Using AI-powered population health analytics, EmpiRx’s model aims to drive better health and financial outcomes with clinical-based pharmacy care.
EmpiRx Health has launched a new model that expands on its “value versus volume” paradigm for delivering PBM services. The new model formalizes EmpiRx Health’s clinically driven approach to pharmacy benefits, as the company aims to work with employers to see pharmacy care as an asset that drives business growth. EmpiRx Health also plans to scale its Member Care Program for patients with the most complex diseases; 2.6% of EmpiRx’s patients consume 48% of its services.
The goal of the scaled-up model is to drive better health and financial outcomes with clinically based pharmacy care. EmpiRx Health’s value-versus-volume approach puts the pharmacist at the center of the care model. Using AI-powered population health analytics, EmpiRx Health pharmacists work directly with prescribers, dispensing pharmacies, and members to coordinate that pharmacy care.
Key to this model is the research EmpiRx and its pharmacists do to support physicians in drug management, John Ridyard, executive vice president, product and strategy, said in an interview. “Our pharmacists are not talking to doctors about a standard rule that’s set in a system,” he said. “They're consulting with doctors as a trusted peer about their clinical review that suggests that there could be a better path forward.”
This effort is now being formalized within EmpiRx Health to proactively provide doctors with data and information that support the use and dosage of prescription drugs, ensure there is appropriate clinical guidelines and help with patient adherence. Ridyard has recently joined the company as EmpiRx Health scales up these efforts.
In the past, EmpiRx’s efforts have resulted in physicians applying their recommendations 64% of the time, Polina Kogan, Pharm.D., chief pharmacy officer, said in an interview. “From the beginning, our main goal was not to push outcomes through volume,” she said. “We wanted to focus on what’s right for our customers and what’s right for our patients.
As a result, EmpiRx Health created a population management engine that helps clients target a clinical strategy in almost real-time for that client’s patient population. The PBM uses the Johns Hopkins ACG System, which is population health analytics software that uses diagnosis, pharmacy and lab data, and big data tools. The information and insight the system produces can be used in population health, patient care, finance and budgeting, and performance analysis.
This model drives value, Kogan said, because it focuses on the maximizing employee health through pharmacy care, because employees who are in good health can perform better at their jobs. At the same time, the model aims to save money for both the employer and the employee by directing physicians to the most cost-effective medications.
The ACG system can create a risk profile, both clinical and financial for its clients. The company then wraps its own AI around the ACG model to bring clinical evidence and personal risk factors such as comorbidities into the picture and creates a profile for each patient within a group. The system is then able to create a list of patients who might need clinical intervention.
EmpiRx Health’s pharmacists work with physicians to switch or optimize medications to lower cost alternatives that are also clinically appropriate. Company executives said they have an 88% engagement with physicians and 93% medication adherence rate.
Kogan said, however, recommendations are not based on formulary placement. “We have an open formulary,” she said. “If patients need a particular drug, we want to make sure they have access to that drug. How we control the appropriateness is through this clinical approach where clinicians work with doctors to identify what’s working and what’s not working for them. We want our patients to get what they need, and not dictated by a set formulary.”
EmpiRx Health’s model is having success in saving money for both employers and employees. On its website, EmpiRx Health provides success stories for its approach, including identifying the proper dosage of Stelara (ustekinumab) for a patient with Crohn’s disease, which saved the plan more than $53,000 annually and a switch from an injectable to an oral osteoporosis medication for a patient who was afraid of needles, which increased adherence and lowered costs by more $41,000 annually.
In another example, EmpiRx Health partnered with the UFCW National Health and Welfare Fund, which provides coverage to those working in grocery, retail, and healthcare industries. EmpiRx Health embedded a member care advocate within the Fund’s benefit team who serves as a clinical and benefits concierge to members. This program has had more than 1,200 engagements with members and has provided the fund more than $2 million in clinical savings.