The Study

Precision Medicine-Based Complex Case Management Research Study

Pharmacogenomic testing and case management for members with complex chronic disease.

Study Lead

Dr. Kimberly Jinnett

The Center for Workforce Health and Performance (CWHP), led by Dr. Kimberly Jinnett, will study the outcomes of employee populations after medical genomics are facilitated, case managed, and applied in high-risk, highly complex plan members. This study will focus on clinical and cost reduction outcomes of medical genomics in employee populations. The entire medical genomic process will be facilitated by Rx-Precision.

Introduction

The Cost of Non-optimized Prescriptions

Most prescription drugs are “one size fits all,” but they don’t work the same way for everyone. Therefore, it’s difficult to predict who will benefit from a medication, who will not respond at all, and who will experience negative side effects. This is especially true for high-cost, high-risk patients with complex chronic disease and polypharmacy.

5

These “non-optimized” medications result in an estimated $528 billion in annual healthcare costs and $200 billion in unnecessary and inappropriate prescription drug utilization1

5

Adverse drug reactions, often caused by non-optimized medications are the fourth leading cause of death and account for 7% of all hospital admissions and 20% of readmissions2, 3

5

Furthermore, many important classes of drugs are effective in only 25-60 percent of the patient population4

Pharmacogenomics is Underutilized

Pharmacogenomics (PGx), the study of how genes affect a person’s response to drugs is potetnial tool to help clinicians prescribe medications with more precision, but is under-utilized in the clinical setting due to:5
5

Low physician awareness, knowledge and interpretation

5

Lack of access to laboratory services

5

A Lack of time and resources to educate patients

5

Lack of time or resources to educate patients

A NEW APPROACH

PGx-Guided Care™

Identifies high-risk, high-cost patients who will clinically benefit from PGx testing and guides them and their physician through the entire testing and medication optimization process

Study Objective

The objective of this industry-sponsored study is to measure the clinical, financial and implementation outcomes of a turnkey Pharmacogenomics intervention designed specifically for payors. The intervention Identifies high-risk, high-cost employees and health plan members with complex chronic disease who have a medical necessity for a PGx test and guides them and their physician through the entire testing and medication optimization process.

Material and Methods

agsdi-bar-chart-2

Inclusion Criteria

A minimum of 2,000 high-risk, high cost members with a medical necessity for a PGx intervention will be identified via claims data.

agsdi-adjust-circle-horiz

Test Selection and Tracking

Members opting-in will be matched to the optimal PGx panel and be supported through a clinical genomic case management process and paired with a genetic counselor.

agsdi-people

Member Enrollment

Members meeting the research criteria will receive education about the study and given the option to opt-in.

agsdi-stethoscope

Genetic Counseling and CDS

The member’s physician will be provided with tools, education, and peer-to-peer clinical decision support to implement treatment changes securely and immediately.

Study Endpoints

Clinical Outcomes

Each study participant will provide baseline pre-intervention clinical data relevant to their current clinical condition. This data will be studied against post-interventional data at intervals of 3, 6 and 12 months to show the effectiveness of the intervention on improving clinical outcomes.

Example Clinical Data Include:

5

Blood Pressure

5

Glucose and A1c

5

BMI

5

Waist/Hip Measurement

5

Symptoms Related to Diagnosis

Process Outcomes

Once the intervention is complete, each study participant, their physician and their employer or health plan will be offered the opportunity to answer brief questionnaires gathering their experience with the intervention, care coordination process and value of the intervention.

Example Clinical Data Include:

5

Member Participants: QOL, Care Satisfaction, Stress, Absenteeism, Presenteeism, Productivity

5

Physician Experience: Care Coordination, Integrating New Technology, Quality of Care

5

Health Plan Experience: Cost Concerns, Implementation via Plan & Providers, Care Coordination

Claims and Cost Outcomes

Medical and pharmaceutical claims data including but not limited to utilization, prevalence of services, dosages, claims patterns and costs will be studied pre and post intervention to evaluate the effectiveness of the intervention in reducing claims costs. Claims data will be studied in both the participant group as well as the control group that qualified for the intervention but opted-out. Controls will be in place to ensure data reported is accurate and accounts for outliers and regression.

Our Partners

Co-founded by Mayo Clinic. Have the most comprehensive, cost-effective PGx test on the market.

Backed by JP Morgan. Delivers genetic counseling to patients and CDS to healthcare providers.

Leading microbiome and RNA sequencing company with the highest resolution of a person’s gut microbiome.

Study Sponsors

Employers

Medicare Advantage Health Plans

Managed Medicaid Plans

Commercial Health Plans

Third-Party Administrators

Payor Benefits

agsdi-doctor

Independently-validated Data

Independently-validated data around a new option for helping high-risk members get better clinical outcomes

agsdi-heartbeat

Full Study Results

Full study results including all clinical, process and claims outcomes

agsdi-dollar

Lower Costs

Potentially lower pharmacy and medical costs for your highest-risk, complex patients

agsdi-people

Member Impact Analysis

Pharmacogenomic impact analysis of your entire member population

agsdi-flash

Improve Employee Productivity

Potentially improved employee absenteeism, presenteeism and productivity

Billed as a Medical Claim

Because we contract with payors as a healthcare provider, PGx-Guided Care™ can be billed to your claims fund as a medical claim (the same way an MRI is billed).

Cost to Participate

The objective of this industry-sponsored study is to measure the clinical outcomes, process outcomes and claims and cost outcomes of the PGx-Guided Care solution for high-risk, high-cost employees and health plan members with a medical necessity for a PGx intervention.

The fees will be used to fund the research staff and process, clinical genomic case management process, telemedicine genetic specialists for participants and peer-to-peer clinical decision support for physicians, PGx testing and analysis and reporting and publishing of the research once the study has concluded. For reference this fee is approximately 50%-90% of Medicare reimbursement for only the PGx test and analysis.

Let’s Get Started

Recieve a complimentary medication risk analysis for your entire member population

Testimonials

Professional Response

“With this advanced genetic test, you can finally take your life back. Free of pain and free of the adverse side effects from medications that aren’t right for you. You can finally feel like you. No more hassle to take four, six or eight pills a day. Now you have the ability to know what will work and what won’t work with your body. No more guesswork is involved. You’re not a science experiment and you shouldn’t have to feel that way.”

Cindy Reed, R.N., PhD

Physician Response

“A.P. is a 41 year old woman with cutaneous lupus, hypertension, diabetes, and chronic pain. She has made great progress with lifestyle changes, but continues to depend on 13 prescription medications to control her symptoms. Your test fortunately revealed that most of the medications she is taking work well with her genetics. She did learn that her body requires higher doses of 2 of her chronic medications to be most effective. She also learned that one of the medications her rheumatologist has suggested for her lupus would NOT be metabolized safely by her body, so she has deferred starting it. She feels empowered by these results to stay consistent with the lifestyle modifications that she knows reduce her inflammation.”

Julia Buchkina, MDCindy Reed, R.N., PhD

Member Response

“Thank you so much for calling me. I am  so happy my insurance covers this test! I  didn’t even know a test like this existed. I  have been having a lot of trouble with my  psych meds and this will be helpful. Wow!  This is really great news!”

Anonymous Health Plan Member

Read More

For Payors

A turnkey pharmacogenomics risk management and medication optimization platform for employers, health plans, third-party administrators and other payors

Improving Clinical Outcomes

Read more about the people behind it all.

The Science

Numerous clinical studies have documented that PGx testing leads to improved clinical outcomes and significant costs savings in the right patient populations.

1. Annals of Pharamcotherapy, 2018. Vol. 52(9) 829-837

2. Lazarou J, Pomeranz BH, Corey PN. JAMA . 1998 Apr 15;279(15):1200-5.

3. Foster, A.J., Murff, H.J., Peterson, J.F. et al. (2003). Ann Intern Med, 2003 Feb 4; 138(3)

4. Spear BB, Health-Chiozzi M, Hu J: Clinical Applications of Pharmacogenetics. Trends Mol. Med. 7, 201-204 (2001)

 

5. Sudia, Jason, “Exploring Barriers to the Adoption of Pharmacogenomic Technology in the Clinical Setting by Clinical Healthcare Providers” (2016) 138(3).

6. J. Med Econ. 2016;19(3): 213-28 Epub Nov 11, 2015.

7. Plos ONE 12(2): e0170905. https://doi.org10.1371/journal.pone.170905.

8. Sudia, Jason, “Exploring Barriers to the Adoption of Pharmacogenomic Technology in the Clinical Setting by Clinical Healthcare Providers” (2016) 138(3).

Resources

Privacy

Terms of Use

Copyright 2019 © Rx-Precision, Inc. All rights reserved.

Rx-Precision, Inc.
2945 Townsgate Rd.
Suite #200
Westlake Village, CA 91361

The Study

Precision Medicine-Based Complex Case Management Research Study

Pharmacogenomic testing and case management for members with complex chronic disease.

Study Lead

Dr. Kimberly Jinnett

The Center for Workforce Health and Performance (CWHP), led by Dr. Kimberly Jinnett, will study the outcomes of employee populations after medical genomics are facilitated, case managed, and applied in high-risk, highly complex plan members. This study will focus on clinical and cost reduction outcomes of medical genomics in employee populations. The entire medical genomic process will be facilitated by Rx-Precision.

Introduction

The Cost of Non-optimized Prescriptions

Most prescription drugs are “one size fits all,” but they don’t work the same way for everyone. Therefore, it’s difficult to predict who will benefit from a medication, who will not respond at all, and who will experience negative side effects. This is especially true for high-cost, high-risk patients with complex chronic disease and polypharmacy.

5

These “non-optimized” medications result in an estimated $528 billion in annual healthcare costs and $200 billion in unnecessary and inappropriate prescription drug utilization1

5

Adverse drug reactions, often caused by non-optimized medications are the fourth leading cause of death and account for 7% of all hospital admissions and 20% of readmissions2, 3

5

Furthermore, many important classes of drugs are effective in only 25-60 percent of the patient population4

Pharmacogenomics is Underutilized

Pharmacogenomics (PGx), the study of how genes affect a person’s response to drugs is potetnial tool to help clinicians prescribe medications with more precision, but is under-utilized in the clinical setting due to:5
5

Low physician awareness, knowledge and interpretation

5

Lack of access to laboratory services

5

A Lack of time and resources to educate patients

5

Lack of time or resources to educate patients

A NEW APPROACH

PGx-Guided Care™

Identifies high-risk, high-cost patients who will clinically benefit from PGx testing and guides them and their physician through the entire testing and medication optimization process

Study Objective

The objective of this industry-sponsored study is to measure the clinical, financial and implementation outcomes of a turnkey Pharmacogenomics intervention designed specifically for payors. The intervention Identifies high-risk, high-cost employees and health plan members with complex chronic disease who have a medical necessity for a PGx test and guides them and their physician through the entire testing and medication optimization process.

Material and Methods

agsdi-bar-chart-2

Inclusion Criteria

A minimum of 2,000 high-risk, high cost members with a medical necessity for a PGx intervention will be identified via claims data.

agsdi-adjust-circle-horiz

Test Selection and Tracking

Members opting-in will be matched to the optimal PGx panel and be supported through a clinical genomic case management process and paired with a genetic counselor.

agsdi-people

Member Enrollment

Members meeting the research criteria will receive education about the study and given the option to opt-in.

agsdi-stethoscope

Genetic Counseling and CDS

The member’s physician will be provided with tools, education, and peer-to-peer clinical decision support to implement treatment changes securely and immediately.

Study Endpoints

Clinical Outcomes

Each study participant will provide baseline pre-intervention clinical data relevant to their current clinical condition. This data will be studied against post-interventional data at intervals of 3, 6 and 12 months to show the effectiveness of the intervention on improving clinical outcomes.

Example Clinical Data Include:

5

Blood Pressure

5

Glucose and A1c

5

BMI

5

Waist/Hip Measurement

5

Symptoms Related to Diagnosis

Process Outcomes

Once the intervention is complete, each study participant, their physician and their employer or health plan will be offered the opportunity to answer brief questionnaires gathering their experience with the intervention, care coordination process and value of the intervention.

Example Clinical Data Include:

5

Member Participants: QOL, Care Satisfaction, Stress, Absenteeism, Presenteeism, Productivity

5

Physician Experience: Care Coordination, Integrating New Technology, Quality of Care

5

Health Plan Experience: Cost Concerns, Implementation via Plan & Providers, Care Coordination

Claims and Cost Outcomes

Medical and pharmaceutical claims data including but not limited to utilization, prevalence of services, dosages, claims patterns and costs will be studied pre and post intervention to evaluate the effectiveness of the intervention in reducing claims costs. Claims data will be studied in both the participant group as well as the control group that qualified for the intervention but opted-out. Controls will be in place to ensure data reported is accurate and accounts for outliers and regression.

Our Partners

Co-founded by Mayo Clinic. Have the most comprehensive, cost-effective PGx test on the market.

Backed by JP Morgan. Delivers genetic counseling to patients and CDS to healthcare providers.

Leading microbiome and RNA sequencing company with the highest resolution of a person’s gut microbiome.

Study Sponsors

Employers

Medicare Advantage Health Plans

Managed Medicaid Plans

Commercial Health Plans

Third-Party Administrators

Payor Benefits

agsdi-doctor

Independently-validated data

Independently-validated data around a new option for helping high-risk members get better clinical outcomes

agsdi-heartbeat

Full Study Results

Full study results including all clinical, process and claims outcomes

agsdi-dollar

Lower Costs

Potentially lower pharmacy and medical costs

agsdi-people

Member Impact Analysis

Pharmacogenomic impact analysis of your entire member population

agsdi-flash

Improve Employee Productivity

Potentially improved employee absenteeism, presenteeism and productivity

Billed as a Medical Claim

Because we contract with payors as a healthcare provider, PGx-Guided Care™ can be billed to your claims fund as a medical claim (the same way an MRI is billed).

Cost to Participate

The objective of this industry-sponsored study is to measure the clinical outcomes, process outcomes and claims and cost outcomes of the PGx-Guided Care solution for high-risk, high-cost employees and health plan members with a medical necessity for a PGx intervention.

The fees will be used to fund the research staff and process, clinical genomic case management process, telemedicine genetic specialists for participants and peer-to-peer clinical decision support for physicians, PGx testing and analysis and reporting and publishing of the research once the study has concluded. For reference this fee is approximately 50%-90% of Medicare reimbursement for only the PGx test and analysis.

Let’s Get Started

Recieve a complimentary medication risk analysis for your entire member population

Testimonials

Professional Response

“With this advanced genetic test, you can finally take your life back. Free of pain and free of the adverse side effects from medications that aren’t right for you. You can finally feel like you. No more hassle to take four, six or eight pills a day. Now you have the ability to know what will work and what won’t work with your body. No more guesswork is involved. You’re not a science experiment and you shouldn’t have to feel that way.”

Cindy Reed, R.N., PhD

Physician Response

“A.P. is a 41 year old woman with cutaneous lupus, hypertension, diabetes, and chronic pain. She has made great progress with lifestyle changes, but continues to depend on 13 prescription medications to control her symptoms. Your test fortunately revealed that most of the medications she is taking work well with her genetics. She did learn that her body requires higher doses of 2 of her chronic medications to be most effective. She also learned that one of the medications her rheumatologist has suggested for her lupus would NOT be metabolized safely by her body, so she has deferred starting it. She feels empowered by these results to stay consistent with the lifestyle modifications that she knows reduce her inflammation.”

Julia Buchkina, MDCindy Reed, R.N., PhD

Member Response

“Thank you so much for calling me. I am  so happy my insurance covers this test! I  didn’t even know a test like this existed. I  have been having a lot of trouble with my  psych meds and this will be helpful. Wow!  This is really great news!”

Anonymous Health Plan Member

Read More

For Payors

A turnkey pharmacogenomics risk management and medication optimization platform for employers, health plans, third-party administrators and other payors

Improving Clinical Outcomes

Read more about the people behind it all.

The Science

Numerous clinical studies have documented that PGx testing leads to improved clinical outcomes and significant costs savings in the right patient populations.

1. Annals of Pharamcotherapy, 2018. Vol. 52(9) 829-837

2. Lazarou J, Pomeranz BH, Corey PN. JAMA . 1998 Apr 15;279(15):1200-5.

3. Foster, A.J., Murff, H.J., Peterson, J.F. et al. (2003). Ann Intern Med, 2003 Feb 4; 138(3)

4. Spear BB, Health-Chiozzi M, Hu J: Clinical Applications of Pharmacogenetics. Trends Mol. Med. 7, 201-204 (2001)

5. Sudia, Jason, “Exploring Barriers to the Adoption of Pharmacogenomic Technology in the Clinical Setting by Clinical Healthcare Providers” (2016) 138(3).

6. J. Med Econ. 2016;19(3): 213-28 Epub Nov 11, 2015.

7. Plos ONE 12(2): e0170905. https://doi.org10.1371/journal.pone.170905.

8. Sudia, Jason, “Exploring Barriers to the Adoption of Pharmacogenomic Technology in the Clinical Setting by Clinical Healthcare Providers” (2016) 138(3).

 

Copyright 2019 © Rx-Precision, Inc. All rights reserved.

Rx-Precision, Inc.
2945 Townsgate Rd.
Suite #200
Westlake Village, CA 91361