Case study: Improving SGLT2i therapy guideline adherence

In the past few years, payers, providers and life sciences companies have significantly expanded their use of real-world data (RWD) in support of activities that promote the triple aim. Whether that involves care variation reduction initiatives within a regional health system or post-marketing studies to demonstrate one therapy’s improved outcomes over the current standard of care, health care organizations are embracing the potential of RWD in a variety of ways.

For Boehringer Ingelheim, a leading pharmaceutical company, it began with the goal of strengthening evidence that its sodium-glucose cotransporter-2 inhibitor (SGLT2i) for patients with Type 2 diabetes and cardiovascular disease not only helped improve patient outcomes, but also lowered the total cost of care.

The American Diabetes Association 2022 Standards of Medical Care in Diabetes already support using of a SGLT2i in the treatment of patients with Type 2 diabetes and cardiovascular disease. But not all eligible patients were receiving guideline-based treatment.

As a long-time Optum Life Sciences client, Boehringer Ingelheim’s leaders turned to our experienced consultants to help address this gap. Together, we sought to leverage our trusted RWD in ways that could support programs and contracting models to encourage more physicians and patients to discuss the recommended ADA guidelines.

This ultimately led to a value-based contract (VBC) between Boehringer Ingelheim and UnitedHealthcare® — supported by data analyses from Optum Life Sciences as a trusted third party — which has resulted in an innovative pilot aiming to scale physician and patient engagement programs to reduce gaps in care. UnitedHealth Group®, the parent company of UnitedHealthcare and Optum, is a diversified enterprise with distinct and separate business platforms.

“Optum Life Sciences has been an important collaborator in bringing together an arrangement that will ultimately benefit more patients in managing their conditions,” says Chris Marsh, senior vice president of market access at Boehringer Ingelheim.

A journey to identify real-world evidence

Before involvement from Optum Life Sciences, UnitedHealthcare independently conducted its own robust clinical review of the company’s SGLT2i therapy based on available evidence and ADA guidelines and made its own formulary placement decision. Then the 2 parties met for preliminary discussions about a value-based contract for the branded therapy.

As a third party, Optum Life Sciences consultants conducted a VBC analysis with deidentified claims data from the UnitedHealthcare commercial population for Boehringer Ingelheim and UnitedHealthcare. The analysis generated strong real-world evidence (RWE) demonstrating the therapy’s value. Over one year, patients taking the manufacturer’s SGLT2i therapy had measurable positive health outcomes and lower total costs of care (TCOC) versus those with similar diagnoses who were not on an SGLT2i.

“Value-based arrangements are part of a longer journey. They’re not just a destination,” says Dr. Brian Solow, chief medical officer at Optum Life Sciences. “We endeavor to align on value in ways that represent wins for the payer, the manufacturer, the physician and, most importantly, the patient.”

The VBC analysis found that patients treated with a SGLT2i had total health care costs that were about 20% lower than patients on other antidiabetic agents included in the analysis. Through their research and analysis, Optum consultants also discovered that as many as 50,000 to 60,000 eligible patients in the UnitedHealthcare commercial population may not be using guidelines-based treatment for their Type 2 diabetes with cardiovascular risk factors. With these results, Optum Life Sciences analysts estimated that a 10% increase in guidelines-based treatment in this population could save the payer an additional $32 million annually.

Turning insights into action

Together with Boehringer Ingelheim, Optum Life Sciences convened a group of medical and pharmacy leaders from Optum and UnitedHealthcare to discuss the results of the total cost of care analysis. They also considered ways they could help educate physicians and identify more patients who may benefit from this guideline-appropriate therapy within the UnitedHealthcare commercial population.

“This was about collaborating with physicians, who are at the center of clinical decision-making, to help close gaps in care by increasing the number of patients on guideline-compliant therapy regimens,” says Erin Hulbert, director of value-based contracting at Optum Life Sciences. “We have years of experience helping clients navigate UnitedHealth Group to identify internal champions, implement programs and demonstrate impact.”

As a result of these discussions, Optum Life Sciences and Optum Health are conducting a pilot program with Optum Health physicians and their patients intended to increase appropriate use of guideline-appropriate therapy among UnitedHealthcare commercial members with Type 2 diabetes and cardiovascular disease.

Thanks to the expertise of Optum Life Sciences consultants engaging different stakeholders in the health care ecosystem and leveraging trusted real-world data sources, this collaboration with Boehringer Ingelheim moved beyond evidence generation to support of a value-based contract. It led to a population health-centered pilot program — an actionable opportunity to meaningfully improve patient outcomes and lower total cost of care at scale.

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