1. Donald W. Kemper, MPH Session 2.02 9:15 AM Friday, February 27, 2004
Helping Seniors Make Smart Prescription Drug Decisions under the New Medicare Prescription Drug Legislation
Donald W. Kemper, MPH
Session 2.02
9:15 AM
Friday, February 27, 2004

2. Helping Seniors Make Smart Decisions about Prescription Drugs
Donald W. Kemper
Chairman and CEO, Healthwise
Chairman, Center for Information Therapy

3. Drug benefit success depends on good drug decisions about
Which drugs to buy
Where and how to buy them
What else to do to improve health
Consumer-directed care requires an informed consumer.

4. Where I’m coming from “The Consumer”
year-old Lieutenant, USPHS
ASG Vern Wilson : “The Greatest Untapped Resource in Healthcare”
“The Consumer”

5. Healthwise founded (not-for-profit)
Mission: to help people make better health decisions

6. The Healthwise Knowledgebase Web-based: Prescription-Strength Information™
8 of 10 largest MCOs
400 + Hospitals
Consumer Portals: AOL, MSNBC, WebMD

7. as part of the process of care
“Information Therapy”
The prescription of specific evidence based medical information
to a specific patient, caregiver, or consumer
at just the right time to help them make a specific health decision or behavior change
as part of the process of care

8. Drugs are Essential to Senior Health for those 65 and over:
10% take 8 or more medications
33% take 5 or more medications
58% take 3 or more medications
In addition, half of the information that managed to gain a foothold in the memory of the patient was later recalled incorrectly.
Problem particularly acute in older patient or in those who were anxious about bad news.
Other research showed that when information was given verbally, only 14% of it was remembered.
However, when pictographs were used, 80% of the information was absorbed.

9. # of Prescriptions Written/Year (12 prescriptions/person/year)
7.3% annual increase

10. Drugs Costs Rise with Co-Morbidity%
Co-morbidities
Cost (1996)
13%
0 Chronic Conditions
Base Cost
44%
1-2 Chronic Conditions
3.1 x Base
43%
3+ Chronic Conditions
6.6 x Base
In addition, half of the information that managed to gain a foothold in the memory of the patient was later recalled incorrectly.
Problem particularly acute in older patient or in those who were anxious about bad news.
Other research showed that when information was given verbally, only 14% of it was remembered.
However, when pictographs were used, 80% of the information was absorbed.

11. Top 10 $ Drugs (2002) Lipitor Cholesterol $5-6 billion Zocor
Prevacid
Ulcers/Reflux
$3-4 billion
Prilosec
Procrit
Anemia
$2-3 billion
Zyprexa
Antipsychotic
Paxil
Antidepressant
Zoloft
Epogen
Celebrex
Anti-inflammatory
In addition, half of the information that managed to gain a foothold in the memory of the patient was later recalled incorrectly.
Problem particularly acute in older patient or in those who were anxious about bad news.
Other research showed that when information was given verbally, only 14% of it was remembered.
However, when pictographs were used, 80% of the information was absorbed.

12. How can you help people decide:
Do I need this drug?
Where and how should I buy it?
What else should I be doing?

13. Do I Need this Drug? Questions
Evidence-based outcomes (important to me)
Risks and side effects
Drug interactions
Alternatives (lower
cost/risk)
When can I stop?

14. Do I Need this Drug? Web-based decision aides Compare pros and cons
Consider alternatives
Check for drug interactions
Promote adherence
Help catch medical errors

15. Do I Need this Drug?

16. Do I Need this Drug?

17. Savings via a Drug Cost Comparison Tool
Brand to Generic
Brand to therapeutic equivalent
Retail to mail order
Retail to Canadian
On-line (drugstore.com)
Wholesaler retailer (e.g. CostCo)
Pill Splitting

18. Confidential, personalized report
260 Discount/other programs
1450 Drugs

19. What else should I be doing?
Disease self-management?
Movement/fitness
Nutrition choices
Self-monitoring and reporting
Medication adherence
Medical Tests?
Surgery/Other treatment?

20. Information Therapy Prescribing: The right information
to the right person
at the right time

21. How Would Ix Work with Drugs?
Information triggers ICD-9, CPT-4, NDC codes
Moments in care Meds: first prescription, refill, dose change
Information prescription
Decision point
Cost Checker
Patient safety
Piggybacking for Information Triggers
EMR: Electronic Medical Records
POE: Physician Order Entry
Appointment Scheduling
The best way to get the information triggers is to piggyback an information therapy application on top of an existing and routinely used information system.
If an EMR is in place, information prescriptions could be automatically sent each time new entries are made.
Computerized Physician Order Entry Systems are also great sources for information triggers.
If a lab test is ordered, the patient can get an information prescription to interpret the results.
If a medication is prescribed, they also get the information that helps them take it appropriately and monitor it for side-effects.
If they are scheduled for surgery, the information prescription can help them prepare for what’s ahead
Information prescriptions can also be send in advance of the decision to give the patient a role in deciding among alternative treatment options.
Clinic scheduling systems can also be good trigger sources. If you schedule a doctor visit for back pain, wouldn’t it be nice to get an information prescription in advance that tells you what to expect in the visit and what you can do at home in the meantime to manage the pain and swelling?

22. Action Plan CMS Medicare.gov Health Plans
Web sites, member portals and PBMs
Employers
Benefits portals
Providers
Patient portals—tied to EMR
In addition, half of the information that managed to gain a foothold in the memory of the patient was later recalled incorrectly.
Problem particularly acute in older patient or in those who were anxious about bad news.
Other research showed that when information was given verbally, only 14% of it was remembered.
However, when pictographs were used, 80% of the information was absorbed.

23. Drug benefit success depends on good drug decisions www.healthwise.org
And so does all consumer-directed healthcare