Changing how members receive clinical pharmacy services

A conversation with Michelle B. Anderson, PharmD

National Director of Managed Care Pharmacy, Mutual of Omaha

Mutual of Omaha Case Study

Mutual of Omaha by the numbers

115,000+

Members qualifying for adherence measures in 2021

172,000+

Overall membership

5,772+

Successful member consultations

4.8 out of 5 stars

Aspen RxHealth pharmacist rating

Tell us about some of the challenges that led you to explore Aspen RxHealth.

As a newer Medicare Prescription Drug Plan (PDP), we determined early on that a shift in our focus was needed to place more emphasis on member education. We sought to assist our members in managing their health conditions via medication adherence and medication therapy management (MTM) programs to drive plan performance and boost Star Ratings. Medication adherence was prioritized and went live first in 2021, with the MTM program implemented at the start of the following plan year.

Why Aspen RxHealth?

We didn’t simply need another vendor on board. We sought an ally who could hit the ground running and offer the flexibility a plan such as ours required After early conversations with the Aspen RxHealth team, we knew their innovative model and domain expertise in delivering comprehensive medication reviews and developing custom medication adherence programs “matched” to our membership population and was a fit. Knowing that our membership may flex from year to year, we appreciated the elasticity provided with Aspen RxHealth’s innovative network. Their collaborative activation process ensured member qualification was efficient and accurate for our Stars-based programs. Prior to activation, the Aspen RxHealth team guided us through outreach strategies to best engage our membership and maximize performance to goal. We also had opportunities to review the scripting of pharmacist consultations and outreach efforts, as well as the performance tracking platform. Their ability to provide our team with an FTP file extract that we could then customize on our end proved extremely helpful.
When exploring a new relationship, we prioritized the ability to deliver a seamless member experience. Particularly, having the ability to address both medication therapy management and adherence all within one singular call was very appealing. We always seek to provide the best possible experience to our members and offering them the opportunity to speak with and “favorite” the pharmacist of their choosing for both MTM and adherence was something extremely unique. Another area we appreciated was the ability to customize various elements of our programs, such as member welcome letters.
Our original goal was to meet a three-star rating in the adherence measures, but as the program progressed, we pleasantly realized the likelihood of achieving four stars by the end of the year. We project we’ll achieve a four-star rating in multiple measures. Aspen RxHealth provided us with performance trend reporting, ensuring we could easily track and monitor performance to get there. To kick-off 2022, we launched MTM services in conjunction with medication adherence. Aspen RxHealth has exceeded expectations in their comprehensive medication review (CMR) completion rates. Our entire team was impressed with how quickly we were able to nearly reach our goal in the first quarter, and we are hopeful for what program success looks like in future quarters. Their high-quality, personalized member experience, and elasticity proved to be the right choice for our MTM and adherence programs.

"Aspen RxHealth has exceeded all expectations in their CMR completion rates, reaching 91% of our CMR completion goal for the entire year in Q1. Their high-quality, personalized member experience and flexible capacity proved they were the right choice for our MTM and medication adherence programs."

We chose Aspen RxHealth based on a few key drivers

Data strategy

One of the unique drivers in working with Aspen RxHealth was their proprietary matching algorithms that paired our members with pharmacists. The two cohorts were matched based on a variety of social and clinical factors, areas of specialty, language, and geography, which has been proven to increase the likelihood of members building a relationship built on commonalities and trust. Then, member personas were used to manage the individual members’ medication adherence performance based on propensity to succeed or fail at the measure. The ability to rapidly determine when the mathematical probability exists for a member to become adherent, and then conduct personalized outreach to said member was invaluable. This program ensured members persisted on their medications, managed refills efficiently and provided insights to member barriers to help us reach our adherence goals. Aspen RxHealth’s ability to manage real-time trending towards our MTM program goals and drive timely member outreach as the year progressed is critical to our success. Aspen RxHealth also managed member qualification and eligibility requirements for our Stars related programs, relieving our organization of the need to build and derive eligibility capabilities.

Flexibility

Aspen RxHealth had the ability to diversify engagements, beginning with refill reminders and late to refill. Together we built a sound methodology that managed to percent days covered (PDC) goals and targeted medication ratios, preemptively engaging members prior to a missed fill. Further, patient education was deployed to drive the importance of medication adherence and the timeliness of picking up their medications. We especially appreciated the ability to have custom scripts developed to meet the needs of our organization and our members.

Elasticity

Their ability to scale based on our specific needs and quickly reach newly eligible CMR members was unlike anything else we had seen from other vendors.

Bundling

Aspen RxHealth was able to easily transition to handle our comprehensive MTM program to complement our existing medication adherence program. One vendor to work with across all our stars related pharmacy services streamlined member interactions as well as plan oversight of the programs.

What has surprised you about the impact and engagement you've seen with Aspen RxHealth?

We’ve appreciated their willingness and ability to become a true collaborator, flexing and adapting to our specific needs throughout the year. From the onset, they developed and delivered a robust prescriber alert library, determined eligibility protocol, and acted as a general extension of our entire team. The level of transparency the team used in relation to all aspects of the program – from set-up to outlining the process as a whole – gave our team peace of mind. From the CMR welcome letters to the consultation scripts and suggested cadences, the Aspen RxHealth team worked hand-in-hand with Mutual of Omaha, making recommendations and taking a consultative approach to our unique goals. They successfully delivered quality CMRs and targeted medication reviews and compiled easily accessible reporting, giving us line of sight into the initiatives in real-time. They pleasantly surprised us in their approach to drive adherence through meaningful, personalized patient engagement. For plans like us, speed to action is imperative and their ability to move the needle quickly exceeded expectations.

What would you tell fellow quality leaders about Aspen RxHealth?

Aspen RxHealth made a very meaningful impact on the clinical pharmacy services we provide to our members. Whether you are a regional or a national health plan, I believe their solutions and consultative approach offer a unique opportunity to vary and customize member outreach strategies based upon the unique needs of your populations. They listened to our goals and objectives and devised a strategy that met our expectations and overall plan performance. Our results without the program likely would have been drastically different and we are very pleased with how the year concluded. What’s also great is that despite being a technology-enabled pharmacy services company, Aspen RxHealth provides the patient-centered care that we expect and that our members deserve. Engaging a company like Aspen RxHealth shows our members that we truly are investing in their health and wellbeing which is so extremely valuable.

Engagements across diverse platforms

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