Ensuring Convenient Refill and Delivery of Specialty Medications

CLINICAL PRIORITY

Credena Health is a health system-based specialty pharmacy that strives to improve patient communication and coordination of refills for expensive and high-risk medications. Credena Health manages a variety of complex conditions, including multiple sclerosis, rheumatoid arthritis, Crohn’s disease, atopic dermatitis, and many other specialty conditions.

Their goal was to minimize telephone calls and voice message management associated with refill coordination and delivery scheduling to improve the patient experience by allowing patients to respond to messages at their convenience. Additionally, staff satisfaction and efficiency were prioritized with the adoption of this patient engagement platform.

The Credena Health team also attempted to improve adherence, measured by medication
possession ratio (MPR), simplify data collection about missed or late doses, and prioritize a novel
outreach mechanism to improve patient outcomes and provide patients with the opportunity to
engage with their pharmacist team.

APPROACH

Credena collaborates with Twistle by Health Catalyst to deliver refill reminders, automate patient follow-up in the absence of initial response, and gather ideal delivery parameters for their medications.

Their pharmacist team also gathers patient assessment data through regular check-ins to monitor for side effects, adherence, quality of life metrics, medication effectiveness, health changes, new symptoms, and disease flare ups. These pathways alert the team when patient responses warrant pharmacist interventions or follow-up.

Patients can respond to messages at their convenience, day or night, without worrying about the pharmacy’s operating hours or being able to reach a pharmacist immediately.

“The Twistle pathway significantly reduces phone calls for our team and patients like that they can respond using the digital forms whenever it’s convenient for them.”

Adam Saulles, PharmD, BCACP, CSP
PHARMACIST AND MANAGER, CLINICAL PHARMACY SERVICES

IMPLEMENTATION APPROACH

Credena implemented Twistle communication pathways to support medication management for an initial pilot group of multiple sclerosis patients. They have now expanded the program to support multiple disease-specific medications for more than 3,500 patients (~58 percent of all Credena patients), and continue to add patients at a rate of about 100 per month.

A series of questions confirm the need for a refill, the delivery address for this shipment, and any special delivery instructions for consideration.

If patients do not require a refill, the system gathers data about nonadherence issues, why the medication might be on hold, or if the patient is considering switching pharmacies.

“The text message reminders and ease of submitting refills have been a great improvement in helping me taking dosages on the same day and time. Thank you!”

Patient
TWISTLE USER

RESULTS*

• Patients report high satisfaction with the message-based prescription management process (4.7/5 rating).
• Patient adoption has reached 95.9 percent.
• The time required to coordinate medication delivery logistics decreased significantly by 57 percent, from ~70 hours to ~30 hours.
• Medication adherence (measured by MPR) increased significantly by 4.4 percent, from 90 percent to 94 percent.
• Credena staff have noticed a considerable reduction in phone call volume, and in some cases communicate with patients solely via secure messaging.

*Based on analysis conducted in 2021 by the Credena Health and 2021 data on patient adoption provided by Twistle