Cost Effectiveness

Cost Effectiveness

High-risk patients interact with many caregivers throughout their healthcare journey. Population Health is one department that makes sure they don’t get lost in the shuffle.

Bruce Newbold is a 52-year-old cancer survivor who received a kidney transplant in 2013. He continues to suffer from many health conditions including diabetes, high blood pressure and ulcer disease, and takes several medications to help manage these chronic illnesses. 

Casie Chappell, RN, a Clinic care manager for Population Health, provides support and education to patients like Bruce who need complex care management.

In May, during one of her weekly phone calls to Bruce, she discovered he was not taking his medications. “I called him to ask about his blood sugar levels and that’s when he shared that he was not taking his medications because he could not afford them,” Casie explained. “I told him we have a pharmacist on our team who I would contact to see what we can do to make his medications more affordable. That’s where Michell came in.”

Michell Butler, PharmD, receives referrals from Clinic care managers, social workers and medical assistants when patients need assistance with their medications.

In Bruce’s case, Michell learned that he was caught in the “donut hole,” or a coverage gap, in his Medicare drug plan. “When this happens, the patient pays out-of-pocket for almost the entire cost of their medications until they fall into the catastrophic range, which requires that they spend about $2,000 first.” Michell described. “It made sense that Bruce thought he could not afford his medications because he was paying about $300 for one vial of insulin.”

Michell discovered that although he had exhausted his Medicare benefit pushing him into the coverage gap, he still had a commercial plan with Cigna that he could apply toward his medications.

“I made several calls and was able to get all of his medications switched to Walgreens, the preferred pharmacy for Cigna commercial, which would have him pay for a two-month supply of medications and receive the third month for free,” Michell explained.

By switching Bruce’s medications over to a preferred pharmacy, he saved more than $2,000.

“The Population Health team is a godsend,” Bruce shared. “Sometimes, as a patient, you feel like you are just a number, but when you have people who reach out to you and advocate on your behalf, it makes all the difference in the world.”

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