Strengthening the connection between pharmacy and health care
Our team is changing the way pharmacy care is offered — making this primary consumer touchpoint more accessible and affordable.
Dr. Sumit Dutta | May 7, 2021
It’s easy to understand why the pharmacy ranks among the most frequent consumer touch points in health care. Half of Americans take at least one prescription drug each month and 40% of U.S. adults are managing two or more chronic conditions. Perhaps researchers weren’t surprised when they found that visits to pharmacies outnumbered trips to a primary care doctor two to one.
Every interaction between the health system and an individual is a precious opportunity to impact overall health. That means contact with your pharmacy — whether in person, online or by phone — can represent much more than a simple transaction.
That’s why we focus on treating the whole person, not just filling the prescription.
It’s clear that pharmacy is going to play a growing role in the design and delivery of better health care for everyone. That’s why OptumRx is focusing on three important areas: tailoring experiences to evolving consumer expectations, simplifying what it takes to access specialty medication, and better integrating pharmacy and mental health needs.
See the whole person, not the condition
What's the role of pharmacies in whole person care? Hear Dr. Dutta's perspective, as told to the Washington Post.
The pharmacy's role in whole-person care is essential because pharmacy is the most accessed benefit in healthcare. If you think about a patient and the way that they engage the healthcare system, they are a set of conditions. Maybe they're diabetic, maybe they're hypertensive. They are a set of drugs that they take, but then if you meet that same person outside in the real world, then they're a human with a set of needs, emotional needs, nutritional needs, financial needs. When you begin to look at a person that way, as we do here at OptumRx, you begin to take into account that patient as a whole person and begin to address their needs that way.
Meeting new and emerging consumer expectations
Our pharmacy care services business connects directly with over 700,000 individuals every day. Serving this many people is a huge responsibility. It’s also a considerable challenge. That’s why we’re doing our part to up the game in terms of convenience, cost savings and community.
Convenience without sacrificing support
While home delivery of medications has always offered convenience and cost savings, it gained new meaning during the COVID-19 pandemic. We saw a notable increase in the demand for home delivery service in 2020, and it will continue to be a critical part of satisfying growing consumer preferences.
But valuable innovation lies in pairing delivery options with virtual support. Telehealth solutions offer individuals with OptumRx prescription benefits the chance to talk with pharmacists about their medications, drug interactions, dosing and side effects.
They also create opportunities to enhance personalized care over the phone with our Next Best Action program, enabling call center agents to make actionable, data-driven health recommendations to individuals in near real-time.
Anticipating the needs of members
Watch how we use predictive modeling and machine learning to provide simple, affordable and personal care, in turn helping us improve experiences and outcomes for everyone we serve while reducing the total cost of care.
For many people, getting the right care and medications they need to stay healthy can be frustrating and confusing. What if there was a better way to provide accurate information with clear choices? And what if we could also determine the best health and savings opportunities, at the best time, for each member?
Guess what? We can.
Just imagine 2-patients with similar conditions. Through intelligence and analytics we can now predict which patient is more likely to join a care management program, changing the course of their health. Or switch to a lower-cost medication to increase savings. How do we do it? When we engage with a member, we integrate all available data points; giving us a holistic view, so we can focus on individual needs. Then, using leading edge predictive modeling and machine learning; made possible through OptumIQ, weâ€™re able to predict the best health and savings options for each individual.
Regardless of how and when the member is engaged, theyâ€™re presented with the best opportunities, ranked by the probability they will accept the option. By personalizing the choices, weâ€™re increasing engagement and acceptance.
In fact, OptumRx members accept health and savings offers more than 60% of the time, which is far higher than traditional outreach methods. Because of OptumIQ and machine learning, recommendations have increased member acceptance rates by 3 times more than average. Predictive modeling and machine learning is a win for plan sponsors too, because providing better choices can drive down the total cost of care. The more complex health care becomes, the more we are simplifying the experience with easy to use tools, and personalized health and savings opportunities when and where needed. To learn more about how weâ€™re improving care and lowering costs, visit Optum.com/optumrx.
Supporting medication affordability
Even when we place consumer experience front and center, we won't realize the value of additional services if someone does not fill their prescription. In fact, one out of four people still struggle to afford their medication.
Those with insurance are often at an advantage when it comes to medication costs, but even insured individuals may struggle with the price of deductibles and copays.
One way to save money on prescriptions is through discount cards. Optum® Perks, now offered digitally and free to all Americans — including those without a pharmacy benefit — allows users to search savings on current prescriptions.
This easy-to-use web and mobile solution offers savings accepted at more than 67,000 pharmacies across the country.
Another option is to increase awareness of lower-cost alternatives. MyScript Finder™ is a digital tool available to those with OptumRx benefits. Members can use MyScript Finder to locate the best medication at the best price, based on their plan.
Using MyScript Finder is leading to an average member savings of $40 per prescription.
If the pandemic has underscored anything, it’s that we still need community, even when we are at a distance. Individuals managing complex conditions and those in need of specialty medications now have a place for support.
The Optum Connections video series serves up virtual resources catered to the needs and experiences of members with specific conditions, from cancer to hemophilia to multiple sclerosis and more.
Members can get help to better understand their condition, how to prevent and manage side effects, and get lifestyle and nutrition support. Being apart does not mean confronting conditions on your own.
Enhancing support for the increased use of specialty medication
A growing number of people need specialty drugs — complex medications that have special administration and management considerations. These drugs offer tremendous hope but often at very high costs.
It’s becoming more and more critical to focus on delivering specialty pharmacy solutions that meet a patient’s needs while also managing their total cost of care.
Optum uses pharmacy, lab, medical benefit data and more to create a 360-degree view of each patient. This complete picture helps clinicians in two crucial pharmacy care areas that impact individuals’ overall experience and costs. They are:
- Medication decision support: Personalized insights can support the prescribing physician’s decision-making by offering detailed clinical guidance to select the best medication.
- Care location decision support: Analytics help guide the physician and patients toward the best care setting for administering these medications. This may be the patient's own home.
In 2020, our Optum® Infusion Pharmacy nurses made 20,000 visits per month to patient homes. The convenience and cost savings gained by individual patients for whom home visits were an option will likely drive continued interest and growth in this type of pharmacy care.
Integrating pharmacy with mental health services in the community
One in five people in the United States are living with a mental health diagnosis, and one in 20 have what is considered a serious and persistent mental health challenges, such as schizophrenia, bipolar or borderline personality disorder.
Taking medications as prescribed can help these individuals avoid unnecessary emergency room visits, hospitalizations and even death. But people with serious mental illness often lack reliable transportation, housing or a support system to help them stay on track.
Our Genoa Healthcare pharmacies, embedded in community mental health clinics, provide a higher level of pharmacy support, which results in a more than 90% medication adherence rate, 18% fewer emergency room visits and 40% fewer hospitalizations.
In this model, the pharmacist is on site and part of the care team, providing real-time consultation on medications to providers and patients.
In addition, they provide medications in pre-filled pill organizers customized for the individual. And because transportation can be a barrier to high quality care, pharmacists sync medication refills to therapy appointments and proactively reach out with refill reminders to avoid gaps in care.
We now have nearly 600 pharmacies in 47 states across the U.S. and Washington, D.C., and we’re continuing to expand this unique model of pharmacy care.
Our expansion will provide pharmacy care to populations living with complex conditions that require several medications, including seniors in assisted living communities.
Toward a whole person health system
At Optum, we have a long history of innovation when it comes to pharmacy care and benefits. Yet, we know more can be done to focus on the whole person and strengthen the connection between pharmacy and care services.
Dr. Sumit Dutta
Senior Vice President and Chief Medical Officer, OptumRx
Dr. Sumit Dutta's primary responsibilities include executive level oversight of clinical strategy, leading the OptumRx Clinical Services team and guiding its tactical and strategic endeavors to improve outcomes and lower overall health care costs.
Dr. Dutta earned his medical degree from Michigan State University and his Master of Business Administration from New York University, Stern School of Business. He completed his internship at the University of Chicago Hospitals and Clinics and his residency at Rush Medical Center. He practiced internal medicine at New York University Health Center.
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