SM-Optimizing Case Management Outreach-KEPRO

I just want to thank everyone from the Funds since my health concerns started in 2017: Non-Hodgkin’s Lymphoma, chemotherapy kyphoplasty and diabetes. I thank God every day for all of you. PATIENT ENROLLED IN KEPRO MEDICATION BASED METRICS AND CASE MANAGEMENT PROGRAM Optimizing Case Staffing Incentives Management Outreach Volume for Med Adherence Driving more effective, efficient medication adherence CM Program More than 75 percent of all healthcare costs Documentation are related to chronic health conditions — including diabetes, heart disease, Population hypertension and mental illness — whose Volume treatment commonly includes long-term medications. Contract Info But since an estimated 50 percent of patients don’t take medications as Program Inputs prescribed, proactive engagement with Cost members, pharmacists and physicians provides a golden opportunity for case Targeted Chronic 1 managers to support collaboration and Disease treatment goal success. They also provide Analysis Data a platform that case managers can use to Lake address specific medication-adherence Atrezzo barriers, from social and economic factors Platform to patients’ motivations and level of physical or cognitive impairment. © 2020 KEPRO | All rights reserved

Data Activities Outputs Analytics PharmD Analysis of: Number of members • Adherence and non-adherence active / inactive / MD declined rates (at Member + Client level) Professionals • Adherence and non-adherence Program reach rate Care Process RxPert costs Baseline and monthly / Management quarterly analysis of Templates* 3 Rx Information for members participating Refining CM Member 2 © 2020 KEPRO | All rights reserved Selection Criteria: * Covering a range of areas • Number of medications of special interest, including • High-risk medications MS, diabetes, hepatitis, HIV, • Cost of medications (e.g. oncology biologics, cystic fibrosis, etc. Hepatitis C) • Complexity of medication adherence • Medication with severe side effects that impact compliance • Member SDOH assessment • Member cognitive and support assessment

Benefits JEFFREY MCWILLIAMS, MD OREGON CASE STUDY Medical Director | Kepro Improve Key Metrics Kepro Medication Adherence at Work: Even missing two or three doses Hepatitis C in Oregon Population Acceptance • Savings • Patient Satisfaction [of hepatitis C medications] can lead to failure of the treatment Some medications require more monitoring and are very dependent upon medication 97.5% and the need to restart from adherence. Two examples are anti-psychotic medications and direct-acting antivirals for the beginning . . . we know hepatitis C treatment. EXAMPLE Percentage of [STATE] Funds Beneficiaries who were that left to manage their own Satisfied/Very Satisfied with the CM Program (CY 2019) medications, at best, 40% Some quick background: Hepatitis C causes liver failure, cirrhosis, liver cancer and death. of patients follow prescribed Estimates are that as many as 6% of “Baby Boomer”-era Americans are infected. Hepatitis C Exceed National Baselines instructions. is now curable with medication (called direct acting antivirals, or DAA). The drugs are oral and taken once a day. Success is very dependent upon adherence. Treatment takes 12 – 24 weeks. Trended HEDIS Rates for Medication Management Metrics for Even missing two or three doses can lead to failure of the treatment and the need to restart Hillsborough County [STATE] show increased compliance over treatment from the beginning. Treatment is very expensive and can cost as much as $1,000 baseline and success against National Benchmarks per pill. We know that left to manage their own medications, at best, 40% of patients follow prescribed instructions. Generate Cost Savings In Oregon, we did a collaborative project with Kepro, the Oregon Health Authority and the ~ $5M Oregon State University College of Pharmacy. When a member was identified as needing hepatitis C DAA treatment, they were assessed by a nurse who coordinated care with the EXAMPLE Savings generated for the State of Oregon through a prescribing physician and dispensing pharmacy. Once the member began therapy, a care hepatitis C program that achieved 98% adherence rate coordinator (a non-licensed individual) called the member each day while in treatment to remind the member to take the medication. We achieved an adherence rate of >98%. Reduce ED Admissions We have served about 100 members in this way. If we assume 60% of members would not have taken their medication as prescribed and half of those had to have a repeat cycle of treatment, this intervention saved an estimated more than $5,000,000. That figure does not include the potential savings of the costs for treating liver cirrhosis or liver cancer. EXAMPLE 50% Percentage drop in complications admissions among new diabetes [STATE] Funds patients with CM outreach Improve Care Coordination Target Highest-Cost, Highest-Risk Members www.kepro.com [email protected] | 800.222.0771