Making health happen

One of the issues with chronic illnesses is that patients often don’t take their medications regularly and therefore the condition isn’t properly managed. As a way to promote better medication adherence—that, in turn, can lower healthcare costs, absenteeism rates and increase productivity—the Asthma Society has partnered with the Ontario Ministry of Health and Long-term Care and has engaged Oxford Outcomes, a consulting firm that specializes in health economics and health program evaluations, to design and implement a pilot project to improve medication adherence.

The project is essentially a reminder system. The pilot will have two research branches: one with primary healthcare practitioners and one with employers. Ideally, researchers will work with organizations to identify and enroll employees with moderate to severe asthma that could be better controlled. Those enrolled in the program will receive messages to take their medicine and to refill prescriptions by phone or text message. They will also have the option to speak directly to a pharmacist.

While this doesn’t seem like an overly inventive initiative, it is one that could have legs. The Ontario government is an active partner in the pilot and Robert Bick, senior manager, reimbursement and market access, with Oxford Outcomes and one of the leaders on the project, expects it to launch later this fall.

“Because this program is a joint pilot with the provincial government, there is a serious opportunity for sustainability,” says Bick. He adds that if it works with people who have asthma, it can be easily implemented for people with other chronic diseases.

Bick explains that employers in the project could see an increase in drug claims due to the fact that employees in the study will now be taking their medications regularly; however, the study will be measuring the impact on absenteeism, productivity and quality of life as well, and it’s likely that those factors will offset the drug costs. Also, other healthcare costs that are associated with not having an illness under control, such as increased doctor visits, time away from work, acute illnesses and medication, could also decrease.

One size doesn’t fit all
Medication adherence was just one of the issues that was brought to the podium at the conference. Gail Attara, executive director of the Canadian Society of Intestinal Research (CSIR), spoke on the need for open formularies and the potential negative impact of therapeutic substitution—a timely topic as organizations look to reduce expenses wherever they can.

Attara gave the example of when, in 2003, the British Columbia government implemented a therapeutic substitutions policy for proton pump inhibitors (PPI). The new policy did not include coverage for the three leading PPIs and, instead, substituted the least expensive brand. The government claimed that by implementing this policy it would save $42 million in healthcare.

“They didn’t do a pilot project or anything to see if [this change] was going to be a good thing,” she says, adding that the policy was made “based on the false assumption” that drugs in the same medical class all work the same.

One study conducted in 2006 by Schneeweiss et al. at Harvard Medical School concluded, “coverage restriction of the leading PPIs led to substantial utilization changes and savings, without increased noncompliance or clinical complication.” However, Attara argued that this study didn’t truly capture the outcome of the policy change and the CSIR conducted a study of its own.

The CSIR study included more data than the initial study and was published in April 2009. It concluded that there were additional net costs over three years of $43.5 million—$24.6 million in additional physician services, $9.75 million in additional hospital services and $9.11 million in increased PPI utilization.

“Remember they were going to save $42 million?” she asks. “It actually cost [more] because costs were deferred to other areas of healthcare.”

Although, for some people, switching from the medication that they were stabilized on to the less expensive brand made no real difference, it didn’t work for everyone. And, while employers are scanning their programs and policies for ways to find cost savings, Attara pleads plan sponsors to keep open formularies and look for other ways to cut costs.
“Strive for an open formulary so patients have access to the right medication quickly so their conditions can stabilize and stay under control,” she says. “It just makes sense. It is intuitively correct.”

Making it happen
One of the biggest issues around workplace wellness these days isn’t convincing people to use the programs, but in finding space in the budget to put the programs in place.

Mike Sullivan, a consultant with Cubic Health, says that the first step to implementing these plans is to get senior management on board. “If you cannot change the behaviour of senior management, then wellness programs won’t start, they won’t have consistent funding and there won’t be the goals achieved, in all cases, that we would like to see achieved,” he says.

And the best way to do this is to speak their language. “We need to speak in a financial context,” he says, adding, “It’s a lot easier to find money in an existing budget than to try to fight to create a budget to get this done.”
But as companies have spent the better part of the year looking for ways to cut costs, it’s reasonable to think that budgets are already stretched. Sullivan argues they aren’t. “In most plans there is 4-8% of opportunity—and that’s being conservative—to optimize what’s going on in the existing environment without making drastic plan design changes.”

So where do these secret dollars hide? “It shows up in inappropriate use of the plan by plan members, inappropriate use of the plan by providers or a lack of proper claims costs management. And it shows up in issues with current contract wording that hasn’t changed since the Olympics were held in Montreal,” he says, adding that most of this information can be gathered by looking at the drug claims data.

By analyzing drug claims, employers can see where the health problems among their populations lie, along with ways that the plan can be made more cost-efficient. Knowing what’s in the data also makes it possible to isolate plan-specific strategies for target areas.

So, while adhering to medication, having open formularies and educating employees are all important factors in managing illnesses in the workplace, Sullivan says it’s the claims data that can form the foundation of managing chronic illnesses in the workplace.

For a PDF version of this article, click here.

© Copyright 2009 Rogers Publishing Ltd. This article first appeared in the October 2009 edition of WORKING WELL magazine.