PATH Sample Reports
PATH Data Analysis Sample Report: Percentage of beneficiaries whose care is inconsistent with selected clinical practice guidelines
| Clinical Practice Area | Total Patients | % of Patients Whose Care Is Not Compliant With Guidelines |
|---|---|---|
| Asthma | ||
| Persistent asthmatics not on a controller | 112 | 32.8% |
| Coronary Heart Disease | ||
| Post-MI, not on a beta-blocker | 46 | 68.7% |
| Sub-acute CHD, not on a statin | 155 | 73.8% |
| Diabetes | ||
| No HbA1c in past year | 1290 | 57.4% |
| No lipid panel in past year | 946 | 42.1% |
| No retinal eye exam in past year | 1308 | 58.2% |
| Diabetes and HTN, no ACE inhibitor or ARB | 491 | 43.5% |
| No proteinurea check in past year | 1372 | 64.3% |
| Hypertension | ||
| HTN & Heart failure, not on an ACE or ARB | 4341 | 28.9% |
| Preventative Health | ||
| Females 50-70 yrs, no mammogram in 1 year | 2016 | 48.0% |
Projected Savings Achieved through Improved Compliance with Specific Disease-Based Clinical Practice Guidelines
| Clinical Practice Rules | Total Eligible Members | Expected Conversion Rate Attributable to Targeted Intervention | Expected # of Members Converted | Expected Annual Savings per Conversion | Total Expected Savings |
|---|---|---|---|---|---|
| Cardiac | |||||
| CHF, no ACEI or ARB | 275 | 13.6% | 38 | $688 | $25,807 |
| CHF, severe, no Aldactone | 74 | 5.9% | 4 | $302 | $1,319 |
| Post-MI, no beta-blocker | 46 | 3.6% | 2 | $606 | $1,015 |
| Diabetes | |||||
| DM, no lipid panel in 1 year* DM, no HbA1c in 1 year* |
1290 | 39.4% | 508 | $900 | $457,434 |
| DM & HTN, no ACEI or ARB | 246 | 6.3% | 16 | $17 | $264 |
| DM & CKD, no ACEI or ARB | 246 | 21.9% | 54 | $2,488 | $133,916 |
| Pulmonary | |||||
| Asthma, persistent, no controller | 112 | 3.5% | 4 | $266 | $1,034 |
| COPD, no ipratropium | 192 | 4.8% | 9 | $940 | $8,591 |
Total $629,380
ACEI = ACE inhibitor
* These DM testing rules are considered
together for the savings analysis
Projected Savings from Changes in Prescription Drug Purchasing
| Formulary Preference Rules | Total Eligible Rx | Expected Conversion Rate Attributable to Drug Therapy Management | Total Expected Savings |
|---|---|---|---|
| On Brand Rx w/ Generic Available | 177,036 | 5% | $265,554 |
| Mail Order Available* | 30,980 | 30% | $92,940 |
Total $358,494
*Analysis for top 20 drugs by Rx claim data
Projected Savings Achieved by Switching from Brand Names to OTC Alternatives
| Medication Class | Total Eligible Rx | Expected Conversion Rate From Targeted Intervention | otal Expected Savings per Rx Converted* | Total Expected Savings |
|---|---|---|---|---|
| Non-sedating Antihistamines | 9,907 | 27% | $31 | $81,771 |
| Proton-pump inhibitors | 9,424 | 28% | $99 | 260,415 |
Total $342,186
* Difference between plan price for
Brand Rx and the OTC price