by Sarah Gunter
“The average person who engages with a Tria Health’s pharmacist takes nine to ten medications a day; we're talking about prescriptions, over the counter, vitamins and supplements. They have six total conditions they're treating, and three of those are chronic. They have three treating physicians, and they're about 50 years old,” explains Matthew Baki, Senior Vice President of Strategic Accounts at Tria Health.
“A lot of times when I describe this, people think, oh, yeah, that's my grandparents, or that's my mom and dad. No, that's your average employee that is on your health plan that could benefit from Tria Health.
Chronic conditions are one driver of rising healthcare costs for self-funded employers. Baki estimates that anywhere between 60 to 85% or potentially even more of cost is driven by 15 to 30% of the workforce population.
For Tria’s average person—who is taking nine to ten medications, treating six conditions, and seeing three different physicians—their doctors and pharmacists are frequently not communicating with each other. Without an advocate to help them navigate the healthcare system, they’re getting information on how to manage their health from doctors working in silos, from the internet, from colleagues, and from family members. No one is managing their different medications’ interactions or treating their multiple health problems holistically. They often don’t understand cost options for their health plans and forego care due to expense. Ultimately, the price becomes worse health outcomes and higher costs in the long run.
“There's really no one in our healthcare system that is sitting down with a person saying, why are you on these medications? How are you taking them? What challenges are you having? What are your goal therapies? Tria not only helps patients optimize their medications, but we also help them improve their level of health literacy around their disease states and how they should be managing their health,” says Baki.
You can find patient-specific success stories on Tria’s LinkedIn page, posted with the #TriaTriumph. One handwritten letter from an employee reads: “I want to thank you for all you do for me and others. I have learned so much about my medications, why I’m taking these medications, and my medical diagnoses…I feel like my health is getting a little better. I’m learning how to control my diabetes and high blood pressure…It’s nice to have someone who cares about me.”
One big misunderstanding at the patient level, Baki explains, is that just because a doctor prescribed a medication, doesn’t mean that your body will metabolize and react well to it or that it won’t interact with another medication or prescription. “Doctors are the expert in diagnosis. Pharmacists are the expert in medications,” he says.
It’s why team-based care is at the center of Tria’s model. Tria coordinates care between the patient, pharmacist, and physician(s), involved in what Baki calls the “circle of care.” Part of this care includes comprehensive medication review for every individual. Baki elaborates on what this means:
“After a physician writes a prescription, it’s then about did you go fill it? Can you afford it? Are you now taking it as your doctor actually prescribed? Is it's working as intended? Are you getting the intended outcomes? Or are you having some type of complication? And if you're having a complication, why? Is it because of the way your body reacts to the drug? Is it because of another drug-to-drug interaction? If you're not getting an outcome, is it because your dosage is too high or too low? When you consider the average person we talk to takes 10 medications a day, there are a lot of reasons why a person’s disease state isn’t well controlled.”
When it comes to improving a plan’s benefit strategy, Baki shares his expertise. Due to covid related interruptions, the identification and strategy around providing benefits to people with chronic conditions has been less of a priority for employers. But analyzing claims data can be a productive way to start.
“Pharmacy data is a great data set to look at, as it can be a better indicator of what people are managing, from that comprehensive standpoint,” Baki says. “While people may not have gone to the doctor over the last couple of years, hopefully they have at least maintained what medications they are filling. We can use that data to identify risks and use it as a way to create a strategy that's going to help the plan as well as their employees.”
Targeting chronic conditions, a large, long-term driver of cost, is a great way to reinvest in your benefits plan and your employees’ overall health. Learn more about Tria Health on The Granite List.
