The city of Toledo, Ohio, implemented over 5,100 members on March 1, 2017 with OptumRx. Known as the Glass city because of its strong presence in the glass and auto manufacturing industry, Toledo is by no means fragile. Toledo's heavy dependence on manufacturing has made it particularly susceptible to the country's economic lows, but the city has bounced back each time through revitalization and redevelopment efforts.
The city selected a full suite of OptumRx services, contracting with OptumRx as a member of the Health Action Council (HAC). HAC is a non-profit organization that serves as a resource for employers, leading efforts to improve quality, safety, efficiency and affordability throughout health care. Leveraging OptumRx services and the relationship with HAC led to increased savings for the City of Toledo, as well as additional opportunities to learn from, and collaborate with, partners facing some of their same challenges.
- Transition 5,100+ members without disruption
- Implement a set of new clinical and specialty programs to decrease PMPM costs
- Achieve transparency and open communication resulting in timely resolution of member issues
- Build a strong partnership rooted in a shared vision for exceptional customer service
The city selected a full suite of OptumRx services including: premium formulary, retrospective drug utilization reviews (RDUR), medication therapy management and adherence programs, specialty SmartFill (90 day), Select 90 program with CVS pharmacies, exclusive Optum Specialty Pharmacy services, medical file integration, and utilization management.
In preparation for the implementation, the OptumRx team worked closely with the City of Toledo to understand all of the requirements; the team met regularly with the city to track progress as it approached implementation. The OptumRx team included senior implementation managers, account management, a pharmacy services specialist, a clinical consultant, a specialty account executive and an eligibility analyst. As stated by the city’s plan administrator, “We implemented our solutions from OptumRx within a very tight timeframe. From conception to implementation, the support we received from OptumRx was incredible. The team, with its account managers, analysts and pharmacist, ensured that each hand-off to another team was smooth. We received superior support and customer service without disruption to our daily operations.”
OptumRx paid special attention to members using specialty medications. These members received a phone call from an Optum Specialty Pharmacy representative to ensure members felt comfortable and aware of the change to their specialty medication provider. Phone outreach also minimized disruption. To avoid additional disruption, OptumRx sent targeted mailings to some members regarding premium formulary exclusions and lower-cost alternative medications, specialty SmartFill services, and available diabetes programs.
An RDUR safety management program to target unsafe and clinically inappropriate therapy added prescriber interventions, while the gaps in care program identified and closed gaps in medication therapy for chronic disease while improving compliance and lowering overall cost through prescriber intervention.
At the end of the first year, OptumRx reported outcomes to the city. All implementation performance guarantees were exceeded or met. All timeframes for completion were met or exceeded. The implementation participating group rating was 100% satisfaction.
The human resources analyst from the city applauded the flexibility and responsiveness of the OptumRx account team. “Any time we needed more information or presented the team with a challenge, they quickly reviewed our concerns and came back with solutions that would benefit the City of Toledo and our members. Admittedly, we were hesitant early on about the enormous size of OptumRx and the flexibility they could offer us; however, we never felt lost in the shuffle – the team is responsive and quickly resolves member issues.”
By the end of their first year with OptumRx, the city was already seeing positive trend changes. Mail order utilization was at 17% compared to the 13% norm for municipalities. And the implementation of the Select 90 program with CVS pharmacies, allows members to fill 90 day prescriptions at their local CVS pharmacy. This has received very positive feedback from City of Toledo employees, appreciating the convenience and cost savings it offers.
On the heels of a very successful implementation, the city moved rapidly to deploy additional programs, including an Opioid Management Program with prevention, utilization management, enhanced concurrent drug utilization review and enhanced plan design. Due to the devastating effect the opioid epidemic has particularly had in Ohio, this was especially vital.
Due to their high cost, specialty drugs often have the biggest impact on overall costs. Specialty PMPM spend for the city was at only 34% of overall spend, compared to the employer average spend of 39%. The highest spend was in diabetes and inflammatory conditions.
Following implementation, OptumRx issued a client survey and received a rating of 5 out 5 by the City of Toledo for overall satisfaction with their implementation experience. The client also commented they would be likely to recommend OptumRx, and rated an average of 4.8 out of 5 on all satisfaction survey questions. The city’s plan administrator commented, “The support of the OptumRx team is amazing; OptumRx is not just a vendor, they are our partner and work alongside us to do what is best for the City of Toledo.”
5 questions: Optum Rx chief pharmacy officer
Taking the Pain Out of Prior Authorization
Learn how we can help solve your challenges
STATEMENT REGARDING FINANCIAL INFLUENCE:
This article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor Optum Rx has accepted any form of compensation for the preparation or distribution of this article.