Utilization of the Ingenuity Health Medication Monitoring Program at Center for Health Care Services Roberto Jimenez, M.D. Denise Canchola, D.N.P.

Objectives: Define: Ingenuity Health Medication Monitoring. Learn how other centers in TX are using Ingenuity: CHCS Demonstrate Positive Patient Outcomes using Ingenuity. Discuss the Implementation Process and Costs

Clinical Goals for using Ingenuity: Objectively assess if patients are taking prescribed medications to allow for early intervention Identify possible use of non-prescribed medications, illicit drugs and alcohol that could interfere with treatment goals Detect whether genetic polymorphisms could be effecting medications prescribed to the patient. Reduce costs associated with relapse, hospitalization, unnecessary med changes, and unused prescriptions. Make clinical decisions with confidence.

Not the Goal of using Ingenuity.

THIS IS THE GOAL OF USING INGENUITY: Partnership with the patient, the provider and the community. WIN-WIN

Ingenuity Health’s Proprietary Antipsychotic Monitoring Method Detects Quantitative Levels of: Aripiprazole (Abilify®) Quetiapine (Seroquel®) Risperidone (Risperdal®) Lurasidone (Latuda®) Clozapine (Clozaril®) Haloperidol (Haldol®) Olanzapine (Zyprexa®) Paliperidone (Invega®) Ziprasidone (Geodon®)

Proprietary Reference Data for Identification of Partial Non-Adherence Reference Data for Adherence available for Abilify®, Risperdal®, Latuda® & Seroquel XR®. Normalized laboratory results are compared to a database of results from patients who have been clinically assessed as adherent, providing additional information about the likelihood of adherence to the patient’s prescribed total daily dose. . . Adherence reference ranges also available for Opioid medications, including Methadone.

Other Testing Available Detects Quantitative Levels of: Antidepressants Benzodiazepines Stimulants Sedatives/hypnotics Anti-Epileptics Opioids/synthetic opiates Illicit drugs Bath Salts, Synthetic Marijuana Alcohol EtG/EtS biomarkers

Center Analytics

Example Center Analytics: Abnormalities Found Ingenuity provides practice analytics to help Centers identify their areas of opportunity. * *

Example Center Analytics: Non-Prescribed Meds Found Ingenuity provides practice analytics to help Centers identify their areas of opportunity.

Determining a Monitoring Protocol

Clinical Assessment of Medication Compliance in Schizophrenia1 1Dolder, CR, et al., J Clin Psychopharmacology 2003;23(4): 389-399 11

Adherence diminishes over time: Keith, S., Kane, J. J Clin Psych. 2003;64(11): 1308-3015 12

Early Intervention Time to relapse after medication non-adherence: Average interval between discontinuation of meds and relapse of symptoms is 1 – 3 months.1 Routine monitoring for medication adherence offers providers the best opportunity for early intervention. 1Emsley, R, et al., BMC Psychiatry 2013; 13:50 13

Center for Health Care Services Monitoring Protocol First Six Months of Program: Initial assessment of all patients Ongoing Protocol: All new patients (either new to the Center or new to the provider) All walk-in appointments All post-hospitalization appointments Risk-based monitoring, as determined by the Provider, based on review of previous report and clinical assessment 14

Outcomes of a Routine Monitoring Program

Center for Health Care Services – Zarzamora 19% increase in patients with antipsychotic levels suggesting adherent use of their prescribed total daily dose over time. * * * Q1/Q2 2015 added monitoring of two additional antipsychotics

Center for Health Care Services – Packard 17% increase in patients with antipsychotic levels suggesting adherent use of their prescribed total daily dose over time. * * Q1 2015 added monitoring of two additional antipsychotics

Center for Health Care Services - Drexel 19% increase in patients with no abnormality detected (all prescribed drugs present and within range, and no non-prescribed drugs or illicits found). * Q1 2015 added monitoring of additional medications

Center for Health Care Services – Restoration Center 11% increase in patients with no abnormality detected (all prescribed drugs present and within range, and no non-prescribed drugs or illicits found).

Implementation and Costs

Texas Community Centers working with Ingenuity Pecan Valley Centers - Granbury EverHealth - Houston Currently in the Implementation process… Texas Panhandle Centers - Amarillo Hill Country MHDD - Kerrville Burke - Lufkin LifePath - McKinney Gulf Coast Centers - Galveston La Paz - San Antonio Center for Health Care Services - San Antonio Bluebonnet Trails Community Services - Round Rock MHMR Authority of Brazos Valley - Bryan Heart of Texas Region MHMR - Waco MHMR Services for the Concho Valley - San Angelo Permian Basin Community Centers for MHMR - Midland Tropical Texas Behavioral Health - Edinburg West Texas Centers - Big Spring Texoma – Sherman Coastal Plains Community Centers - Portland

Implementation Process All sample collection and shipping materials are supplied by Ingenuity Health. Collection process is noninvasive and performed during routine visits. Ingenuity team works closely with the Center to design and implement a simple workflow for the collection process. In most cases, Ingenuity provides a Specimen Processor onsite if Center staff is unable to perform the sample collection themselves. Ingenuity team provides on-site training and continual support for providers and staff.

Traditional Billing Policy Overview No cost to Clinic Covered 100% by Medicaid and Medicare and all billing is performed by Ingenuity Billed to private insurance, per patient’s plan Uninsured and Out-of-Network maximum bill $99, with sliding scale financial assistance available to all patients who qualify. Additional discounts beyond sliding scale may be available, based on patient need. $0 $25 $50 $75 23

Traditional Billing Policy in Action: Texas 24

Alternative Billing Policy Now Available Covered 100% by Medicaid and Medicare Billed to private insurance, per patient’s plan Uninsured patient testing billed to Center at maximum bill of $55, with sliding scale adjustment made based on the patients’ financial assessment. $0 $14 $28 $41 25

Ingenuity Health Contact Information Amy Varhely Mental Health Account Executive - Texas (512) 937-8184 amy.varhely@ingenuityhealth.com www.ingenuityhealth.com