The past year has prompted changes to our health system in many ways. Since the pandemic began, OptumRx has introduced new innovations to help reduce costs and improve health outcomes. These include COVID-19 vaccination reminders, proactive mental health support for members and new initiatives designed to make drugs affordable while safeguarding plan resources.
To learn how the pandemic has impacted clinical solutions, we recently spoke with Chris Le, director of national clinical partnerships for OptumRx. In this role, she collaborates with teams across the organization to develop clinical programs and solutions to some of the toughest challenges in health care.
1. How has the pandemic intersected with the need for clinical programs offered by OptumRx?
Over the past 12 months, there have been many challenges we've faced as individuals, employers and providers of health care. OptumRx has kept a keen focus on moving new innovations forward and enhancing the programs we have. We’ve built out new solutions designed to provide better care for members and reduce cost. These include cost management strategies that will help clients manage across both the pharmacy and medical benefits.
For example, as COVID-19 progressed, it became clear that there would be an increased use of telemedicine. This really confirmed an earlier decision to significantly invest in building out digital provider engagement tools. Our aim was to enhance the member experience and save time and money throughout the health care system. Unlike many digital benefit solutions out there, OptumRx chose to build our solutions in-house from the ground up.
The advantages of this approach for our clients are twofold. One advantage is that we can bring innovations to market faster. Secondly, there is a flexibility component. For clients that have custom formularies, in-house pharmacies, or for our health plan clients, we can collaborate to determine how best to engage their providers or members with these tools.
2. One of the early concerns about the pandemic was the toll it could take on mental health. How has OptumRx responded from a clinical perspective?
During the pandemic it was also evident that many struggled with lifestyle changes from childcare to financial instability. As a result, our clinical team enhanced our clinical programs to help assist our members affected by COVID-19-related issues.
For example, we can connect members to our support line where an advisor offers counseling and recommendations to find mental health resources. For members that need more urgent support such as thoughts of suicide, they are warm transferred to a suicide helpline. This helps ensure they get the help they need immediately.
We also have an adherence program specifically focused on helping members stay on their mental health medications. Specifically, this includes medication-assisted treatment (MAT) therapies for opioid dependence. These are life-saving therapies that help members overcome opioid addiction.
3. How has COVID-19 shaped client expectations around costs?
The issue of affordability has always been a top priority but never more than now. The economic downturn affected many of our clients during the past year. Early on, we were very proactive in running analytics and consulting with clients to help identify ways to cut costs now and over the next few years. Importantly, we’ve seen a new flexibility from clients. They have been willing to adopt a wider range of solutions to increase affordability.
For example, we recently brought forth the OptumRx® Critical Drug Affordability Program. For this program, we looked across the pharmacy benefit and identified five key classes of medications that were life-sustaining. These categories included insulins, anticoagulants and HIV treatments.
We chose the lowest-cost option available and built it into a convenient plan design that worked synergistically with our standard formularies. Clients can choose to bring the cost-share down as low as $0 for their members. Our account teams can also provide clients with plan-specific analytics to aid their decision-making.
If implemented, the OptumRx Critical Drug Affordability Program helps make these critical medications available to members in a simple and affordable way. In the long run, members adhering to medications will help improve their health outcomes and reduce medical side costs for clients.
There are other programs that may be practical and helpful during this time and in the long run will also help decrease costs. Even before the pandemic we knew that a person worried about basic necessities can’t focus on managing their health. The FirstLine Benefits™ Program is a suite of supplemental food and over-the-counter (OTC) benefits to help reduce inequities in food and essential health care items.
Clients that purchase one of our fee-for-service programs can provide FirstLine Benefits to their members. The member receives a prepaid debit card with an amount that the client determines. The member then has access to thousands of products through a catalog, online store, and major retailers like Walmart and local independent pharmacies.
Our results show that members who used their OTC benefits saw improvements across four key metrics including hospital admissions and ER visits.*
4. Currently, a big area of focus is COVID-19 vaccination. What is OptumRx doing to facilitate vaccination?
One area of focus is processing claims promptly for COVID-19 vaccination. This ensures that people have access to the vaccine at no cost to them.
Another area of focus is adherence. If members are yet to complete both doses of the vaccine, we will initiate an interactive voice call to remind them. During that phone call, members have the option to connect with their local pharmacy or the clinic where they received the first dose.
We also have an important role to play educating clients and members. We have included COVID-19 engagement and support with both our inbound and outbound clinical program member outreaches. We have prepared our pharmacists and staff to answer any questions related to vaccines and COVID-19.
5. What lessons have we learned from the pandemic that will remain important?
I think one lesson is the value of holistic solutions. Here, we are fortunate that we can easily incorporate resources from our broader enterprise to create integrated programs.
During the pandemic a lot of us saw many of our health routines fall by the wayside. Through an existing partnership with our Optum enterprise partner, Rally, we were able to offer Real Appeal® to members. This is a disease-prevention program aimed at helping members achieve sustainable lifestyle changes.
In the long run, these lifestyle changes will help decrease the risk of hypertension, high cholesterol, diabetes and other chronic diseases. Through this partnership, we helped participating clients achieve large cost savings by reducing disease progression and usage of resources on the medical benefit.
Another example of this holistic mindset is our Diabetes Management Program, which focuses on members already diagnosed with diabetes. Across all our clients, diabetes is one of the top cost drivers on the pharmacy benefit.
One unique aspect of this program is that we are using a data and analytics model built on OptumIQ™ to help clients risk stratify their members. We take in and model client-specific member information, and OptumRx then tailors our approach and outreach to those members. The highest-risk members will receive personalized consults with our certified diabetes specialists, who are also pharmacists.
These are just a few of the ways that we have shaped clinical solutions to help members and clients during the pandemic. Going forward, I think an overall lesson is that committing to innovation is now more important than ever.
*Optum Advisory Services. Analysis of a full year of health care utilization data across Medicare and dual-eligible, or D-SNP, population. Sample size 361,229. Group “With OTC” represent members whose plan includes FirstLine Benefits programs. “Without OTC” represents members whose plan does not have those programs. All utilization measures were fully risk-adjusted between the two groups. Study concluded in August 2020.
STATEMENT REGARDING FINANCIAL INFLUENCE:
This article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor OptumRx has accepted any form of compensation for the preparation or distribution of this article.