Gojji Technology &Enhanced Diabetes Program

Chris Chan, PharmDCo-Founder & Chief Clinical Officer, Gojji, Inc.

Binal Patel, MPharm, BCGPDirector, Clinical Outcomes & Therapeutic Optimization, PerformRx

Chronic Conditions: The Facts

A mental or physical health condition that lasts > 1 year and requires ongoing medical care and/or limits daily activities

Leading cause of death and disability in the US

90% of the nation's $3.3 trillion in annual health care

expenditure is for individuals with chronic and mental health

conditions

Major Chronic Diseases include:

Heart disease and Stroke

Cancer

Diabetes

Risk factors:

Excessive Alcohol Use

Poor Nutrition

Lack of Physical Activity

Tobacco Use

https://www.cdc.gov/chronicdisease/about/index.htm

Chronic Conditions: Prevalence

Prevalence of Top Chronic Conditions (2014)

Buttorff C, Ruder T, Bauman M. Multiple Chronic Conditions in the United States pdf icon[PDF – 392 KB]external icon. Santa Monica, CA: Rand Corp.; 2017.

Chronic conditions: Comorbidities

Buttorff C, Ruder T, Bauman M. Multiple Chronic Conditions in the United States pdf icon[PDF – 392 KB]external icon. Santa Monica, CA: Rand Corp.; 2017.

Chronic conditions often are not stand alone

42% of adults had > 1 chronic condition

12 % of adults had > 5 chronic conditions

Chronic Conditions: Prevalence & Spend

Buttorff C, Ruder T, Bauman M. Multiple Chronic Conditions in the United States pdf icon[PDF – 392 KB]external icon. Santa Monica, CA: Rand Corp.; 2017.

Prevalence & Spending by Number of Chronic Conditions (2014)

Drug Therapy Management Program

Medication therapy review is a systematic process of:• Collecting patient-specific information

• Assessing medication therapies to identify medication-related problems

• Developing a prioritized list of medication-related problems

• Creating a plan to resolve them

Medication therapy reviews can be comprehensive or targeted to an actual or potential medication problem

Whether comprehensive or targeted, the individual patient’s medications are evaluated in the context of the patient as a whole, taking into consideration all of the patient’s conditions and medication therapies.

American Pharmacists Association, National Association of Chain Drug Stores Foundation. J Am Pharm Assoc. 2008; 48(3):341-53

Current DTM Programs

General Drug Therapy Management

• Diabetes• Asthma• Behavioral Health and

Antipsychotic• Transitions of Care

Other types of Drug Therapy Management

• Recipient Restriction

Specialty Drug Therapy Management

• Multiple Sclerosis

• Hepatitis C

Medication Therapy Management Program

• CMS compliant MTMP

• DMP

DTM Program Goals

Increased Engagement

Optimized Medication Regimens

Access to Care/Meds

1. Decrease health plan expenditure

2. Improve member outcomes

3. Improve quality measures

DTM Program Process

Identification

Medication Review

Member Outreach

Pharmacist Intervention

Outcome determination

Diabetes Burden

> 30 million Americans have Diabetes

Serious complications include CVD, PVD, ophthalmic, and renal complications

In 2017, diabetes cost our healthcare system $237 billion

26 % increase in economic costs of diabetes from 2012 to 2017

45% increase in cost of medications to control diabetes from 2012 to 2017

Diabetes Care. 2018 May;41(5):917-928. doi: 10.2337/dci18-0007. Epub 2018 Mar 22.

DTM Program Barriers & Solutions

CURRENT BARRIERS

Review completed at one moment in time

Delayed or patient reported lab values (blood glucose readings)

Difficulty establishing initial contact

POTENTIAL SOLUTIONS

Real time feedback

Continuous access to blood glucose readings

Initial contact establish when device is provided

Priorities in Pharmacy Benefit Management

>40% of Drug Cost

Which Chronic Disease Management Programs do you have?

RMP? $1497 per year

PCP? No time

Standalone Chronic Care Service? Expensive and limited # of patients

CDE Classes? Not cost-effective

All Started With another Pilot…

• Cost-effective

• Least budget impact

• Leverage existing benefit

• Aim for the entire patient group

• Must include med optimization

• Must impact HEDIS

Results

What We Have Learned…

• Most patients do not know about their conditions; more than 40% of patients have medication issues

• Bundling supplies to services increase engagement rates

• Physicians loves collaborative agreement but requires a lot of education

• Physicians/ancillary care providers & Health Plans collaboration is the most welcomed feature

• Clinicians do a poor job interpreting Blood Glucose Data

• Service model supports large number of patients without increased cost burden

• Bluetooth meter or “data hub” won’t bridge data gap

• EHR/PHR data and HP Data exchange is key

Diabetes Chronic Disease Management Elements

DKA Prevention &

Management

Reduce PA & barriers related

to drugs and supplies

Hypoglycemia

Prevention &

Management

DDI (19%), Dup Therapy (53%),

Contra. Ind (4.5%) & additive SE

(61%)

Resolve Poly-pharmacy issues

Appropriate insulin Utilization &

resolve suboptimal dosage

4+Oral Meds Focus Review

Use ACE/ARB & Statin

Gestational Diabetes

Management

Eye and foot exam, A1C test and control,

BP control, Nephropathy screening100% Data Upload and real-time

communications

Traditional Approach

New Approach

Chronic Disease Management Approach

Patient Engagement Rate

Text Message or Call

Our Non-digital

Diabetes Program GOJJI w/Digital HealthTypical CM

Program

<30%* <30%* 70%* >90%**

The power of combining Product (Test strips, drugs, or other supplies) + Service (Full Clinical Care Management Service) + Digital Health

*AMCP presentation and internal data**Anticipated Rate

Real-time feedback & Message

Check Ketone reading now

3 or more high BG readings in 1 week

We have a message for you regarding your medication

Hypoglycemia alerts

No BG readings over 30 days

Time to get your flu vaccine & A1C test done

Personalized Treatment Plan

Exercise Plan

Care PlanDiet Plan

Insight & Analysis

Reminders

Diabetes Management Evolution

Enhanced Chronic Disease Management Program

• Leverage technology to monitor patient’s condition continuously

• Leverage our engagement to optimize medication and other care gaps continuously

• Empower patients to promote self-management

• Promote coordination between stakeholders to bridge care gaps

Comprehensive CDM

Partnership: GOJJI & PerformRx

• Allow program enhancements with technology

• Encourage member engagement

• On-going member education

• Outcome measures:• Decrease in medical costs• Change in HbA1c• Nephropathy screening• Eye exam• BP control• Statin use

Thank You

For your time…

QUESTIONS?

www.performrx.com