Costs Avoided by Network 8 PBM
$4,033,789
$18,129,848
$34,484,025
$58,866,612
$79,640,676
$102,317,644
$129,110,473
$142,128,045
$167,544,442
$206,415,470
$224,466,137
$245,656,605
FY99
FY00
FY01
FY02
FY03
FY04
FY05
FY06
FY07
FY08
FY09
FY10 est
1999
-
2000
STORM/FORM
RECYCLED
DATA
MART
DEVELOPED,
PRINCIPLES &
RULES PACT
INITIATES
COLLABORATION
BEST CONTRACT
COMPLIANCE
MED
SAFETY:
NARCOTICS
DRUG DRUG
INTERACTIONS
MONITOR LABS:
SPLIT TABLETS
GLUCOSE STRIPS
NOT ON INSULIN
1999
-
2005
NORM
ING
:
SELF BENCHMARK:
LAST YEAR'S
AVG
ACHIEVEMENT
INDICATORS FOR
ACCOUNTABILITY
TO EACH OTHER:
LOW HANGING
FRUIT AND WIND
FALLS
--
eg
AB RATED
NITRO SL GENERIC
PARETO CHARTS
UNIQUE TO SITE
ONE "
BYE"per
SITE
UNIFORM DATA
PRECISE DEFINITION
1999
-
2000
-
2001
-
2002
-
2003
-
2004
-
2005
--------------------------------------
2006
-
2007
-
2008
-
2009
-
2010
2006
-
2010
NORM
ING
:
NATIONAL BENCHMARK:
LAST YEARS BEST 3
VISNS
PERFORMING
2000
-
MED
SAFETY SPIN OFF
2001
-
DATAMART
-
VISN
4,7,8
2001
-
TECHNOLOGY FINALIST
2001
-
First
VISN
8 MAP
Mbr
2004
-
Award winning
STATIN
SPLIT
TAB Paper at Am Heart
Asso
2005 Am J Cardiology Publication
2005
Copay
Revenue Accuracy
2009 5
VISN
8 MAP
Mbrs
2010 Orlando Drug File Collaboration
Additional slides about
Collaborative
Data Mining in Rapid
ly
Changing Environments
Robert Goodhope, MD, MBA
CMO Tallahassee VA Outpatient Clinic
Chair Network 8 Pharmacy Utilization Committee
Summary in Non
-
technical terms
§
Synergy from Melding Business Principles, Clinical
Knowledge and Data Technology
§
Network 8 Pharmacy Benefits Collaboration
l
Desperately Needed a
Low Cost
Centralized Pharmacy
Information Support System. Completed
-
1999
l
Struggled with Many PBM Processes and Discovered
Stark, Wheatley, Snowantle & others
--
1999
-
Present
FOR MORE INFO...
Look at the VISN 8 Home Page (http://vaww.visn8.med.va.gov)
Data Recycled
for Data Mining
§
Raw Outpatient Pharmacy Data
l
Emailed to National for One VA formulary
l
Copy Emailed to Server for Network 8 DataMart
§
Operational Transactions become Uniform
Archival Data when transformed to
Thirty Day
Equivalent Rx *
in
S
erver Query Language
l
*Allows accurate Financial Metric comparisons
l
* Sine qua None Innovation by VISN 8 PBM
l
Accessible to Trained Searchers at each Facility
Data Mining Evolution
& Benefits
§
Data Mining Operations:
l
Prospecting, Nuggets
l
Test Holes
l
Mining Veins of Data
l
Refining “Mother Lode” into Beneficial Information
§
Data Mining Benefits:
l
Review: Outcomes Oriented Resource Utilization
l
Monitor: Effectiveness of Formulary decisions
l
Practice Trending: Drug Use and Lab Results
Test Hole: Top 25 Drugs=45% of Drug Cost
Veins of Data: Cost Position by Quarter
Q1FY01
Total Cost
Q2FY01
Total Cost
Q3FY01
Total Cost
Q4FY01
Total Cost
SIMVASTATIN
#
SIMVASTATIN
#
SIMVASTATIN
#
SIMVASTATIN
#
LANSOPRAZOLE
#
LANSOPRAZOLE
#
LANSOPRAZOLE
#
OLANZAPINE
#
OLANZAPINE
#
OLANZAPINE
#
OLANZAPINE
#
GABAPENTIN
#
METFORMIN
#
METFORMIN
#
METFORMIN
#
METFORMIN
#
GABAPENTIN
#
GABAPENTIN
#
GABAPENTIN
#
EPOETIN
#
FELODIPINE
#
FELODIPINE
#
FELODIPINE
#
FELODIPINE
#
EPOETIN
#
EPOETIN
#
EPOETIN
#
CLOPIDOGREL
#
SERTRALINE
#
SERTRALINE
#
CLOPIDOGREL
#
ALBUTEROL
#
ALBUTEROL
#
CLOPIDOGREL
#
SERTRALINE
#
SERTRALINE
#
FLUOXETINE
#
ALBUTEROL
#
ALBUTEROL
#
FLUOXETINE
#
CLOPIDOGREL
#
FLUOXETINE
#
FLUOXETINE
#
LANSOPRAZOLE
#
GOSERELIN
#
GOSERELIN
#
GOSERELIN
#
RISPERIDONE
#
LAMIVUDINE
#
LAMIVUDINE
#
LAMIVUDINE
#
ROSIGLITAZONE
#
TERAZOSIN
#
RISPERIDONE
#
RISPERIDONE
#
LAMIVUDINE
#
RISPERIDONE
#
PAROXETINE
#
ROSIGLITAZONE
#
GOSERELIN
#
REBETRON
#
IPRATROPIUM
#
PAROXETINE
#
REBETRON
#
IPRATROPIUM
#
SURE STEP
#
SURE STEP
#
PAROXETINE
#
PAROXETINE
#
INSULIN
#
INSULIN
#
SURE STEP
#
INSULIN
#
ROSIGLITAZONE
#
IPRATROPIUM
#
FOSINOPRIL
#
SURE STEP
#
FOSINOPRIL
#
FOSINOPRIL
#
INSULIN
#
FOSINOPRIL
#
REBETRON
#
REBETRON
#
DONEPEZIL
#
BECLOMETHASONE
#
FEXOFENADINE
#
DONEPEZIL
#
IPRATROPIUM
#
ROSIGLITAZONE
#
LISINOPRIL
#
LISINOPRIL
#
RABEPRAZOLE
#
LISINOPRIL
#
DONEPEZIL
#
TERAZOSIN
#
LATANOPROST
#
DONEPEZIL
#
BECLOMETHASONE
#
FEXOFENADINE
#
CITALOPRAM
#
“Well begun is Half done . . . 49.7% of
Benefit comes from 1% of effort.”
1%
50%
19%
30%
30%
19%
50%
1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
1% : 50%
20% : 80%
50% : 99%
WASTED
LAW OF EVENTUALLY DIMINISHING RETURNS
EFFORT
BENEFIT
VISN 8 Lost Opportunity Cost
Annualized based on Q3FY01
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
$1,400,000
Olanzapine
Citalopram
SimvTS
Strips/Day
OxySA
Divalproex
Amlodipine
Fexofenadine
COX-2
ParoxTS
Carvedilol
SertTS
Tamsulosin
CitaloTS
OlanzTS
Cilostazol
RisperTS
Irbesartan
Pareto Line
Having Picked the Low Hanging Fruit
And Having Shaken Tree
--
The Pony
Waits For Windfalls
--
Hoping for
Branch Lowering Technology or
Something New to stand upon
The Soft Stuff of
Managing Innovations
Paradox:
Innovations
Require Conventions
Most Important Where Change
Most Rapid
--
Margaret Wheatley
He leads best who leads least, so in the
end, they know they did it themselves
-
Lao Tse
And form a Social Network which Outlives
the Initial Collaboration
–
David Stark
www.santafe.edu
$
1/4 Billion Cost Avoided &
A Seminal Publication
Parra D, Beckey N, Raval H, Schnacky K,
Calabrese V, Coakley R, Goodhope R
Effects of Splitting Simvastatin Tablets for
Control of Low Density Lipoprotein Cholesterol
American Journal of Cardiology
2005
95(12):1481
-
83. Cited 12 times (in addition to
the Popular Press)
theledger.com
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