Asthma is the most common chronic illness in children, accounting for 10.5 million missed school days annually. It also accounts for 14.2 million lost work days for adults. The economic impact is estimated to be $20.7 billion annually. It is reported to result in over 450,000 hospitalizations and 2.1 million emergency room visits per year. It affects over 26 million Americans and accounts for over 4,000 deaths per year.
Afflicting more than 16 million Americans, chronic obstructive pulmonary disease (COPD) is the 3rd leading cause of death in the United States. Direct annual healthcare expenditures exceed $30 billion annually making it a major driver of AVOIDABLE health care costs. The term COPD is used to describe many progressive lung conditions including chronic bronchitis and emphysema.
The Conversio RITEMedTM Program is a multi-disciplinary approach to care coordination and delivery capable of greatly reducing unnecessary hospital admissions while markedly improving the quality of life for patients of all severity. As is the case with many chronic conditions, medication adherence is a crucial aspect of controlling exacerbations along with patient education and coordination along the care continuum.
Health Plan pharmacy and medical claims data are mined by Conversio Health to determine the population most likely to benefit from the program
a. Members are stratified based upon proprietary algorithms, identifying those most at risk of repeat hospitalizations
b. Particular emphasis is placed upon those members currently not on a controller medication (as required by HEDIS and STAR measures)
Once the target population has been identified, Conversio Health works with the partner Health Plan to educate members and providers about the program
Conversio Health contacts members via phone and letter inviting them to participate in the program
During the initial patient phone call additional clinical information is gathered regarding the patient's condition as well as an understanding regarding any financial or medical barriers to a prescribed treatment regimen
A complete medication reconciliation is completed for each patient by a licensed Conversio Health Pharmacist
The Pharmacist contacts the patient's physician to develop a Collaborative Care Agreement outlining the most appropriate clinical regimen for the patient based upon their disease state, tolerance to specific medications
The patient is provided education regarding their disease state, the physician's orders and the proper use of the medication and delivery device if applicable
Patients are continuously monitored with the frequency of contact dictated by the initial risk assessment and following changes in disease status
The medication regimen available to chronic respiratory patients varies from traditional therapy via metered dose inhalers (MDIs) to customized medications tailored to meet individual tolerances and the patient's specific disease state. Individuals vary with respect to their condition, dexterity, coordination and tolerances. As such, in an effort to improve compliance and medication delivery, the Conversio Health team relies on a variety of treatment regimens customized to the individual.
Metered Dose Inhalers are the most commonly prescribed treatment for COPD. Unfortunately not everyone is capable of using the device effectively given limitations in dexterity and coordination.
For patients lacking dexterity or intolerance to MDIs, or where clinically warranted, nebulized medications are provided. A nebulizer is easy to use and when combined with the right medication, can provide long-acting sympton relief.
Patients suffering from Stage III and Stage IV COPD often require specialized combinations of medications containing inhaled corticosteroids. Conversio Health's Specialty Pharmacy customizes medications when necessary.
Conversio Health is not a disease management company but rather an important partner in the delivery of care. As a multi-disciplinary pharmacy, Conversio Health can provide a comprehensive treatment approach through its team of case managers, nutritionists, respiratory therapists and licensed pharmacists. All aspects of the member's condition are addressed in cooperation with the patient's primary care provider and the health plan case management team. Detailed effectiveness reporting is provided regularly to document progress toward common goals in improving care delivery and efficiency.