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Heart Failure

A recent review of a client’s medical and pharmacy claims data showed that only 13% of the members with a diagnosis of heart failure were on therapy as established by widely accepted clinical guidelines.

Clinical Impact: Following established clinical guidelines reduce morbidity and mortality in patients with heart failure which lowers hospitalizations, emergency room visits and overall healthcare cost.

Solution Member First team of clinicians is highly trained to engage patients and educate them about the importance of medication adherence as well as engage providers to address the gaps in therapy. Our program does not only help client save money but also improves patients’ health and quality of life.

Reference: Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld JA, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137–e161. doi: 10.1161/CIR.0000000000000509.

Biosimilars

To date in the US, 39 biosimilars have been approved by the FDA, and 22 products have been launched. These biosimilar launches have saved an estimated $21 billion in savings for the healthcare system over the past 6 years. However pharmaceutical manufacturers are offering PBMs more rebate dollars to continue utilizing original reference products. Our Member First team is here to advocate on behalf of clients and ensure patients receive the most cost effective and lowest cost therapy.

Diabetes

A recent review of a client’s medical and pharmacy claims data showed approximately half of their diabetic members not on any cholesterol lowering medications as widely accepted treatment guidelines established by the American Diabetes Association call for.

Clinical Impact: Diabetic patients who take cholesterol lowering medications have a lower heart disease as well as mortality rate which in turn lowers hospitalizations, emergency room visits and overall healthcare cost.

Solution: Member First team of clinicians is highly trained in managing disease states which account for millions of hospitalizations and emergency room visits every year. Our program is designed to find and address the gaps in therapy which doesn’t only help client save money but also improves patients’ health and quality of life.

American Diabetes Association Indications for Statins in Diabetes

Site of Care

Tremendous variation exits in the cost of administering injectable biologics depending on where it is delivered. For example, at an infusion center vs. hospital vs. patient’s home. Our Member First team is well poised to look for these opportunities and ensure injectables are administered in the most cost-effective setting with no disruption to patients.

Patient Centered Care

Comprehensive Medication Consults: we provide comprehensive medication consults that follow CMS MTM rules and requirementss.


Disease Management: Clinical algorithms are built using evidence-based clinical guidelines with special emphasis on the most expensive disease states such as heart failure, chronic obstructive pulmonary disease (COPD), diabetes, etc.


Specialty Medication Management: Our clinical team is highly trained to analyze and find cost containment strategies aimed at actively managing specialty medications which account for a staggering 51% of total pharmacy spending even though < 2% of plan’s membership uses these drugs.


Targeted Medication Consults: We provide targeted medication consults that follow CMS MTM rules and requirements.


Patient & Provider Education: We engage and follow patients over time. More than 95% of patients say that their lives and well-being have been improved because of an effective medication management program. Coupled with that, we work closely with providers to execute on clinical recommendations and interventions.


Transition of Care Management: Patients who experience change in their care level are engaged as soon as possible to ensure their new care plan is well understood and executed to minimize hospital readmissions.


Quality of Care & Medicare Part D STARS Measures: As our clinical team engages patients and manage them, that yields to positive outcomes and higher performance on quality of care metrics including the Medicare Part D STARS measures.


Our Patient Testimonials

"I don't know where I would be at this time without the support, advise, assessments this program has provided. The major bonus is that I've had you! Your professionalism, knowledge, kindness has gotten me though some difficult times with my physical and mental health.

I am forever grateful to Members First, and especially you, for these months of involvement in my health care."

Sincerely,

J
Member First Patient

"Pharmacist does a great job and offers articles and information on anything they are needing."

J.O.
Member First Patient

“I had a great visit. He was kind and assuring. Helps me feel more in tune with my care. I love the zero copay as well”

E.G.
Member First Patient

"Steve was excellent. If all your clinicians are like him, you have a great program”"

L.D.
Member First Patient

"You guys are doing a great job! Special thanks and appreciation for having bi-lingual Pharmacist"

L.B.
Member First Patient

"I appreciate the $0 copay.. wish I had that and the support sooner. My husband who passed away earlier this year took a lot of medications. I appreciate the support of the clinical pharmacist being able to offer added help for watching for drug interactions and someone to visit about potential side effects with"

D.W.
Member First Patient