Case Study Emphasizes the Need for Whole-Patient Healthcare Approach

EmpiRx Health’s Population Health Management solution stratifies patients by clinical risk, providing visibility into other health conditions and critical underlying social, behavioral, and physical comorbidities to help our pharmacists influence precise prescribing strategies with physicians. In this study, we highlight an exceptional achievement of over $400,000 in clinical savings, while preventing serious adverse reactions for the patient!

EmpiRx Health’s Population Health Management solution takes a condition-neutral approach to healthcare. By looking at the “whole” patient, we optimize drug utilization to improve both clinical and financial outcomes. We stratify patients by clinical risk, providing visibility into other health conditions and critical underlying social, behavioral, and physical comorbidities to help our pharmacists influence precise prescribing strategies with physicians.

CASE OVERVIEW
In this case study, a 41-year-old female was prescribed Acthar 80 units subcutaneously twice weekly for the treatment of Rheumatoid Arthritis (RA) flare ups. Our Population Health engine identified this case as needing clinical review due to a high-cost specialty medication.

As part of our clinical appropriateness review, our Clinical Pharmacist requested chart notes from the physician. A review of the patient’s medical history identified potential drug-disease interactions. The patient has uncontrolled hypertension and severe depression. Achtar should not be used (contraindicated) in patients with uncontrolled hypertension and may aggravate depression. Our Pharmacist discussed these findings with the physician and recommended a steroid treatment during RA flare ups in place of Achtar. The physician agreed with the recommendation.

CLINICAL OUTCOME
EmpiRx Health’s Population Health Management model prevents serious adverse reactions with clinically appropriate patient care.

  • Original Prescription: Acthar 80 units subcutaneously twice weekly
  • Clinical Recommendation: Prednisone 40mg orally once daily
  • Clinical Savings: $413,287

FINANCIAL OVERVIEW
As our results demonstrate, appropriate clinical and specialty management drives clinically appropriate care at the lowest cost to the plan and members.

  • Specialty cost as a percent of total plan cost remained flat year-over-year despite a 3.3% increase in utilizers
  • Specialty plan cost per Rx decreased by 0.2% despite 3.4% uptick in specialty claims
  • EmpiRx Health drove over $4MM in deep sustainable savings for FY 2021

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