Case Study Underscores Clinically Appropriate Patient Care Within Labor-Specific Populations

60% of our membership is Labor. We recognize Labor has a higher clinical risk and needs greater service-related handholding, and we align our services and care approach accordingly. In this success story, you’ll see our Population Health Management solution in action – ultimately leading to improved patient conditions and $1.9M in clinical savings for the client.

EmpiRx Health’s highest priority is to produce the best health outcomes for our members. As a trusted partner among many in labor, we intrinsically understand the priority placed on healthcare value. Our Labor partners expect high-quality service and clinical care backed by guaranteed cost savings. Their expectations are core to who we are and what we value as a company.

We recognize this membership has an innately higher clinical risk and needs greater service-related handholding. EmpiRx Health’s Population Health Management solution stratifies patients by clinical risk and identifies opportunities to determine medical justification for high-cost medications. Our Clinical Pharmacists engage physicians to discuss the patient’s whole health condition to determine clinically appropriate therapy. As this study will show, adherence to a prescribed regimen is key to better health outcomes and can greatly reduce client and member overall health care costs.

CASE OVERVIEW
A 39-year-old female diagnosed with Hidradenitis Suppurativa (painful skin lesions) was prescribed a weekly dose of Humira 40mg/0.4mL injections. Our population health engine identified this case for review due to new high-cost specialty therapy.

Our clinical protocols align with evidence-based medicine, including use of first-line therapy before a more aggressive or costly treatment. A review of prescription history found that the patient was already utilizing Doxycycline for this condition but had shown little improvement. For this patient’s condition, clinical guidelines recommend a minimum 3-month treatment duration of the medication prior to assessing the response. Our Clinical Pharmacist determined the patient had not completed a full course of therapy. Working with the prescriber, the Pharmacist recommended keeping the patient on Doxycycline 100mg capsules until the full course of treatment is completed at which time the patient’s condition could be reassessed.

CLINICAL OUTCOME
In this case, the patient’s condition improved with the clinical recommendation to continue an oral antibiotic treatment versus a high-cost specialty injectable!

  • Original Prescription: Humira 40mg/0.4ml Injection, 1 syringe subcutaneously weekly
  • New Clinical Recommendation: Doxycycline 100mg Capsules, 1 capsule by mouth daily
  • Clinical Savings: $95,666

FINANCIAL OUTCOME
EmpiRx Health’s Population Health Management solution drives value and positive outcomes. In this success story, we drove multi-year financial sustainability, resulting in $1.9M of deep clinical savings.

  • 30.1% decrease in PMPM trend from 2020 to 2021
  • 21% decrease in Cost per Rx from 2020 to 2021
  • As a result of implementing a specialty cost containment solution in July of 2020, the specialty percent of spend has decreased from 45% to 10%

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