Track 2: Cost Optimization Strategies for Factor Replacement Therapy This activity is supported by independent educational grants Jointly provided by from Novo Nordisk, Inc., Baxalta, part of Shire, Biogen, and Grifols.
Agenda Hemophilia Treatment Centers: Michael Tarantino, MD A Cost-Effective Comprehensive Care Model Professor of Pediatrics Division of Pediatric Hematology/Oncology University of Illinois College of Medicine Medical Director Bleeding & Clotting Disorders Institute Recommendations to Maximize Cost Outcomes Joan Couden, BSN, RN National Director, Bleeding Disorder Program Option Care Measuring Success: Tools and Resources to Vanita Pindolia, PharmD, BCPS Document Care and Cost Outcomes of Payer Vice President, Ambulatory Clinical Pharmacy and Specialty Pharmacy Hemophilia Programs Management Henry Ford Health System/Health Alliance Plan of Michigan Case Study Presentations/Faculty Idea Exchange Faculty Panel Audience Question and Answer Session All Key Takeaways and Closing Comments Faculty Panel 2
Learning Objectives • Describe current and evolving strategies used by managed care organizations (MCOs) and specialty pharmacy providers to facilitate high quality care for members with hemophilia • Cite the most recent clinical recommendations for the treatment of patients with hemophilia, including prophylactic factor replacement and the role of emerging agents • Explain hemophilia-related complications associated with inhibitor development and its significant clinical and economic consequences • Identify processes for MCOs and specialty pharmacy providers to improve communications with HTCs • Apply methods to enable optimal cost management of factor replacement therapy to be realized by multiple hemophilia stakeholders including MCOs and specialty pharmacy providers 3
Track 2: Cost Optimization Strategies for Factor Replacement Therapy This activity is supported by independent educational grants Jointly provided by from Novo Nordisk, Inc., Baxalta, part of Shire, Biogen, and Grifols.
Hemophilia Treatment Centers: A Cost-Effective Comprehensive Care Model Michael Tarantino, MD Professor of Pediatrics Division of Hematology/Oncology University of Illinois College of Medicine Medical Director Bleeding & Clotting Disorders Institute 5
Hemophilia Patients Require Health Care Across their Entire Lifespan Age Distribution of the US Hemophilia Population 1 60 Percent of US Hemophilia Population • Age of diagnosis is <2 years of age 2 48% • Life expectancy exceeds 70 years 2 40 36% • Older patients tend to have comorbidities (eg, CVD, HCV, and HIV) 2 • ~60% of hemophilia patients are 20 insured under commercial plans (ie, 13% both fully and self-insured plans) 3 3% 0 2 to 19 20 to 44 45 to 64 65+ 1. Centers for Disease Control and Prevention. Report on the Universal Data Collection Program, 2005-2009, January 2014:1-26. 2. Centers for Disease Control and Prevention. Hemophilia. http://www.cdc.gov/ncbddd/hemophilia/data.html. Accessed March 12, 2015. 6 3. Express Scripts. 2014 Drug Trend Report. http://lab.express-scripts.com/drug-trend-report. Accessed March 12, 2015.
Goals of Care for Patients Health care providers are to: • provide the best possible care available to the patient with hemophilia • educate the patient with hemophilia • enable the patient with hemophilia to live as normal and productive a life as possible Patients with hemophilia have extraordinary health care needs 7
Comprehensive Care Comprehensive care constitutes a multidisciplinary team of health care providers (hematologists, nurses, physical therapists, social workers, dental professionals, and more) working in collaboration with the patient and family to minimize the effects of hemophilia using prevention strategies and enlisting community support , while maximizing quality of life . 8
C omprehensive Care…. • …addresses the whole person/family • …is collaborative • …is coordinated • …is based on education • …instills advocacy • …encourages adherence • …improves health -related quality of life (HRQoL) 9
Comprehensive Care Represents a Multidisciplinary Approach Centered on the Patient Hematologist Physical Orthopedists Therapists Patient Laboratory Nurses Technicians Psychosocial Dentists Workers 10
Historical Perspective of Comprehensive Care • Based on integrative public health approach 1 • Successful public health program 2-4 • Improved health outcomes for patients • Reduced health care resource utilization • Effected change in the delivery of care for patients 5,6 1. Ludlam CA. Textbook of Haemophilia Malden. MA, USA: Blackwell,2005:350-365. 2. Manco-Johnson MJ, et al. Semin Thromb Hemost . 2003;29:585-594. 3. Soucie JM, et al. Blood . 2004;103:2467-2473. 4. Steen Carlsson K, et al. Hemophilia . 2003;9:555-566. 5. Hoots WK. Current Hematology Reports . 2003;2:395-401. 11 6. Evatt BL. Haemophilia . 2006;12:13-21.
What is an HTC? An HTC is a federally recognized comprehensive hemophilia treatment center that has a multidisciplinary team with expertise in the care of patients with bleeding disorders and whose staff spend a majority of their time caring for these patients. 12 Soucie JM, et al. Blood. 2000;96(2):437-42.
Family-Centered Care and HTCs • HTC multidisciplinary teams work within a framework of family-centered care • Pivotal role of family is recognized and respected • Families are supported in traditional roles of decision- making and care-giving • Families’ individual styles and strengths are valued and efforts made to minimize lifestyle disruptions • Approach requires ongoing coordination of care and communication with community based medical and social service providers and agencies 13 Slide courtesy of Partners in Bleeding Disorders Education Program www.partnersprn.org
Improving Hemophilia Outcomes Through Comprehensive Care • Comprehensive care is defined as the continuous supervision of all medical and psychological aspects affecting the patient and family • Optimal treatment is based on: • Early detection and diagnosis • Prevention and treatment of bleeding episodes and any complications, particularly hemophilic arthropathy • Detection and management of inhibitors • Psychosocial and educational support • Monitor for treatment-related comorbidities • Coordination of care with other providers involved in management of the patient 14 Ruiz-Saez A. Hematology. 2012;17(supp1):S141-143.
Historical Perspective of HTCs • First HTCs originated in the UK during the 1940s 1 • Other countries soon followed – France, US, Australia, Sweden, Japan, Italy, Israel • Have become mainstay for treatment of patients with hemophilia 2 • Developing countries with HTCs report improved survival 3 • Recommended as the model of care by World Federation of Hemophilia (WFH), World Health Organization (WHO) 4 1. Biggs R. J R Coll Physicians Lond . 1969; 3: 151-160. 2. Hoots WK. Current Hematology Reports . 2003; 2: 395-401. 3. Chuansumrit A, et al. Haemophili a. 2004; 10: 542-549. 15 4. WFH Fact Sheet. http://www1.wfh.org/publication/files/pdf-1393.pdf.
HTCs Serve a Patient Population with Severe Bleeding Disorders and Complex Comorbidities Characteristics HTC (%) Non-HTC (%) P Severity Mild 21.8 52.8 <.001 Moderate 24.2 26.7 Severe 54.0 20.5 Inhibitors 6.0 2.3 <.001 Liver disease 2.3 0.7 .002 HIV infection 31.1 17.1 <.001 AIDS 8.2 5.9 .02 16 Soucie JM, et al. Blood . 2000; 96(2): 437-442.
Benefits of Comprehensive Care: Initial Findings Background/Methods Results • 2,112 patients seen in 11 HTCs • Federal funding established increased to 4,742 at end of study 1975 (PL 9463) • 514 patients on self-infusion increased • 11/22 comprehensive HTCs to 2,001 reported • 36.0% of patients unemployed prior to • Standardized data collection HTC care decreased to 12.8% four form used years later • Days lost from work or school decreased from 14.5/y (9.4 inpatient) to 4.3/y (1.8 inpatient) • Hospital admissions decreased from 1.9/y to 0.26/y • Insurance coverage increased from 74% to 93% • Annual per patient cost of care decreased from $15,800 to $5,932 17 Smith PS and Levine PH. Am J Public Health . 1984; 74: 616-617.
Benefits of Care Delivered Through an HTC: Mortality and Hospitalization For Patients Receiving Care via an HTC: Mortality Rate Decreases by 40% and Hospitalization Rate Decreases by 40% Relative Mortality 1 Relative Number of Hospitalizations 2 2 2 1.5 1.5 Relative Risk Relative Risk 1.0 1.0 1 1 0.6 0.6 0.5 0.5 0 0 HTC Other Source of HTC Other Source of Care Care HTC=hemophilia treatment center. 1. Soucie JM, et al. Blood . 2000; 96:437-442. 18 2. Soucie JM, et al. Haemophilia . 2001; 7:198-206.
HTCs Across the Nation are Organized into a Regional Network Northern Mountain States New England States Great Lakes 16 HTCs 22 HTCs 11 HTCs 21 HTCs 3747 (12%) 4513 (14%) 2600 (8%) 5557 (17%) Great Lakes University of University of Hemophilia of Hemophilia Massachusetts Colorado - Michigan Denver Western Mid- 14 HTCs 4072 (13%) Atlantic Children’s 17 HTCs Hospital - 3507 (11%) Orange City Children’s Hospital of Philadelphia Southeast Great Plains 24 HTCs 15 HTCs 4503 (14%) 3518 (11%) University of University of North Texas Gulf States Carolina - Hemophilia & Chapel Hill Thrombophilia Center (GSHTC) 19
Recommend
More recommend
