“What if I told you at least one in four members of your benefits plan has an unresolved health risk?” asked Radpay, the president of HumanisRx, during Benefits Canada‘s 2021 Tech Insights: Spring Edition conference.
In a study in partnership with Munich Re, HumanisRx reviewed the insurer’s claims history experience for 85,000 plan members and patients over a three-year timeframe, as well as Munich Re’s actuarial analysis. Across pharmacy and private insurance claims data, HumanisRx found at least 25 per cent of plan members were living with a potential or existing health issue.
As well, mental health was the No. 1 condition contributing to risk in a benefits plan, followed by diabetes and cardiovascular disease. “It’s not surprising,” she said. “These are usually the top three offenders that are afflicting a benefits plan and within a population.”
Medications are a key part of managing many of the common disease states that plan sponsors see in their employee population, particularly at the outset when a plan member is first starting their treatment, said Radpay. “Someone really needs to be there to oversee them, to make sure they don’t stop their medication, which can lead to issues that are harder to manage down the road — such as time off work, short-term and, ultimately, unfortunately, long-term disability.”
HumanisRx responded to that growing challenge with its MedCheckUp program, which connects plan members with pharmacists who can provide in-depth medical consultations. Radpay described the program as an “in-depth check-out of a plan member’s medication to make sure they’re optimized, ensure they’re taking their medication and not experiencing adverse effects that can lead to further and more costly issues down the road.”
The program is available to plan members at work, as well as those who are currently on short- or long-term disability, to help them return to the job sooner.
The company currently provides the service to Canada Life plan sponsors and members. According to data from that population, medication changes are necessary in more than 80 per cent of the cases in which the service intervenes. “That is quite a striking number when you think about it.”
HumanisRx found optimizing plan members’ medications through the service could have “very significant, positive results,” said Radpay. For example, more than half of plan members with depression (57 per cent) and anxiety (56 per cent) said their condition improved, along with 65 per cent of those living with pain. Almost a quarter (23 per cent) of plan members with depression and 30 per cent of those with anxiety said they achieved remission with their condition, while 50 per cent of people with pain said their condition was now tolerable.
To provide medication management to more plan members more efficiently, HumanisRx created software called MedMonitor, which identifies plan members with health risks and intervenes proactively. Instead of focusing on the medication itself, Radpay said the software focuses on the plan member to determine whether the drug is working properly.
“Using software to do what software does best, which is using predefined parameters to scan and identify issues, we then get clinicians and experts involved to resolve the issues identified, decrease adverse effects or avert potential negative consequences and ultimately reduce cost to the benefits plan.”
Using a plan sponsor’s drug claims data, MedMonitor is able to identify adherence issues such as non-refilled medications; safety risks such as interactions between two different drugs a plan member is taking, duplicate therapies or patients taking their maximum dosages; gaps in care such as drugs that the patient should be taking according to clinical guidelines; possible cost savings such as therapeutic substitutions or reduction in dosing frequency; and disease screening for diabetes, drug abuse and misuse and mental illnesses. Internal users can decide, along with the plan member, whether a flagged drug therapy problem is true or false and if intervention is required.
Radpay cited two examples, one of a plan member who was filling multiple prescriptions at five different pharmacies in a six-week period — something that all provincial prescription monitoring systems should be able to catch, but may not — and another that flagged a plan member who was taking the maximum dosage of two opioids and filling 54 prescriptions at six pharmacies over a three-month period and may be at risk of experiencing opioid use disorder.
“Our software can easily identify these situations, but we also have the interventions to have those difficult conversations with the plan member,” she said. “Our interventions and outreach can certainly move the dial in the right direction.”
Read more articles from the 2021 Tech Insights: Spring Edition conference.