Podcast Show Notes

Our podcast discussion today between Michael Andrade and  Pramod John, CEO of Vivio Health.  We discuss what Vivio Health does to deliver Precision Care in specialty medication compliance versus the traditional prior authorization process.  You may be surprised to learn some things that are contrary to what you may think are true about your doctor’s knowledge of prescriptions and the FDA’s job when it comes to approving medications.  Vivio health adds value in targeting appropriate treatment in the specialty medication solution, bulk purchasing through national contracts, manufacturing assistance programs, and testing treatments more often than any PBM.  In our interview we discuss the current challenges within managing specialty management for both the patients and doctors and how Vivio is addressing individuals needs by using data, clinical trial information, patient DNA and a process he’ll refer to quite a bit as failing quickly to deliver value and reduce costs.

What does Vivio Health do?  They are specialty medication outsource provider that works directly with employers, doctors, and patients to deliver a specialty medication therapy regiment designed to save money by getting people to the right medication as quickly as possible while eliminating many of the inefficiencies and misaligned incentives in the healthcare industry.

How should medication work? Using a few examples Pramod discusses a simple example for how a medication should work.  In the case of cancer it’s pretty straight forward.  Outcome is to improving life expectancy, overall survival rate, or is curative.  For simplicity sake, question should be answered why should someone be put on a medication that would improve their situation or perhaps lead to other complications.

In case of other diseases, the decision/determination is quite a bit less obvious.  Humira is a great example of a drug with a wide variety of effectiveness and it’s all based off an individuals DNA and ability to absorb the medication.  Globally we have an issue where many folks are getting this medication and it’s having no or an ineffective result.  Vivio’s service model is to help individuals and doctors get to the right medication balance as quickly as possible.

“When we spend $250k on a therapy doesn’t work, we forego the opportunity to spend $250k on therapies that do work.” – Pramod John

What is the FDA’s role in approving medication?: FDA approval process is different than what you think.  Approval is not based off Effectiveness, it’s based off safety of the medication.  Most people commonly think that if it’s FDA approved that it’s effective for a disease.  It’s not.  It’s based off the safety of the medication.  Many people will receive the same benefit with a placebo vs. the actual medication.  Bar for approval process is set pretty low and some individuals will improve.  With specialty medications being very expensive (Humira, $70k) per year, Vivio works with individuals and phyiscians to assure a great benefit from the medication, it’s the right medication, and also to properly dose based off the clinical trials [add to this].

How does the current Prior Authorization model work for your PBM?: Current model based on somebody must be managing the process.  Typical carrier model is to have specialty meds in the Rx and Medical parts of the plan.  Prior auth process now is simply about checking the boxes, no one is asking the question: Is the person really getting a benefit for the medication?  If you think your doctor is doing it, you may be wrong as most doctors can only spend 7 minutes with their patients.  “Ask your doctor what are the top 3 drugs you prescribe and hen was the last time you read the clinical trials for those drugs?  I’d be surprised if they’ve ever read the clinical trials for those medications.”

Could have mis-alinged incentive with PBM process, dispensing of drugs, and formulary management.  PBM has an economic incentive to make more money to approve a medication and also force folks to potentially ineffective medication through formulary management.  Why do most PBM’s own their own pharmacies?

What is Precision Care?: How do we get the person to the optimal care as quickly as possible? It’s a therapy planning process.  Program works differently than a traditional PBM approach.  Vivio can carve out medications from both the Medical and PBM parts of the medical plan and Vivio is put in charge of the relationship with the provider and patient to get the right medication for the patient.  Ask for all the clinical information from the provider and what drug they want to put the person on.  Vivio will make their own determination and then give a Kayak type summary of medications by cost to the provider and get to the patient data and common decision making should agree if you are looking at the same patient, same data.  Vivio works with doctors to get to a common understanding of what the outcome is, what the data is, what treatment options are available, and how they’ll measure and agree on success measures.  One of Vivio’s goals is to test the success measures and fail quickly.  If they fail quickly, they know the person is not on the right medication and a responder for the therapeutic value of the medication organized by the lowest cost therapeutic treatment.

Value based care – how can we get to value based care if we continue to pay for care that adds no value? Specialty medications on the medical side are value less in that you pay significantly more than you need to compared to what Vivio can procure and also what can be done through your own PBM.  Vivio will take care of the logistics and use their procurement process as leverage with the hospital systems trying to overcharge and decrease the value of therapy.

Link to Vivio Contact Page

If you’d like to learn how this and other programs can fit into your benefit strategy please feel free to contact me: Michael Andrade (832) 236-8966