Overview

• This program was implemented across a large payor network utilized predictive modeling to tailor insulin therapy adherence interventions in order to improve diabetes management. 
• Three levels of progressively more targeted interventions were implemented to assess whether delivering more intensive insulin-adherence interventions to individuals with type 2 diabetes who were predicted to benefit most was more effective than delivering a lower-intensity intervention to an unselected larger group of individuals.

Organization Name

Horizon Blue Cross Blue Shield of New Jersey

Organization Type

• Insurance Provider

National/Policy Context

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Local/Organizational Context

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Patient Population Served and Payor Information

Horizon Blue Cross Blue Shield is the largest insurer network in the state of New Jersey. 

Leadership

Study staff members from the pharmacy-benefit management company regularly monitored the delivery of the intervention.

Funding

This project was supported through unrestricted funding from Sanofi, U.S.

Research + Planning

Adherence: For each patient, the predicted risk of non-persistence to insulin was calculated by applying a regression-based algorithm to Horizon’s enrollment data as well as its pharmacy and medical claims data. The algorithm uses demographic and clinical information from enrollment data and claims as predictors. These predicted risks were then used to identify the patients that would be best suited for each type of intervention that was piloted during this program.

Tools or Products Developed

Text Message Program: The study investigators developed a text messaging program incorporated in a text messaging platform that focused on supporting medication-taking behaviors, lifestyle choices, and glycemic control. This text messaging program was included as one potential tool to optimize adherence to insulin. It was offered to some but not all participants based on the study arm and assignment to receiving the intervention based on predicted need.

Training

All pharmacists received training in medication therapy management and motivational interviewing.

Tech Involved

• Telephone
• Text messaging

Team Members Involved

• Pharmacist
• Physicians

Workflow Steps

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Budget Details

• Labor costs associated with the pharmacists and primary care providers involved in the program
• Development and maintenance costs for text message program development

Where We Are

The trial was conducted from July 2016 through October 2017 (patients were followed for 1 year). Analyses were conducted from February 2018 to September 2018. The project was published in March 2019.

Outcomes

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Benefits

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Unique Challenges

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Glossary

Persistence was defined as not refilling their insulin prescription before a set threshold of time, which was assigned based on historical claims data from Horizon as the 90th percentile of time between each fill, adjusting for insulin type and quantity dispensed. 

Sources

• Lauffenburger JC, Lewey J, Jan S, Makanji S, Ferro CA, Krumme AA, Lee J, Ghazinouri R, Haff N, Choudhry NK. Effectiveness of Targeted Insulin-Adherence Interventions for Glycemic Control Using Predictive Analytics Among Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open. 2019 Mar1;2(3):e190657. doi: 10.1001/jamanetworkopen.2019.0657. PubMed PMID: 30874782.