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

2. 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

3. 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.

4. Not the Goal of using Ingenuity.

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

6. 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®)

7. 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.

8. 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

9. Center Analytics

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

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

12. Determining a Monitoring Protocol

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

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

16. 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

17. 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

18. Outcomes of a Routine Monitoring Program

19. 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/Q added monitoring of two additional antipsychotics

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

21. 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).
* Q added monitoring of additional medications

22. 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).

23. Implementation and Costs

24. 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

25. 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.

26. 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.
$ $25 $ $75 23

27. Traditional Billing Policy in Action: Texas24

28. 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.
$ $14 $ $41 25

29. Ingenuity Health Contact Information Amy Varhely Mental Health Account Executive - Texas (512)