Florida hospital promotes drug savings
Miami’s Mercy Hospital says participants in its self-sustaining preventive care program are seeing average savings of $140 per prescription, often putting the cost of their drugs below what it would be if they bought them in Canada or Mexico. The savings come through a program the hospital developed with Hollywood, FL-based Freedom Healthcare intended to reward patients with lower drug prices if they follow preventive care guidelines established by the U.S. Preventive Task Force.
"We are excited to be the first hospital to successfully implement the Freedom program," says Manuel Anton III, Mercy Hospital senior vice president and medical director. "The program offers the community a truly valuable service that is in keeping with the mission and commitment of our faith-based, nonprofit community hospital. This program also is very much in line with current federal health care initiatives," he explains.
Improving patients’ compliance
Mr. Anton tells State Health Watch the hospital was looking for a way to improve compliance of its patients with preventive care recommendations and use of prescribed drugs. Often, case managers and doctors were concerned that patients were unable to comply with a treatment regimen, especially because they could not afford the drugs, he points out.
The hospital decided to partner with Freedom Healthcare, which was developing technology to allow it and its partners to take advantage of the federal government’s 340B program to provide cost savings on name-brand FDA-approved prescription drugs.
As a community-based disproportionate share hospital, Mercy is eligible to participate in the program. Patients must meet a number of criteria to be able to enroll in the Mercy Hospital Freedom Program, including living in the Mercy service area and receiving preventive care as an outpatient from a credentialed participating physician at Mercy Hospital.
A one-time $25 enrollment fee covers an initial screening for the patient and also is used to secure a firm participation agreement from the patient.
Technology key to success
Travis Leonardi, the CEO of Freedom Healthcare, tells State Health Watch his company’s innovative technology platform allows the Mercy Hospital Freedom Program to automate its preventive care initiative.
Patient compliance is monitored, and prescriptions are delivered safely to patients by mail. Physicians are given quarterly "Coordination of Care Reports" that detail patient compliance, participation, and cost savings. Enrolled patients receive prompts to comply with the individualized Road Map to Better Health they get from the program and are notified when prescriptions need to be refilled.
There also is a portable electronic health record of each patient’s health care and preventive care plan so patients can authorize easy access to the record for any health care provider they visit.
Freedom applies national recommendations and guidelines from the U.S. Preventive Task Force to deliver the message and motivate patients to apply prevention as a key health strategy.
Mr. Leonardi says that Congress and the Centers for Medicare & Medicaid Services have expanded Medicare’s acute care model to incorporate prevention as a major theme by expanding payments to providers for preventive care interventions, promoting quality initiatives such as diabetes and congestive heart failure programs through community-based hospitals.
"Freedom’s objective is to take the tools the federal government has made available and deliver them directly to patients in a meaningful way," he says.
Mr. Anton says the preventive care guidelines used in the program are well documented and well referenced so health care providers and patients can be confident that patients should be helped if they follow the program. "The program’s objective is to promote or encourage and incentivize patients to take care of chronic conditions by giving them access to lower-cost drugs," Mr. Anton says.
With feedback going to the hospital and health care providers, patients can be dropped from the program if they habitually fail to follow their Road Map to Better Health. The hospital works with patients to determine reasons for occasional noncompliance and tries to overcome any barriers that are identified, but if patients persist in not following the recommendations, they could lose their drug benefit, he notes.
Low-cost scrips tied to self-care
"It’s true that low-cost prescriptions are a help," Mr. Anton explains, "but this is a linked program" that also depends on following steps that will improve quality for those with chronic conditions. He notes that when there are economic or other reasons why patients fail to live up to their end of the bargain, the hospital’s safety net programs can step in and direct patients to other resources that can help them, like drug company discount programs.
The program covers some 20 to 30 chronic conditions including major issues such as congestive heart failure, asthma, hypertension, and diabetes. There are no formulary restrictions on the drug because the program is not operating to cut financial risk. So any brand-name drug that is medically necessary can be prescribed and will be provided at the federal government’s 340B price.
"What this program amounts to is drug price negotiation rather than utilization negotiation," Mr. Anton explains.
He notes that over the next one to five years, he wants to improve program outreach because there still are many people in the service area who could benefit from participation but have not yet accessed that opportunity for a variety of reasons. Mr. Anton says he also would like to do research to determine whether the program has improved the health status of participants.
Asked why the program has worked well, he credits success to the relationship between Mercy and Freedom. "This would be hard if not impossible to do without an ongoing development relationship," he points out.
"We needed everyone from both groups at the table constantly working through how we were going to do this. I truly believe that if Mercy had tried to do this on its own, it would have been virtually impossible. And on the other side, Freedom needs a disproportionate share hospital to be able to use its technology for the 340B drug pricing. We had an opportunity to learn a lot and to create a valuable program together. What made this happen was two committed entities working well together," Mr. Anton adds.
Mr. Leonardi says the business model works because the hospital uses his company as a bolt-on infrastructure for a preventive care clinic.
The model also has been installed in Detroit’s St. John’s Hospital and plans are under way to open sites in New Jersey, New York, and Pennsylvania.
Patient compliance improving
Mr. Leonardi says they’ve learned a lot from listening to patients as they work through their Road Maps for Better Health. "We hear so many people saying, I didn’t know I should be doing that,’" he notes. "We’re seeing rapid increases in compliance once people start the program."
According to Mr. Leonardi, while managed care has done many good things, it has created problems by leaving community hospitals, doctors, and patients out of the management-of-care equation. He says he wanted to create a new model based on those three and believed that one of the by-products would be that care would be managed. The whole concept fits well with the current emphasis on empowered patients, he says. "People don’t want to only listen to their doctor," Mr. Leonardi explains. "They also want to know for themselves."
[Contact Mr. Anton at (305) 854-4400 and Mr. Leonardi at (954) 585-4882.]
Miamis Mercy Hospital says participants in its self-sustaining preventive care program are seeing average savings of $140 per prescription, often putting the cost of their drugs below what it would be if they bought them in Canada or Mexico.
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