Advanced Therapeutics Program drives adoption of health preserving medications

UMass Memorial Health’s new Advanced Therapeutics Program’s multidisciplinary approach connects eligible patients with innovative cardiometabolic therapeutics and alleviates the burden for primary care doctors.
Advanced Therapeutics Team

Photo above: Members of the Advanced Therapeutics (ATRx) team meet regularly to discuss patients who may benefit from the program. From left to right: David McManus, MD; Sandy Aiello, ACNP; Michael Hyder, MD; and Eric Alper, MD (Photo credit: Matt Wright).

The UMass Memorial Health Advanced Therapeutics (ATRx) program has been operational for only six months, but it is already breaking down barriers that prevent patients with diabetes, heart and kidney diseases from accessing the latest in cardiometabolic therapeutics. In the short time since being established, the ATRx program, in close collaboration with the UMass Memorial Health specialty pharmacy, has successfully enrolled over 120 patients.

The world of medicine is constantly evolving and producing innovative therapeutics. While these new prescriptions are beneficial, they often require significant coordination by care teams and are thereby prescribed by specialists more often than by primary care physicians (PCPs).

The benefits of the Advanced Therapeutics program are twofold. PCPs collaborate with the ATRx team to identify patients who would benefit from these advanced therapeutics, which reduces the burden placed on the PCP teams. Additionally, patients receive highly individualized care based on their medical needs, circumstances and finances. From how to use the medication properly to navigating health insurance coverage, the ATRx team supports patients every step of the way.

“Providers see this as a huge win because we can give them immediate feedback from a multidisciplinary team of specialists with personalized recommendations to help improve their patient’s care. We also eliminate the administrative burden that PCPs often deal with to gain approval from insurance plans,” said Michael Hyder, MD, Executive Director of Center for Digital Health Solutions, UMass Memorial Health and Associate Professor, UMass Chan Medical School. “The feedback has been extremely positive, and patients are really appreciative of the individualized care they receive.”

The intersection of advanced digital innovation and human expertise

The ATRx program leverages data mined from Epic using the Tableau software, which identifies patients with cardiometabolic diseases since these chronic conditions typically have significant morbidity and mortality rates when not managed appropriately. By focusing on this critical group of patients, members of the ATRx program hope to open therapeutic opportunities for patients, reduce the burden of illness and save lives.

Currently the ATRx program is using therapies such as Jardiance, Farxiga, Ozempic, Trulicity, Repatha and Praluent to treat cardiometabolic conditions such as Type 2 diabetes, fatty liver disease and atherosclerotic cardiovascular disease.

The program uses a push/pull method, including both artificial intelligence  technology and doctor insight to streamline referrals for eligible UMass Memorial patients who would benefit from advanced therapeutics.

“There are two ways to get into the Advanced Therapeutics Program. The first is through use of advanced analytics to find patients, and work with PCPs, to evaluate patients and ultimately enroll them if it makes sense. So, we are in essence ‘pulling’ patients from our analytics into therapy,” Hyder, who is regarded as the architect behind the ATRx Program, explained. “The second is simply when the PCPs send or ’push’ a referral directly to us.”

Another unique feature of the ATRx program is its multidisciplinary approach to orchestrating patient care. Once an eligible patient is referred and accepted to the ATRx program, a comprehensive team of Advanced Practice Providers (APPs), pharmacists, cardiologists, diabetologists and nephrologists review the patient’s case for appropriateness, medical selection, dosing and other aspects. 

Hyder explained that when a patient is diagnosed with an illness such as breast cancer, they work with a team of specialists in oncology, radiation, surgical oncology, among others. Using that same model, the ATRx program relies on the teamwork of APPs working collaboratively with cardiologists, nephrologists, endocrinologists and pharmacists to determine the best course of action for each patient. The medical professionals meet on a regular basis via online teleconferencing and follow the patient’s case every step of the way.

“That's really where a lot of magic is happening,” Hyder said, “Every week, this team comes together to discuss the best approach for each patient. We provide concise and thoughtful recommendations back to our primary care colleagues that otherwise wouldn't exist or could only happen offline and over several weeks or months.” 

Dismantling the barriers to therapy that PCPs and patients encounter

According to Eric Alper, MD, Chief Clinical Informatics Officer and Senior Vice President, Chief Quality Officer, UMass Memorial Health and Professor, UMass Chan Medical School, there are more than 10,000 patients with PCPs in the UMass Memorial system who are eligible for these advanced therapeutics but have not yet been prescribed these medications. In contrast, only about 20% of patients who would benefit have begun taking these medications. Ultimately, the goal is to put advanced therapeutics into the hands of the vast majority who have never received the opportunity to benefit from these new therapies.

While providing the best care possible for patients, PCPs often run into hurdles navigating the world of advanced therapeutics. For example, complex insurance approval or prior authorization, access to specialty care, the ongoing management of complex therapy, patient monitoring and the inclusion or exclusion criteria of newer drugs are all barriers to therapy.

“They are up against a lot in terms of managing the care of their patients,” Alper said about PCPs. “They have dozens of things that they need to screen for in their patients when they see them and there's limited time. These medications are complex, and in many cases, they're newer, meaning that primary care physicians may not have that much experience with them and may not be comfortable prescribing them. As a result, they may have to refer the patient to a specialist, which in many cases the patients may not be interested in. Ultimately, creating a process that makes it as easy as possible for the primary care physicians to close these care gaps is really the secret sauce of this program.”

The ATRx team is set up to help both PCPs and patients from the beginning referral to obtaining therapies and managing the patient’s ongoing use of the medications. The goal of the ATRx program is to help relieve the PCPs’ burden and help streamline the process for getting advanced cardiometabolic therapies into this critical patient population.

"The ATRx program is revolutionary to Central Massachusetts and is something not seen in other health care systems. Nearly a decade ago, UMass Memorial Medical Center created the Specialty Pharmacy program, which is a unique component and a key to the ATRx program's success," said Alper.

Rethinking health care by promoting accessibility and equity 

Teamwork is at the heart of ATRx’s success. The regularly scheduled meetings allow specialists to confer about patients on a case-by-case basis. Furthermore, by monitoring the patients from different perspectives, the ATRx team can make changes and pivot the therapies based on the patient’s individual needs.

The ATRx program’s focus on open communication between departments is changing the way medical services will be delivered, according to David McManus, MD, Chair, Department of Medicine and Director, Atrial Fibrillation Treatment program, UMass Memorial Health, and Professor, UMass Chan Medical School and Co-Sponsor of the ATRx program.

The current health care system follows an episodic model in which a patient shows up for an appointment, the doctor writes a prescription or completes a procedure and then their portion of the healthcare delivery is done. With so many patients to see, the opportunity for medical professionals to regularly brainstorm with others is lost.

Meanwhile, the ATRx program rethinks this model and promotes discussion among health experts for a holistic assessment that benefits the patients, especially those with comorbidities.

“Functionally our health care system is set up to prevent what is a really good thing, which is people actually pausing to look at data together and reflect on the right treatment as a group. At a regularly scheduled time, the doctors in the ATRx program all get together, and they run through the 12 or 15 patients that the advanced practitioner has identified as being at risk,” McManus said, “It's really cool to see them rounding, like you would on an inpatient ward, but instead we're talking about patients in their homes. Instead of episodic treatment and disease-based care, we're talking about longitudinal disease prevention and patient-based care.”

The ATRx program promotes health equity and patient accessibility in a multitude of ways. First, the program lets patients know that they are eligible for these new medications. The team also works with insurance companies and pharmacies to determine the affordability for patients, which helps reduce the financial barriers to advanced therapies. And by mostly conducting meetings through online teleconferencing or by phone, the program allows patients to receive information from the comfort of their own homes. This is especially helpful for the cardiometabolic patient population who face high-risk diseases and may find it difficult to travel to medical appointments for consultations.

“By reaching out to primary care patients and by trying to make the evidence-based guidance that you might only receive at a specialist, available to all, we are promoting health equity improvement,” McManus said.

Treating patients like the individuals that they are

When the ATRx program first became operational, it collaborated with PCPs from the Tri-River Family Health Center to support their advanced therapeutics needs. 

Sandy Aiello, ACNP, nurse practitioner, UMass Memorial Medical Center, is the advanced therapeutics cardiometabolic lead APP for the ATRx Program who works alongside the PCPs to ensure clear communication and care is achieved. As someone who worked in inpatient care previously, Aiello understands the rush and high demand that PCPs face daily. Through her role in the ATRx program, she is happy to have the time to speak with patients on an individual basis and have in-depth conversations that answer patients concerns, questions, and follow-ups regarding new therapies. From beginning eligibility to coordinating virtual appointments and processing insurance paperwork for patients, Aiello and her other team members are there every step of the way.

“So many of my patients tell me how appreciative they are of the telehealth appointments to learn about the benefits as well as side effects of a new medication they will be starting. They also love the time to ask questions without feeling rushed and the follow-up phone calls to check in and see how they are adjusting to the new medication. Some of the prescribed medicines require frequent follow up for dose titration and side-effect monitoring and it allows for a good relationship with the ongoing communication between patients, the cardiometabolic program and the PCPs,” Aiello said.

The reception from physicians at Tri-River Family Health Center has also been positive. Karen Peterson, MD, Chief, Division of Tri-River Medicine, UMass Memorial Medical Center and Associate Professor, UMass Chan Medical School said, “Tri-River’s experience with the Advanced Therapeutics program for GLP-1, SGLT2, and PCSK9 inhibitors has been a tremendous benefit for our patients and relieved a prior approval burden on our staff.”

Looking towards the future

As the ATRx team continues operations, they plan to expand the number of APPs involved and branch out to serve patient populations with other diseases. In the meantime, the team works hard to give eligible patients the best access to advanced therapeutics possible.

“At this point, we're still just scratching the surface,” Hyder said. “For me, success looks like improving patients’ longevity and quality of life, reducing hospitalizations and equitably distributing these medications to as many patients that would benefit within the community we serve."

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