Implementation of a Risk-Stratified, Cost-Effective Multiple Sclerosis Expected Practice Module in a Large Safety Net Health System (5153)

Objective: To develop and implement a risk-stratified expected practice (EP) module that (1) sets an evidence-based framework aligned with the safety-net system infrastructure and operations; (2) informs provider practice; and (3) ensures accessibility. Background: Multiple sclerosis (MS) is a chronic neurological disease associated with significant health inequities due to the economic burden it imposes on patients and healthcare systems, largely attributed to its high cost disease modifying treatments (DMTs). In many intances, providers are not aware that DMT efficacy is not tied to cost, but is tied to access. Furthermore, clinicians serving in safety-net settings often lack understanding of which DMTs are accessible, and how to link pharmacy programs that serve these vulnerable populations. Design/Methods: The development of the MS EP factored real-life practice including pre-assessment findings noting variability in provider’s DMT practice patterns, overutilization of non-formulary high cost DMTs, and lack of accessibility. Elements from the Kaiser Permanente MS care model which considers disease activity and rituximab when choosing DMT was integrated. The EP was used to educate general neurologists, primary care physicians and improve system assessment of DMT dispensation under a 340B program. We used audit and feedback from diverse stakeholders; neurologists, pharmacy and leadership. Internal dispensation patterns of high cost DMTs through pharmacy were generated across four safety net hospitals. Results: The implementation of the EP decreased provider practice pattern variability and increased accessibility to high efficacy DMTs for those patients at high risk of disability progression. An incremental cost-savings of $4.1 million+/year was generated over 3 years (sample of 128 patients). Conclusions: Our study illustrates how implementation of a risk-stratified EP can be cost-effective and decrease health disparities. The program has high potential to provide greater accessibility to DMTs, decrease disability and redirect unspent resources to other necessary health services to MS. Disclosure: Dr. Amezcua has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for serono. Dr. Amezcua has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Amezcua has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Amezcua has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for genentech. Dr. Amezcua has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. The institution of Dr. Amezcua has received research support from National MS Society. The institution of Dr. Amezcua has received research support from Genentech. The institution of Dr. Amezcua has received research support from Medday. The institution of Dr. Amezcua has received research support from Bristol Myers Squibb Foundation. The institution of Dr. Amezcua has received research support from NIH NINDS. Kevin Vu has nothing to disclose. Dr. Momtazee has nothing to disclose. Dr. Burnett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Prism. Dr. Burnett has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD serono. Dr. Burnett has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for EMD Serono. Dr. Burnett has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Burnett has received research support from Genentech. Hal Yee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for RubiconMD. Hal Yee has received stock or an ownership interest from RubiconMD. Dr. Towfighi has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law firms. The institution of Dr. Towfighi has received research support from NINDS.