Study Shows PGx and CMM Shows Positive Clinical and Economic Outcomes

A new peer-reviewed case study published in the Journal of Personalized Medicine shows the positive clinical and economic outcomes of a combined pharmacogenomics (PGx) and comprehensive medication management (CMM) program.

The paper, co-authored by eight professionals, was accepted for publication on March 8, 2022, with six of the authors from the Philadelphia-based precision medicine company, Coriell Life Sciences, and the other two with the University of Kentucky-based Know Your Rx Coalition.

Coriell Life Sciences says that the study, “Real-World Impact of a Pharmacogenomics-Enriched Comprehensive Medication Management Program”, was in response to provide real-world data on the clinical and economic outcomes of PGx and CMM at scale.

Showing the power of PGx testing, which allows physicians to deliver personalized healthcare based on a patient’s genetic make-up, the case study reported that all 5,000+ participants involved demonstrated at least one known genetic variant that can impact medication outcomes, and even more important, 2 in 3 of the study participants had genetic risks for medication they were currently prescribed.

Study Analyzes Direct Outcomes of PGx + CMM Program

The published study analyzes the direct outcomes of Coriell Life Sciences (CLS) pharmacogenomics-enriched comprehensive medication management (PGx + CMM) program, unified by the CLS GeneDose LIVETM clinical decision support system, on 5,288 Medicare Advantage members (age 65+) from January 2018 to August 2020.

These individuals tracked in the study enrolled in the voluntary program through their healthcare benefits plan with the Teachers’ Retirement System of the State of Kentucky. The program is still ongoing and now has more than 10,000 participants.

“The clinical adoption of pharmacogenomics has been stymied by numerous barriers and concerns. This paper addresses many of them head-on and proves that scalable PGx implementation can significantly lower healthcare costs, improve outcomes, and provide a better experience for patients and clinicians,” says study co-author Jeffrey A. Shaman, PhD, MS, Chief Science Officer at Coriell Life Sciences.

How the PGx + CMM Case Study was Conducted

The system wide PGx + CMM real-world case study a number of elements including:

• Member engagement
• At-home saliva collection
• Genetic testing to identify unique medication safety risks for each individual

Each patient analysis considered how an individual’s DNA impacts their response to medication, as well as many more traditional risk factors like drug-drug interactions, lifestyle factors (e.g., foods, alcohol, smoking), and age-related concerns.

CLS says that using GeneDose LIVE, results were assessed by trained pharmacists from the Know Your Rx Coalition who consulted with each patient to create a medication action plan summarizing any proposed changes.

Those recommendations were then given to the patient’s own prescribing physician, who was responsible for implementing any medication changes.

Key Findings in PGx + CMM Case Study

Key findings from the PGx + CMM real-world case study highlighted the program’s positive economic and clinical outcomes:

CLS says the three biggest takeaways from the peer-reviewed study were:

• Improvements in Medication Safety: Studies have shown nearly everyone has variants in their DNA that impact medications and that proved true in this population. 100 percent of participants had at least one variant known to impact medication therapy outcomes, and 66 percent of participants had genetic risks detected in a currently prescribed medication.
• Consistent Reduction in Healthcare Resource Utilization: Inpatient visits by case study participants decreased by 14.9 percent. Emergency department visits decreased by 6.8 percent. Outpatient visits decreased by 1.9 percent.
• Significant Economic Savings: Direct medical charges were reduced by $218.34 per participant per month for a cumulative savings of $37,027,769 over 32 months.

Savings were largely a result of the decrease in participant emergency department visits as well as inpatient hospitalizations.

This current case study backs up another comprehensive study published last year on the cost-effectiveness of PGx testing.

PGx Can help with Quadruple Aim in Healthcare

“One of the key takeaways we observed was a positive shift in healthcare resource utilization away from acute care services and toward more sustainable and cost-effective primary care options,” notes Dr. Shaman. “As a result of this program, patients, healthcare providers, and the healthcare system as a whole benefited in synergistic ways. This evidence suggests that widespread adoption could significantly advance the goals of the Quadruple Aim in health systems globally.”

The Quadruple Aim is built upon the Triple Aim approach in healthcare.

According to Privis Health, The Triple Aim is an approach developed by the Institute for Healthcare Improvement (IHI) in order to optimize health system performance. According to IHI, the goal of the Triple Aim is to “improve the patient care experience, improve the health of a population, and reduce per capita health care costs.” IHI stresses that the strategy is a single aim with three dimensions.

Privis Health says that, “while this model has worked great in guiding the optimization of health systems since its inception, recently, an additional aspect has been adopted by many healthcare professionals — improved clinical experience — leading to the creation of the Quadruple Aim. The idea is that without an improved clinical experience on the provider side, the three other patient-centric aspects won’t reach their full potential.”

Improved patient outcomes under Quadruple Aim can include:

• Safety
• Effectiveness
• Patient-centeredness
• Timeliness
• Efficiency
• Equity

Wise Diagnostic Systems is developing pharmacogenomics tests based on advanced molecular assay technologies, which is expected to further support physicians in offering better informed clinical decisions.