HEALTHIER OUTCOMES
REQUIRE
BETTER
DECISIONS
This has been our mission since 1986, when a forward-thinking group of healthcare advocates began to apply the rigors of scientific research to the pharmacy benefit. Their goal was better clinical outcomes for members and better financial outcomes for plan sponsors.
Today, that team has expanded. Our employees now number in the tens of thousands, all sharing the same passion and drive for helping more than 100 million Americans. Our vision and our product portfolio have expanded as
well, to include the most comprehensive set of solutions in the industry. We now provide best-in-class Pharmacy Benefit Management (PBM) services and industry-leading home delivery and specialty pharmacy services to a diverse client base.
Our mission, however, remains the same.
We’re helping our clients preserve the pharmacy benefit and minimize pharmacy-related waste — while improving the health outcomes of the patients we serve.
True to our heritage of applying proven, scientific methods to the problem of waste in the pharmacy benefit, we’re now addressing the root cause of suboptimal outcomes:
bad health decisions.
WHAT DO BAD
HEALTH DECISIONS COST US?
At Express Scripts, we make the use of prescription drugs safer and
more affordable for millions of Americans. We do this by enabling
better health decisions that lead to healthier outcomes.
WHAT’S DRIvINg DECISIONS LIKE THESE?
COSTLy DECISIONS By pATIENTS, CAREgIvERS AND pAyERS LEAD TO:
• poor clinical outcomes
• poor financial outcomes
COSTLy DECISIONS By pATIENTS, pROvIDERS AND pAyERS LEAD TO:
• poor clinical outcomes
• poor financial outcomes
BAD HEALTH DECISIONS
ADD Up TO MORE THAN ANNUALLy IN U.S. $ 418 B
pHARMACy-RELATED WASTE Avoiding plan changes at all costs.
Under-managing pharmacy spend. Providing broader pharmacy networks than members need.
Making mistakes when pressed for time. Prescribing brand- name drugs over clinically equivalent generics. Failing to catch serious errors.
Using more expensive
medications than necessary.
Skipping doses of
essential medications.
Going to nonpreferred
pharmacies. Delaying refills.
pATIENTS
pROvIDERS
pAyERS
$55.8B
DruG cHoices
$33.5B
pHarmacY cHoices
$329B
HealtH cHoices
Humans are
99.9995%wired for inattention and inertia rather than engagement and decision-making. This creates a gap between our good intentions and our actual behaviors. These human cognitive limitations affect patients and providers alike. So, the best benefit plans must solve for both engaged and disengaged participants.
the human brain can process over 10,000,000 bits of information per second ...
HOWEVER:
the conscious part of the brain, the part that is making decisions, processes only 50 bits per second.
1INERTIA
INATTENTION
INFORMATION OVERLOAD
WHAT CAN WE DO?
1http://lab.express-scripts.com/patient-behavior/the-50-bits-problem/
In order to drive waste from the system and realize better clinical and financial results, better decisions are required.
To address this challenge, we have brought
together three complementary capabilities.
BEHAVIORAL SCIENCES
We apply proven strategies from the behavioral sciences to make better health
decisions easier. Choice architecture and message framing help manage inertia and inattention to close intent- behavior gaps. We call this approach Consumerology
®.
CLINICAL
SPECIALIZATION
We offer disease-specific expertise to help people make better choices in treating costly chronic and complex conditions. More than
1,200specialist pharmacists and nurses at our Therapeutic Resource Centers
SM, and throughout our pharmacy operations, work directly with patients and caregivers to enhance care.
ACTIONABLE DATA
“Big Data” is meaningless if it can’t be acted upon to improve outcomes. To that end, we deliver relevant safety and savings information to pharmacists, physicians and patients at the point of decision. And we provide clients with the dashboard analytics they need to make better plan-level decisions.
KEy CApABILITIES
FOR BETTER DECISIONS
We are continually learning more about why people make the decisions they do and what we can do to support better choices.
THeSe THree caPabiliTieS cOmbine TO fOrm OUr
UniqUe PlaTfOrm Of innOvaTiOn and diScOvery ...
SM
Through our proprietary platform and accompanying solutions, we’re helping more people achieve better health with safer and more effective care.
express Scripts is applying decision science to the most pivotal health decisions. We use proven scientific and clinical methods to develop practical solutions that deliver healthier outcomes.
caPabiliTieS
BEHAVIORAL SCIENCES CLINICAL SPECIALIZATION ACTIONABLE DATA
SOlUTiOnS DRUG CHOICES
PHARMACY CHOICES
HEALTH CHOICES
clinical OUTcOmeS
financial OUTcOmeS
An Express Scripts pharmacist identified a patient who filled 43 controlled-substance prescriptions from 17 prescribers and 5 pharmacies. The patient was notified that, through her pharmacy benefit, she would be restricted to a single prescriber and pharmacy. A nurse case manager worked with the patient and enrolled her in an Employee Assistance Program for rehabilitation.
drUg cHOiceS
GIVING BETTER AN ADVANTAGE
$ 500 M
estimated healthcare savings due to 435 cases referred to authorities in 2011
RetuRn on Client
3:1
investment For every $1 of abused drugs
obtained through “doctor shopping,”
an additional $41 are wasted on related medical claims.1
fraUd, WaSTe & abUSe // CASE STUDY
Our drug-choice solutions increase drug safety and savings by facilitating the proper use, selection and amount of the safest, most cost- effective generics and preferred brands.
Formulary management makes it easier for patients and their physicians to choose safe and cost-effective drugs. Utilization management makes it easier for them to choose and use prescription drugs in a safe, effective and affordable manner.
Enhanced support in the area of drug choice ranges from advanced formulary and utilization management to medical benefit and medical channel management. We offer special services to combat fraud, waste and abuse.
1Research from WellPoint, Inc. Dec. 2007. http://www.insurancefraud.org/downloads/drugDiversion.pdf
We provide the most comprehensive set of solutions in the industry, advantaging better decisions in three key areas ...
pRACTICAL SOLUTIONS
FOR HEALTHIER OUTCOMES
DRUG COST HEALTHCARE WASTE
clinical OUTcOmeS
Janet — a wife, mother and grandmother, and self-described
“dog lover” — has a diagnosis of pulmonary hypertension (PAH), an incurable progressive disease of the blood vessels. “I consider Specialty Pharmacy part of my healthcare team. I’m very grateful that I have that team watching out for me.” The average life expectancy with PAH is 5 years. Janet has lived with PAH for 10 years. “People like me are the end result of the care we get from Express Scripts.”
GIVING BETTER AN ADVANTAGE
financial OUTcOmeS
exclUSive SPecialTy // CASE STUDY
Pharmacy-choice solutions increase pharmacy quality and savings by helping people choose the most cost-effective and highest quality pharmacies for a diagnosed condition.
To help patients with acute conditions, more than 56,000 retail pharmacies participate in our national network. For greater plan savings and convenient access, express advantage networkSM uses behavioral science and cost-sharing strategies in a tiered approach.
For patients with chronic conditions, we offer home delivery pharmacy services, independently verified as the safest, most reliable path between patients and their medication.1 exclusive Home delivery is ideal for clients who want to maximize member savings, plan savings and member adherence to medications.
Select Home delivery increases home delivery utilization, adherence and savings while preserving member choice.
For patients with complex conditions, such as cancer, hemophilia and multiple sclerosis, accredo® specialty pharmacy offers the most advanced range of services available to improve patient care and add value for plan sponsors. exclusive Specialty encourages the maximum number of patients to take advantage of Accredo.
1http://www.ncbi.nlm.nih.gov/pubmed/16232024
2Express Scripts Research
PHarmacy cHOiceS
ExclusivE spEcialty, when combined with utilization management solutions, cuts spEcialty trEnd by half.2
Unmanaged
27.8%
13.6%
tightly managed AnnuAl SpeciAlty Drug trenD
$ 21 M
in pharmacy savings for a Large nationaL empLoyer
20 %
HigHer adHerence
clinical OUTcOmeS
An Anchorage, Alaska physician credits RationalMed as being “lifesaving to my patient” — a woman with a deep-vein thrombosis (blood clot in the leg) who began a postmenopausal estrogen hormone replacement therapy.
RationalMed identified the potential safety concern — patients with thrombotic disease should avoid estrogens due to stroke and heart attack risk — and alerted the physician.
$ 288 M
in pharmacy savings for clients in 2011
2 M
SucceSSful Safety InterventIonS
HealTH cHOiceS
GIVING BETTER AN ADVANTAGE
financial OUTcOmeS1
4x
annualprogram cost
8x
annualprogram cost
Pharmacy savings
raTiOnalmed® // CASE STUDY
Our health-choice solutions improve patient health and safety, coordinating care across providers. Solutions in this area are designed to prevent drug-related adverse episodes, detect potential issues, address gaps in care, identify savings opportunities and improve patient adherence to medication.
concurrent drug Utilization review and Physician connectivity support better health choices. Advanced support for those choices includes our rationalmed® program that evaluates medical, pharmacy and lab data to detect critical health and safety issues and gaps in care, and targets effective outreach to physicians, pharmacies and patients.
expressAlliance® enhances care, improves adherence and increases safety for patients with chronic and complex conditions. Healthcare professionals provide care coordination services that include analysis of prescription data for clinical and member savings opportunities.
ScreenrxSM is the industry’s first tool that identifies patients at elevated risk of nonadherence — up to a year in advance —leading to improved health outcomes for members and significant savings for clients. We use proprietary predictive models to detect future nonadherence, and then proactively reach out to at-risk patients with interventions tailored to address their individual adherence obstacle.
HealtHcare savings
1Express Scripts Research
let’s work toGetHer to
Deliver BETTER DECISIONS AND HEALTHIER
OUTCOMES WE’RE FACINg
DRAMATIC CHANgES IN THE pURCHASE, DELIvERy AND
REgULATION OF
HEALTHCARE
Solutions for new challenges require better systematic support for an individual shift in behavior — on the part of patients, physicians, pharmacists, caregivers and plan sponsors — at the same time as our country is undergoing a collective shift as the future of healthcare unfolds.
Leveraging 25 years of experience, Express Scripts is uniquely positioned to address that future by continuing to answer industry-wide and client-specific challenges.
We are committed to driving the evolution of our current tools to support a better healthcare system for all patients and payers, deploying resources where and when they will have the most impact.
We are more confident than ever that we have the people, programs and processes in place to bring to fruition our vision of safer, more affordable and effective care. We are more passionate than ever about applying scientific research to the pharmacy benefit.
As our nation grapples with the challenge of creating a more effective, efficient, economical healthcare system, we are more focused than ever on driving better health and value for millions of americans.
© 2013 Express Scripts Holding Company.
All Rights Reserved.
13-0053
Express Scripts is committed to following, promoting and implementing sustainable practices. We apply global sustainability principles to the way we do business and the way we fulfill the needs of clients, patients and employees. Express Scripts is committed to proactively balancing economic development with environmental stewardship and social development, and operates its business in a manner that respects the environment and conserves natural resources.
We uphold our commitment to environmental stewardship by printing this brochure using emission-free inks on recycled stocks that are certified by the Forest Stew- ardship Council (FSC). This is printed on paper stock that has 10% post-consumer waste content (PCW). It was produced in a certified Sustainable Green Printing (SGP) shop, one of only 26 printers world-wide to earn this designation, using renewable energy provided by Pure Power from a Missouri-based wind farm.
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