Costs Avoided by Network 8 PBM

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