based care program, which includes 2,000 practices and more than 2 million Highmark members.
Once the analytics teams flag potential medications that can be adjusted or discontinued, Highmark deploys its pharmacists to work directly with primary care doctors to disseminate the latest clinical guidance on those diabetes medications. The goal, officials said, is to avoid adverse drug events and boost adherence.
There can be significant cost savings for both the provider and the patient in reexamining medication regimens, Highmark said. For diabetes, the use of more expensive brand-name products is common.
In one case, for example, Highmark identified a member who was taking two brand-name diabetes drugs, Trulicity and Januvia, in a combination that is duplicative and ineffective. Pharmacists recommended discontinuing Januvia, which saved the member $520 in yearly copays and the provider $4,600 in attributed drug costs.
Kelsey Moss, a population health pharmacist for Highmark Health, told Fierce Healthcare that many primary care providers may lack the resources—and direct access to pharmacists—to conduct such reviews themselves.
She said that so far, providers accepted the advice in 70% of cases and discontinued the medications as suggested.
"I think the reason we are getting such large acceptance rates by the providers is because we do have pharmacists taking out these opportunities to practices that historically may or may not have had pharmacy resources available to them," Moss said.
The savings opportunities for improving medication management are substantial, Highmark said. Adverse medication events cost the U.S. healthcare system an estimated $30 billion each year, and up to 60% of older adult patients are potentially taking inappropriate medications.
As such, Highmark may take its data-driven program beyond diabetes in the future, Moss said. For instance, proton pump inhibitors for acid reflux could be a next set of medications to look at, she said.
"I do really think there’s a large opportunity for deprescribing within the pharmacy space," Moss said.