Delivering Integrated Care and Cost Management
The IHTC works collaboratively with payors to optimize care. We ensure that the patients and families we serve have access to care and therapies, thereby helping to contain costs and reduce both bleeding events and utilization of resources.
The IHTC Pharmacy’s ability to purchase clotting factor through the Public Health Service 340B discount program and our overall pricing structure benefit payors and patients by dispensing clotting factor at significantly reduced prices.
Disease & Care Management
The Disease Management Program (DMP) of the Indiana Hemophilia & Thrombosis Center (IHTC) is designed to effectively contain the overall cost of care while optimizing health outcomes for patients with bleeding disorders who participate in the program. The program brings together expertise, experience, and advanced technology in a patient-focused approach.
The key goals of the program include:
- Cost containment or reduction
- Reduction in resource utilization
- Fewer inpatient hospital days / unplanned hospitalizations
- Fewer emergency room visits
- Decreased clotting factor utilization
Included elements of the DMP are targeted toward the most accurate, effective, and efficient methods to diagnose, manage and treat patients with bleeding disorders. Through targeted interventions and enhanced quality assurance, this program results in improved patient care and cost stabilization/savings. The IHTC DMP components can be tailored to meet the specific needs of payors. A cost effective program can be developed for any size population.
Program components may include:
- Free annual comprehensive clinic evaluation with the IHTC multidisciplinary team
- Dispensation of clotting factor concentrate through a qualified Public Health Service 340B covered entity such as the IHTC Pharmacy Program , with all prescriptions for clotting factor concentrate written and signed by IHTC physicians
- Utilization of a web-based infusion log system or smart phone app to track and monitor bleeding events and administered treatment
- Twice yearly treatment adherence assessment using VERITAS-PRN or VERITAS-Pro
- Close ongoing contact through telephone, email and home visits to discuss health issues and concerns, educational needs, treatment adherence, and bleeding episodes; and to coordinate scheduling of appointments as needed to assess current/ongoing conditions
- Annual knowledge assessment to measure participants’ knowledge of their condition, complications of bleeding disorders, dental and oral care, physical activity, home therapy, and infection control
- Educational initiatives to enhance participant knowledge of bleeding disorders and address gaps identified through the knowledge assessment
- Regularly scheduled meetings among the IHTC DMP team and clinical staff
Evaluation of Progress
The following tools are used to evaluate program progress:
- Monthly meetings of the multidisciplinary team to review DMP patients’ health status, progress, and needs;
- Pharmacoeconomic analysis of claims data – i.e., annual insurance claims are reviewed from year to year and prescription adherence with a special focus on costs of care, costs of clotting factor, source of care (e.g., HTC, emergency department), and changes in costs and utilization from one year to the next;
- Annual reporting of specific cost and utilization outcomes:
- Average costs of clotting factor, medical, and hospital care;
- Average number of clotting factor units dispensed, emergency department visits, and inpatient hospital days;
- Regular patient assessments:
- Diagnosis-specific knowledge assessments – to assess a patient’s knowledge of his or her own condition, and to assess changes in knowledge over time;
- Quality of life survey – to assess a patient’s health-related quality of life, and to assess changes in quality of life over time;
- Treatment adherence scale – VERITAS-Pro or VERITAS-PRN for patients who use a home infusion regimen.
Initial results as well as results after 5 years of program implementation were published in Haemophilia, a leading, peer-reviewed academic journal in the field. The IHTC performed disease management for the Indiana Comprehensive Health Insurance Association (ICHIA), Indiana’s high-risk insurance pool, from October 1, 2004 through December 31, 2013. In the 5-year post-implementation study, the ICHIA DMP documented significant and consistent reductions in total costs, outpatient clotting factor costs, and other costs, such as inpatient medical, outpatient medical, prescription drugs (see Figure 1).
Highlights at 5 Years After Implementation of Disease Management Program
- All costs, as well as emergency department visits, remained below pre-implementation levels.
- Inpatient hospital days remained below pre-implementation, with a few spikes in costs for medically necessary surgeries.
- Program patients benefited from the focus on proactive, preventive care and personalized interventions.
- The IHTC DMP is administered by healthcare providers rather than a third-party disease management entity.
- This ensures that the program staff has direct access to the multidisciplinary medical team, physicians, and pharmacy.