Health Connect 360: The Fix for Fragmented Care

We all want better, simpler health care – at the lowest cost, with the best possible clinical outcomes. This includes lower hospitalizations and unnecessary emergency room visits due to unmanaged conditions.

So, what’s preventing us from achieving these goals?

Unfortunately, it can be the health care system itself. The same system that provides some of the best care in the world is also a system that is fragmented and complicated. That fragmentation is costing a lot of money - $765 billion in annual waste due to unnecessary and inefficiently delivered services, as well as preventable conditions, and lack of care coordination.

We see it every day: a patient’s multiple health care providers aren’t connected; pharmacy interactions aren’t connected back to the provider in real time; data from various health tracking devices a patient may be using aren’t visible to those who need it most – the health care providers.

Let’s take a look at just a few of the ways this disconnect in care shows up in our world:

• Diabetes prevalence continues to rise despite a constant stream of disease management advances
• Over 36% of patients living with diabetes are non-adherent to their medications
• 735,000 Americans are having heart attacks annually

Furthermore, statistics suggest what’s around the corner over the next decade is going to present even more challenges for us:

• 10,000 people A DAY age into Medicare and the average number of prescriptions that retiree takes is 54 per year
• 1/3 of the U.S. population will have 3 or more chronic conditions

At Express Scripts, we’re daring to take on these challenges and create a better clinical management approach. We want to stop gaps-in-care, keep people on a healthier path, and help them have a great health experience. Too much to ask? We think it’s the one goal in health care that matters most.

Earlier this year, Express Scripts introduced Health Connect 360, an industry-first, outcomes-based model of care that guarantees clinical targets and connects patients’ touch points across the care continuum.

We’re addressing our clients’ areas of biggest concern – highest spending and missed opportunities. Those missed opportunities are actions that could potentially prevent a member from an unnecessary trip to the ER, or worse.

We’re offering clinical outcome guarantees for several key chronic conditions, spanning across medical and pharmacy, within our clients’ population segments.

How do we do it?

Our clients determine the measures of improved health that is right for their plan and we select and implement the right clinical management approach for each individual.

Real Results for Real People

With Health Connect 360, we’re also introducing new clinical care team members, our population health managers, trained clinicians using Health Connect 360’s proprietary Care Insights Hub at the patient- and population- level.

Let me tell you about Brooke, our population health manager for a current client who deployed this outcomes based model with us this year. Through our new care insights platform, Brooke identified a 45-year-old member who was not taking her blood pressure and cholesterol medications. She also was able to see the patient’s last HbA1c lab values showed hemoglobin over 11%, that resulted in a medical diagnosis of diabetes, yet no diabetes medication was on file for this patient.

As part of a holistic, total person health approach, Brooke was able to access all of our clinical capabilities and referred this member’s health care provider to the academic detailer who contacted the physician to discuss diagnosis and missing medications on file. Shortly following the outreach, we saw in our claims data that the doctor started the member on insulin. The member also was referred to a pharmacist at our Therapeutic Resource Center^® for consultation on her nonadherence to current blood pressure and cholesterol medications.

After speaking with the pharmacist, the member felt comfortable using her insulin injection and understood the importance of staying adherent to her medications. She also committed to using a pill box to help remind her to take her medication as prescribed.

This member now has a greater chance to manage her diabetes, control her blood pressure and have a healthy heart. Most importantly, she’s able to live a longer, healthier life. This represents over 40% savings in health care costs compared to a patient who didn’t have these interventions.

This member is just one example of many. Behind each and every chronic condition is the need for real total medical and pharmacy savings. But, most important, behind these conditions are real people with real stories and aspirations in life. If we help them manage their total health better NOW, they can realize their full potential, personal accomplishments and dreams.

Personalizing health care, driving towards real clinical outcomes, and building the infrastructure to put it all together is hard, but we’re doing it.