November 6, 2017
Optimizing Health for Members With COPD

An estimated 15.7 million Americans have been diagnosed with Chronic Obstructive Pulmonary Disease (COPD).1  COPD is an irreversible and progressive lung condition common among smokers and the elderly. Common symptoms include shortness of breath, frequent respiratory infections, and chest tightness/congestion.

According to the most recent results published by the American Lung Association, there were an estimated 715,000 COPD hospital discharges in 2010 and 133,965 deaths due to COPD in 2009, making COPD the third-leading cause of death in the U.S.2

 

 

 

 

 

 

COPD has clearly become a significant health concern, and Navitus has made it a goal to confront it head-on.

Navitus’ Solution

In August 2017, we launched the COPD Management Program, a component of our Respiratory Health Program. The COPD Management Program optimizes the health of members by promoting the appropriate use of inhalers and other COPD medications, encouraging tobacco cessation and coordinating care between providers and members.

COPD Management Program Goals:

  • Coordinate care between the member, the prescriber, the plan sponsor, and the PBM
  • Optimize treatment regimens
  • Improve the member’s adherence to therapy and quality of life
  • Prevent COPD exacerbations
  • Prevent hospitalizations
  • Increase cost savings for the client and the member

How the Program Works

Our clinicians work with members and their prescribers to ensure that members receive the correct medications and use them as prescribed. We use retrospective pharmacy claims data and/or diagnosis codes to identify members with COPD. We then identify those members who have the potential to be non-adherent to their medication regimens and who are at risk of experiencing COPD exacerbation. Upon identifying these at-risk members, we mail intervention letters to members and their prescribers. We measure and track outcomes post-intervention, using pharmacy and medical data (if provided). These measures provide cost savings for our clients, change member behavior through education and ultimately improve the health outcomes of our members.

1Wheaton AG, Cunningham, TJ, Ford ES, Croft JB. Employment and activity limitations among adults with chronic obstructive pulmonary disease—United States, 2013. MMWR. 2015:64 (11):290-295.
2
American Lung Association. Trends in COPD (Chronic Bronchitis and Emphysema): Morbidity and Mortality. March 2013. Accessed on April 20, 2017 at: http://www.lung.org/assets/documents/research/copd-trend-report.pdf

by Jessica Darling