1. CIM
CITY COMMISSION INFORMATION MEMORANDUM
December 8, 2016
ADMINISTRATIVE BRIEF FROM NATALIE FISCHER
HUMAN RESOURCES
Last August, the City Commission authorized staff to enter into an initial contract with
Tria Health. Tria Health is a medication therapy management company that partners
with MedTrak, our prescription benefit management company. The focus is on
controlling costs and reducing risk for the health plan and its members. They follow a
between patients, pharmacists
and physicians. This approach includes a variety of programs. Two success stories and
some overall results from the initial year of November 1, 2015 October 31, 2016 are
highlighted below.
High risk plan members were identified as eligible for their Pharmacy Advocate Program
if they were prescribed four or more prescriptions for one or more of eight conditions
deemed chronic. The program participation was voluntary for plan members but
incentives were offered to cover either a portion or all fees related to the prescribed
drugs, depending upon if they were generic or other alternatives.
Patient #1 had an initial consultation March 2016. The individual had a history of high
blood pressure, fibromyalgia, GERD and arthritis. The patient was taking an expensive
The prescribing physician agreed and the switch was made. When Tria followed up, the
Annual cost for brand prescription: $2,976 ($2,083 for City; $893 for patient)
Alternative drug: $169 ($118 for City; $51 for patient)
Annual savings: $2,807
Patient #2 had an initial consultation February 2016. The individual had a history
including a heart attack, diabetes, high blood pressure, high cholesterol and depression.
The Tria pharmacist noticed the individual was continuing to take a prescription
prescribed by a general practice physician even though a cardiologist prescribed a
different prescrip
The Tria pharmacist contacted the cardiologist to inform that the individual was taking
two prescriptions in the same class, and suggested an increase of the latter prescription
and discontinuation of the first one. The cardiologist agreed. When Tria followed up, the
Annual savings for drug discontinuation: $1,000 ($700 for City; $300 for patient)
Potential specialist visit avoided: $564
Those two examples provide insight into how the program is working with plan
participants to lower risk and cost. Overall results were reported in the following areas.
Prescription Savings: $32,640 net savings
Health Care Savings: $26,128 estimated
Compliance: $100,393
In the area of prescription savings, our participants lowered costs through three generic
substitutions; six less expensive, more affordable substitutions; and eleven discontinued
medications. The total net savings for these changes were $32,640.
For health care savings, our group did not avoid emergency room visits or hospital
admissions, but outpatient clinic visits, specialist visits, urgent care visits and lab
monitoring services were avoided. The estimated savings for these totaled $26,128.
The last category, compliance, is the estimated savings for individuals whose behavior
and approach to care changed in accordance with the voluntary program. Conditions
properly treated following consultation included diabetes, heart disease, high blood
pressure, high cholesterol and respiratory. The compliance savings totaled $100,393.
Since the programs targeted members deemed high risk, 280 individuals were eligible.
On the average, we cover 1,360 lives including spouses and children so 20.6% of our
plan participants are considered high risk. Of those 280 eligible members, 66 members
voluntarily engaged. The average age of our participants was 46, including 37 (56%)
females and 29 (44%) males. There were 1,014 drugs for 628 conditions reviewed for
that group, and 108 problems were identified with the medication. This means that
10.7% of the prescriptions for the individuals in the high risk area were flagged for
change and account for savings noted in the prescription section above. The most
common issues included the dosage being too low, drugs prescribed that cause
adverse reactions when taken together, and individuals not complying with the
medication as prescribed. It was explained that sometimes with compliance, the issue is
the ability to pay for the me
remedy this issue for some participants.
rogram was $38,128,
yielding total savings of $159,161 and net savings of $121,033. Should the City of
Salina opt to continue the program, the goal would be to increase the participation from
23.6% to 30% to lower expenses and risk for both the participants and the health plan.
Enclosed are other items on the agenda. If any Commissioner has questions or cannot
attend the meeting, please contact me.
Jason A. Gage, City Manager