A Patient-Centric Approach: Care Plans for Patients Pay Off

A patient-centric approach that assesses patients for risk of nonadherence and provides support through care plans reduces hospitalizations and adverse events, Biologics by McKesson executives said today in their presentation at the 2021 Annual National Conference of the Pharmacy Benefit Management Institute.®

Paula Bickley

Paula Bickley, vice president of market access, and Ashleigh Burdette, senior director of clinical innovation, described a program that assesses the risk of patients being nonadherent and providers care plans. They said that about 1 in 3 patients fall into the high-risk category. Biologics by McKesson is a specialty pharmacy that focuses on cancer patients.

Bickley and Burdettte said that their company's analysis shows that hospitalizations for patients on care plans are reduced by 35% and that patients are four times less likely to report disease progression, presumably because they are taking their cancer medications as prescribed.

Bickley said the essence of a patient centric approach is giving the right drug to the right patient at the right time: "It sounds simple, but it is anything but."

Ashleigh Burdette

Burdette said in interview before the PBMI meeting that the the company developed its own risk assessment tool because it couldn’t find one that “we felt truly captured a holistic picture of who that patient was.”

“We wanted to look at things such as does the patient have a caregiver living in the home or not, because that that tends to have a significant impact on the patient's ability to stay adherent to therapy or not,” Burdette continued. “We also wanted to look at whether the patient had lingering side effects, whether that was from a previous therapy that they were on, or maybe even related to the disease or the diagnosis that they've received. We also wanted to look at what the level of health literacy was for each patient on that individual level. And so there were a lot of things that that we felt would truly give us that holistic understanding of the patient. What drives them? What challenges do they have?”

That information can be used, explained Burdette, to personalized clinical support so that's meaningful and effective with patients.”

An increasing proportion of oncology treatments are pills. While oral drugs are often seen as being easier to take, they present their own adherence issues.

“You don't have to get in your car, to drive to the doctor's office, you think, gosh, wouldn't it be so simple, I have my capsules or tablets, I take them, and then I go about my day,” Burdette said. “Unfortunately, it's just not that simple for a lot of reasons. Some medications require you to titrate up. And that means that you might start with one capsule today. And then next week, I have to go to two capsules. And then two weeks after that, I have to go to three. Sometimes it takes a month or more to establish that maintenance therapy or titrate, up to that maintenance dose, so that can add in a layer of complexity.”

Burdette said another challenge is forgetfulness: “You would think it's easy to remember, but we’ve all been prescribed some oral therapy that we didn't take exactly as we were supposed to because we forgot — life got in the way, we went to work, we left our medicine, we just forgot.”

Oral cancer drugs can also have side effects that make people not want to take them as prescribed, noted Burdette. Fatigue and nausea are among the top side effects. “When you're at home, by yourself, or even with a caregiver, learning how to manage those side effects in the home, can be challenging,” she said They can be difficult, and depending on the patient and the level of severity of those side effects, side effects can lead to a patient skipping a dose or deciding that they're not going to take the medication anymore. And that's a little different from, say, a patient who might be going into the clinic to get IV therapy, and they have clinicians right there with them, helping them manage those things.”

“I think the another really important thing that we're looking at, especially as we think about patient-centered care is what the patient's say about this type of support. Do they like it? Do they feel like it's helpful?” Burdette said, who mentioned that a patient had recently written that “she simply could not have done this without having that dedicated level of support, and that she would have thrown in the towel a long time ago, because she just would not have been able to, to manage some of the side effects that she personally experienced on her therapy.”

Burdette also shared some case studies. A 75-year-old ovarian cancer told a nurse about having shortness of breath that she had not discussed with her doctor, partly because she was taking her cancer medication at home. The patient was admitted for a 24-hour observation period, but ultimately, because of the education that she had received about how to manage pursed lip breathing, and other clinical interventions, she avoided more serious and expensive care. Burdette said her company estimates the early intervention saved $16,000. In another case described by Burdette, an ovarian cancer patient had mouth sores because she wasn't using a mouth rinse. The savings from her using the mouth rinse (she had some other problems as well) was calculated at only $600 but multiple that by thousands of patients and the savings become substantial, Bickley and Burdette said.

Editor's note: The video was recorded prior to the PBMI meeting.