Consumerism in HealthCare
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1 Consumerism in HealthCare The Role of Pharmacy Michael Rea, PharmD Founder/CEO
2 Confusion $95.99 Atorvastatin, 20mg #90 Zip code: $29.67 $ $ $22.24
3 2015 Cost of Care. Trillion Dollars $36,000 Out-of-pocket cost for a family of four Source: CMS
4 What do you get for $3.2 Trillion $211B $358B $373B $390B $738B $252B $276B And still have $600B! Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group; Yahoo Finance All logos are registered trademarks of their respective companies and included only for demonstration and do not imply endorsement of Rx Savings Solutions
5 Unmet Market Need Health Spending Year-Over-Year Growth Source: Alatrum monthly national health spending estimates
6 Unmet Market Need Rx Spending (In Billions) Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. 1 Total expenditures equals the sum of out of pocket, health insurance, and other third party payers
7 Source: The Advisory Board Company Cost and Quality
8 All logos are registered trademarks of their respective companies and included only for demonstration and do not imply endorsement of Rx Savings Solutions Cost and Quality
9 Cost and Quality Until now we could only control costs using the following macroview measures. 1) Pricing- AWP and MAC 2) Generic Substitution/Utilization 3) Rebates 4) Mail Service 5) Cost-Sharing copays coinsurance
10 Consumer Awareness Shopping for a Flight Shopping for Healthcare? All logos are registered trademarks of their respective companies and included only for demonstration and do not imply endorsement of Rx Savings Solutions
11 NHE Distribution 2012 NHE Distribution: $2.8T Source: Kaiser Family Foundation calculations using NHE data from CMS, Office of the Actuary, National Health Statistics Group
12 Current Solutions
13 Facts CMS projects an 86% increase in their annual pharmacy spend by 2020 CDC Reports: Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group; Center for Disease Control
14 How it Works Data Input Engagement SMS Alert Alert PRESCRIPTION USE Our system receives pharmacy claims information and begins to proactively analyze the data. CALCULATED SAVINGS Our patented software analyzes all of the possible clinical and financial therapies to save employees and employers money. EMPLOYEE ALERTS We proactively notify employees of savings via text or . Personalized reports are received within one business day.
15 Solving the Problem Our patented software is the only system on the market that looks for thousands of clinical recommendations, analyzes the best financial therapy for all parties, and directly notifies members on savings opportunities. Clinical Savings All recommendations derived from clinical guidelines and pharmacist research Techniques employed by pharmacists Therapeutic Alternatives Drug Segregation Generic Clones & Substitutions Tablet Splitting Dosage form interchanges Financial Savings Market Competition Manufacturer Copay Assistance
16 Solving the Problem How we re helping solve the problem and encourage consumerism 1. Raise Awareness 2. Make Consumers Care 3. Relevant Tools 4. Personalize Information 5. Engagement
17 Reporting and Engagement Sample SMS Report Ready to View Executive Summary Report
18 Employee Savings Avodart Atorvastatin Aciphex Cymbalta Escitalopram Pantoprozole Zolpidem Tartrate Cost to Employee $35 for 30 $30 for 90 $50 $10 for 30 $10 for 30 $10 for 30 $25 for 90 Annual Savings for Employee $ $53.40 $ $ $69.36 $44.72 $66.28
19 Payer Savings Avodart Atorvastatin Aciphex Cymbalta Escitalopram Pantoprozole Zolpidem Tartrate Cost to Company $ $ $ $ $26.93 $16.74 $ Annual Savings Per Claim $1, $ $3, $2, $ $ $ TOTAL $8,499.32
20 Population Health Management SMS Alert Alert Hypertension Needs to update. Claims Data Engagement SMS Alert Diabetic Not on proper regimen SMS Alert Antibiotic Needs periodic reminders
21 Population Health Management Specialty Opportunity with Core Solution
22 Results Rx Consumerism Leading the Way Measurable ROI Opportunity to Change Behavior Consumer Savings Healthier Consumers
23 How We Do It Push cost savings initiatives through channel management Reach People where they live Harness the power of data -Deliver pertinent information -Personalize information -Provide it in real-time Communication in preferred medium
24 Healthcare Consumerism The Future 2015 Changing behavior on Rx Changing behavior throughout HC
25 Our Clients
26 Learn More Download the whitepaper to see how the State of Kansas found a way to save $5 million annually and uncover an additional $13 million in savings for its State Employee Health Plan.
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