BioScrip Clinical Services and Disease Management Programs

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	Clinical Services and Disease Management Programs

Delivering the very best value for medication distribution.

Persistent double-digit annual increases in prescription drug costs have generated considerable interest in strategies to control growth in drug spending. Specialty pharmaceuticals are the fastest growing area of these pharmaceutical costs and while only a small percentage of patients are afflicted by a chronic condition, these people account for the largest percentage of outpatient drug spending.

Exacerbating the high drug cost dilemma is the fact that chronically ill patients aren’t taking the necessary steps to improve their health thus compounding costs through prolonged and unnecessary care. Of the 750 million prescriptions written each year in the United States and England, over 520 million result in partial or total nonadherence, resulting in excessive mortality, morbidity and medical costs.1 Specifically, nonadherence causes the loss of 125,000 lives and the loss of 20 million workdays, or $1.5 billion in salary per year. Additionally, in a 1998 study 3.5 million patients were admitted to hospitals at a cost of $15.2 billion annually because of nonadherence..2 Monetary waste associated with nonadherence is estimated to be as high as $300 billion a year.³

Nonadherence can be associated to numerous factors. Some of these factors include

regimen complexity, drug administration issues, dosage frequency, therapy longevity, lifestyle changes, side effect severity, drug interactions which may limit their adherence, fear and misuderstanding. These individuals need ongoing support from a health care team including a clinical pharmacist and nurse to help manage and improve their success of their medication regimen.

BioScrip’s Clinical Services and Disease Management Programs are an integrated array of services focus on providing optimal patient care by addressing patient nonadherence issuses while providing various strategies for cost containment. The level of clinical service or disease management program required to effectively manage your patients is determined by a risk assessment of the disease state, progression with medication failure or nonadherence, complexity of the medication regimen, and historical projections of nonadherence to medication therapy in addition to the economic impact of such a service on the management of the medication costs.

Through this tiered approach of clinical services, BioScrip is able to offer payors targeted clinical and disease management programs that provide the necessary level of support to help patients achieve the best healthcare outcomes and economic benefits for payors. For example, our full array of Basic Clinical Services is available for all patients and disease states. These services are then augmented for higher risk disease states (such as hepatitis C, organ transplant, multiple sclerosis, rheumatoid arthritis, psoriasis, osteoarthritis etc) with Disease Management Programs. These programs provide additional resources, counseling, and monitoring by nurses with the goals of maximizing effectiveness of therapy and in turn lowering the overall healthcare costs.


	Basic Clinical Services

The following services are available for all disease states.

Comprehensive Formulary Management

Formulary development and annual review
Prior authorization programs and criteria based upon evidence based medicine and consensus treatment guidelines
Medical necessity medications
Quantity limits – managed drug limitation
Generic substitution
Waste Limitation
Therapeutic substitution/intervention to preferred, less costly medications

Pharmaceutical Care and Prospective Drug Utilization Review

Concurrent/prospective review at the point where the clinical pharmacist insures that the regimen and dose are appropriate given disease state, age, organ function, weight, drug interactions, pregnancy, and allergies.
Issue screening - identification of unnecessary, duplicative, and potential drug therapy problems are identified and rectified and the goals of therapy and importance of adherence communicated to the patients and reinforced over time. Medical errors and potential therapeutic misadventures are lessened or adverted.
Patient Education - counseling about side effects, injection techniques, and adherence.
Clinical follow-up and monitoring and adjustment of regimen as appropriate
Retrospective Drug Utilization Review
- Programs that determine patterns of drug utilization and costs and compare to standards to provide payors a mechanism to improve quality of medical care received and to manage costs by reducing inappropriate utilization.
Adherence reminder calls to patients with targeted messages and intervention with Clinical Pharmacists as needed to help patients remain adherent.
Patient education
- Extensive print educational pieces that are sent out with medications or available through retail locations
- Extensive web education and resources
- Patient support groups for select disease states
Clinical Pharmacist Consultation
- 24/7 access for counseling about medication side effects, administration issues, interactions
Nurse Consultation
- Access to nursing staff for additional counseling about injection techniques if needed


	Disease management programs

In addition to our Basic Clinical Services delineated above, BioScrip offers Disease Management Programs to provide additional levels of support to people living with chronic illnesses. The need for these programs are based upon the complexity of the disease state and medications used to treat the disease, risk of nonadherence with medication and subsequent progression of disease, and historical data proving such disease management programs impact outcomes and economics. Research has shown that disease management programs can effectively improve adherence, patient knowledge, understanding and self care, and over time improve healthcare outcomes while decreasing other healthcare expenditures such as hospitalizations, emergency room visits, and doctor visits.

While the premise and backbone of the each of our disease programs are similar, there are differences between programs based upon the specific disease state in terms of intervention, monitoring of outcome parameters, and disease metrics or benchmarks. We have found this approach to Disease Management provides our patients the appropriate level of disease management and supports they need while not being cost prohibitive for payors.

Development of Programs

BioScrip’s Disease Management Programs are designed following the NCQA standards for Disease Management. Each program is developed in conjunction with a multi-disciplinary advisory board of healthcare professionals and people living with the chronic disease states to ensure the programs are clinically sound, of utmost benefit and convenience for our patients, and providing the outcomes payors need.

The clinical practice components of our programs and the outcome parameters we monitor and track over time are based upon the recommendations of nationally recognized clinical practice guidelines and consensus panels when applicable or evidence based medicine literature when guidelines are not available.

Our programs are current and innovative and are revised as clinically sound data, monitoring recommendations, or patient empowerment techniques are released.

Nursing Based Call Programs

BioScrip’s Disease Management Programs provide in-depth counseling sessions with nurses via phone. These calls follow a frequent call schedule and are structured to address treatment adherence, education, lifestyle modifications, nutrition, side effect management, assessment and monitoring of outcomes. Calls are set up on days and times that are convenient for the patient. Each patient has his/her own designated nurse who becomes familiar with their situation and needs. We pay particular attention to the “first call” which is a key building block to an ongoing relationship with the patient. We focus on building patient trust, confidence and making them feel comfortable working with his/her nurse, as part of their healthcare team, to manage their disease over the continuum. This approach has proven beneficial in circumventing potential problems by quickly addressing issues such as side effects, adverse reactions and by getting their healthcare team involved in a timely manner, it has also empowered patients to proactively contact us regarding health concerns, treatment questions or a need for additional support.

In addition to the regularly scheduled calls, our nurses and pharmacists are available for questions anytime.

Outcomes Assessment- Service to the Plan Sponsor

When designing a Disease Management Program we analyze pharmacy data, patient- reported clinical information, and health risk assessment data to identify high risk candidates who would benefit from our program. Outcomes are measured and tracked throughout the program including:

clinical parameters
laboratory indices
quality of life
medical claim data
other disease specific health assessment scores when applicable or available.

Our state-of –the-art analytic tools and information systems, combined with our reporting mechanisms, provide plan sponsors the outcome and economic data needed to validate an improvement in plan member care and management as well as improved economic outcomes for plan sponsors. .

Clinical Expertise on Staff

BioScrip’s clinical Pharmacists and nurses play a role pivotal role in delivering quality Disease Management. According to The National Council on Patient Information and Education, more than half of all Americans with chronic diseases don't follow their physician's medication and lifestyle guidance. This non-adherence can lead to disease progression, decreased quality of life, and increased healthcare utilization over time.

Our nurses are specially trained in each of the disease states in which we specialize. They are also trained to ask questions about medication use and analyze medication refill data to identify potential cases of nonadherence and offer coaching and tools to increase adherence.

Clinical pharmacists are also available to program members. With numerous drugs currently on the market and over 600 new drugs in development, the expertise of our clinical pharmacists is invaluable in addressing medication questions or concerns.

Our nurses and pharmacists are experts in helping people:

administer injections
manage side effects
take medications properly
avoid drug interactions
manage other aspects of their health such as nutrition and exercise

Patient Self Management and Empowerment

Our nurses and pharmacists value their role as part of our patients’ healthcare team. We strive to make patients as independent as possible. By educating patients we hope to empower patients to take an active role in managing their disease and health outcomes. We help patients:

Understand their disease
Understand the medication therapy including: proper administration, usage, compliance and side effects
Incorporate their treatment into their lifestyle
Manage issues related to their disease over time

BioScrip nurses coach and teach our patients how achieve maximum benefit from their treatment regime. We also provide

On-going feedback to the patient and prescriber on the progress toward achieving treatment goals.
Targeted print education materials
Recommendations on groups or web based resources that can provide additional support, based upon patient responses or concerns during their support call.

Patients who have participated in our Disease management programs have rated their satisfaction as “very satisfied” or “extremely satisfied” and feel our nurses and pharmacists are a vital resource and asset in helping to keep them on therapy and achieve a better quality of life.

Prescriber Service

Ensuring patient success is a collaborative effort with the physician. We work closely with the prescriber to ensure the treatment is being carried out according to his or her instructions. In addition we are able to advise physicians on issues arising from our DUR screening. When appropriate we may make recommendations to ensure therapy is consistent with evidence-based recommendations and treatment is appropriately monitored. We also provide valuable feedback to prescribers on the condition and progress of their patients managed by our programs through quarterly reports or phone calls.