In 2013, the U.S. healthcare system spent more than $300 billion addressing the consequences of patients failing to take drugs they were prescribed, according to research from pharmacy benefit manager Express Scripts.
That’s a massive number — and a big issue that the St. Louis-based company is tackling at its Express Scripts Lab. The lab, which opened in 2010, roughly tripled in headcount last year and now houses more than 100 employees. One area of focus: working with data to better predict which patients will need extra nudges to stick to a medication regime.
“The mission of the lab is very much aligned with the mission of our company, Express Scripts, and that is to make drugs safer and more affordable for our plans and our members,” says Mark Bini, the company’s vice president of new solutions. “We have a research and advanced analytics team that takes mounds and mounds of data, mines that data, and develops meaningful insights from that data.”
Using Data to Head off Problems
Since Express Scripts manages drug benefits for about 85 million Americans, it has enough data to identify more than 400 factors that can help predict how well patients will stick to their prescription regimes. Those factors range from demographic categories like age, gender, and ZIP code, to facts like how regularly they and others on the same insurance plan have filled their prescriptions in the past.
The company’s statistical program, called ScreenRx, can accurately predict up to a year in advance which patients won’t stick to their schedules, including those who are taking drugs for chronic conditions like diabetes or congestive heart failure.
“We almost look at non-adherence as if it’s a medical condition,” says Bini.
And as with most medical conditions, an ounce of prevention can be worth a pound of cure, so the program, first publicly launched in 2012, also aims to find the right ways to preemptively keep each of those at-risk patients on track and out of the hospital.
“What we’ve done over the past several years is really honed our intervention strategy to make sure that we’re offering the right solution to the member, based on the root cause of non-adherence,” says Bini.
If patients are simply having trouble remembering to take a daily pill or finding the time to pick up a monthly refill — some of the most common issues — the company can help them shift to a mail-order pharmacy or provide them with simple timers that chime when it’s time for a dose, Bini says. If the issue’s cost, the company can suggest cheaper pharmacies or generic alternatives, and if patients experience unpleasant side effects, the company can put them in touch with one of their specialized pharmacists, he says.
“If it’s someone who’s having adverse side effects, we’re going to put them in touch with a pharmacist who treats that condition every day and can help them through those side effects and also help them understand why they’re on that medication,” he says.
Backing New Programs With Financial Guarantees
The program has worked well enough that Express Scripts has been able to financially guarantee health plans that their patients who fill prescriptions through its specialized pharmacy program will stick to costly hepatitis C treatments, which can cost up to $100,000 per patient and often need to be restarted if patients cease taking the drug.
In general, Express Scripts looks to have its lab programs go beyond mere data collection and analysis to actually create and test pilot programs aimed at delivering concrete benefits to patients, says Bini.
“We don’t believe that big data’s enough,” he says. “That data has to be actionable on behalf of our clients and our members and also our other constituents.”
New Kinds of Collaboration
That’s why the lab houses not only statisticians and insurance benefit specialists but also pharmacists and nurses who directly interact with patients. The company encourages patients with complex and chronic diseases to consult by phone with pharmacists specifically trained on their conditions. And working alongside those health professionals are behavioral scientists who can rapidly roll out and quickly quantify the successes of new programs of various complexity.
“If we’re trying to just reframe the way that we speak to patients on the phone, we can quickly go up to our therapeutic resource center in the lab and do what we call a snap trial,” says Bini.
A quick test like that would likely involve behavioral scientists sitting alongside pharmacists speaking to patients on the phone—something that’s easy to arrange, since specialists in different disciplines all work in the same building. Results of lab experiments are then quickly disseminated through the organization and put into practice, says Bini.
Communicating Inside the Company — and Out
“We have monthly updates that we provide to not just the senior level folks at our company but all folks at our company,” he says.
Bini, who reports to the company’s senior vice president of clinical, research and new solutions, gives monthly webinars and sends e-mailed updates throughout the company.
The lab also makes many of its results available to the public, through a mix of peer-reviewed journal articles, white papers and other publications, including its widely-cited annual Express Scripts Drug Trend Report, which monitors changes in U.S. pharmaceutical spending and prescribing. And employees throughout Express Scripts, as well as representatives from the insurers it works with, are invited to visit the lab and see what researchers are working on.
The company also works with insurers to develop and conduct its larger trials and projects—something that’s made easier by the fact that plans generally sign long-term contracts with Express Scripts, and will reap the benefits of cost and health improvements for years, says Bini.
“Most of the things that we’ve developed have required progressive clients that are able and willing to try new things with us,” he says.
One on-going project looks to find reliable statistical ways to identify patients who are at risk for opioid painkiller addiction, well before they’re having issues with the drugs. Addictions stemming from legitimate painkiller prescriptions are tremendously costly in both health and financial terms, and many patients aren’t aware of the dangers and warning signs, Bini says.
The company is also working on smarter technology to measure blood sugar in diabetes patients, recording levels over time using a smartphone app that connects to a Bluetooth-enabled glucose meter. If there’s a dangerous reading, the system can even warn the patient or a caregiver in real-time.
“This app that is on the patient’s phone is cloud-based, and it sends the information in a secure fashion…from the meter to the phone to Express Scripts,” says Bini. “They’ll also be able to monitor their carbs and their exercise and their medication as well.”
The lab is planning to expand its IT capacity in the next few months, he says, bringing on about fifty specialists like Web and mobile app developers and designers. It’s also starting to conduct focus group-style usability tests with consumers in the lab, seeking to improve Express Scripts’ digital interactions with patients.
“We’re going to be really kind of investing more in this space, because we really believe in this model,” says Bini. When it comes to communication and getting different constituencies at Express Scripts to work together in new ways, he says, “We’ve broken down silos.”