In Texas, BlueCross BlueShield is using its pharmacy claims data to help improve adherence to statin therapy among individuals who have suffered a major adverse cardiac event.
As part of the pilot program with a national employer, BlueCross BlueShield of Texas used medical records and pharmacy claims data to identify patients who were at highest risk for a major adverse cardiac event but who were not taking cholesterol-lowering medication. Starting in 2007, the health plan sent letters to physicians advising them that their high-risk patients should be on statin therapy and sent another letter to patients about the benefits of cholesterol-lowering drugs. “The idea was to alert physicians that their patients weren't filling their statin prescriptions,” said Tom Tran, Pharm.D., who is divisional vice president of pharmacy programs for the insurer.
Physicians typically prescribe the right medications, but they lack information on whether those prescriptions are filled. “They're sort of practicing in the dark,” Dr. Tran said.
Both national data and experience within BlueCross BlueShield of Texas show that even among people at high risk for another adverse cardiac event, only about half are taking the medication a year after a myocardial infarction (JAMA 2002;288:455–61). Patients just feel that they don't need the medication, Dr. Tran said.
Health plan pharmacy data gives the physician more information to use in a meaningful discussion with the patient, Dr. Tran said. For example, if a patient hasn't been taking his medication and his cholesterol is up, the physician may assume he is not responding to the medication and increase his dosage or switch him to a new therapy. If the patient then fills and starts using the new prescription, he may be exposed to increased and potentially unnecessary side effects, Dr. Tran said.
Through the pilot program, health plan officials did see an uptick in adherence to statins. For every 17 members who received some type of physician intervention, 1 additional individual initiated and continued statin therapy, compared with a control group. The interventions were aimed at patients at highest risk for a recurrence of a major adverse cardiac event among more than 44,000 insured employees. Dr. Tran estimates that if the program were to be expanded to all individuals insured by BlueCross BlueShield of Texas, more than 100,000 high-risk members would be on cholesterol-lowering medications.
In addition to improving medication adherence, the pilot project also sought to save money by putting patients on generic drugs. As a result, the pilot included a step therapy program in which patients were asked to try a generic statin first; those on a brand-name statin could stay on that drug.
Generic use saved the employer group 5 cents per member per month, or about $26,000 per year. The cost savings does not include “medical avoidance” cost savings resulting from fewer hospitalizations from heart attacks and strokes.
Given the success of the statin project, officials at BlueCross BlueShield of Texas are considering trying the same approach with other chronic conditions including diabetes, high blood pressure, and asthma, Dr. Tran said.
The pilot program was one of four Blue Cross and Blue Shield company programs recognized by the Blue Cross Blue Shield Association as innovative approaches to improving health and wellness. The other “BlueWorks” winners include programs that coordinate care for children with special health care needs, address racial and ethnic disparities in health care, and encourage children to adopt healthy lifestyles.
The BlueWorks program is juried by the Harvard Medical School's department of health care policy in consultation with physicians from the American Academy of Pediatrics, the American College of Physicians, and the American Cancer Society.