By Laura Hungiville
Think of the last time you visited the doctor when you were sick. Odds are, she examined you – gave her diagnosis – and wrote a prescription to help you get better. Most likely, you immediately headed to the pharmacy to have it filled. You then took your medication exactly as prescribed. For the first few days, you followed the prescription to a tee – but as you felt better, you may have started missing a few doses.
Well, imagine if you had an existing condition like diabetes, high cholesterol or hypertension that required you to take regular medications, only the symptoms weren’t obvious. You might be getting better or worse and have no idea. Unfortunately, almost 7-out-of-10 Americans with these conditions think they’re taking their medications correctly – but are not. Many assume they don’t need to take them as prescribed because they can’t physically feel their condition.
So how can a doctor ensure patients with chronic conditions actually ‘take’ their medications correctly? Surely, making hundreds of house calls isn’t the answer! Fortunately, WellCare partnered with RxAnte to offer RxEffect, an online tool that analyzes patient pharmacy claims to help doctors with this very issue.
Simply put, RxEffect allows doctors online access to a real-time list of patients and their medications. The tool realizes that not all patients are the same. Some will always take their medications, some will take them off-and-on, and others will simply forget. RxEffect uses a feature called ‘predictive analytics’ to help doctors pinpoint patients who are likely to need the most help. This allows them to keep better track of their patient prescriptions and intervene before problems arise. RxEffect even alerts doctors to increase prescription lengths from 30 to 90 days to help patients with the hassle of monthly refills.
Not only is RxEffect essential for patients, but doctors also benefit through improved communication, higher satisfaction scores (CAHPS), and a recently introduced bonus that offers them $50 per patient in three therapy areas: diabetes, high cholesterol and hypertension, for a maximum of $150.
To say RxEffect has been helpful would be an understatement. In 2015, doctors who used the tool increased the likelihood that patients would take their medications as directed. It is our most effective intervention and we have seen improvement of up to 8 percent in our highly engaged practices! This figure is impressive, as similar nationwide programs typically show less than a 2 percent increase in a given year.
WellCare always works to make sure our provider network has access to tools, like RxEffect, that make it easier for people to get and stay healthy. It’s our responsibility to help doctors better educate our members on why, when and how to take their medications without fail – their health depends upon it!
Dr. Laura Hungiville serves as WellCare’s chief Pharmacy Officer. She leads the pharmacy team and is responsible for our PDP business. This includes the pharmacy spend, oversight of the PBM, pharmacy network, formulary, clinical programs, coverage determinations and appeals, as well as growth and profitability.