Gregg Masters 00:08
PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand narrative alive by original or value-added digitally curated thought leadership content for omnichannel distribution and engagement. Connect with us at www.popupstudio.productions. And welcome everyone. I’m Gregg Masters managing director, producer, and co-host of PopHealth Week. Joining me in the virtual studio is my partner, colleague, and lead co-host Fred Goldstein, president of Accountable Health LLC. On today’s show, our guest is Caitlyn Tung, a fourth-year student at the University of Washington School of Pharmacy, also known as UW, Caitlyn received her undergraduate degree in biochemistry at UW as well as a dual degree MBA. She has experience as a market analyst for a small consulting firm whose clients are smaller biotech companies. Caitlyn was also the AMCP Foundation, Pfizer managed care summer intern at Cigna and Pfizer this past summer where she learned a lot about the pharmaceutical industry and managed care, we discussed the role of analytics to improve the quality of care and outcomes for diabetic populations, her career trajectory, and the attractive role of the pharmacists innovating in the managed care space. So, Fred, with that introduction over to you help us learn more about Caitlyn, and her work in this space.
Fred Goldstein 01:43
Thanks so much, Gregg. And Caitlyn, welcome to PopHealth week.
Caitlyn Tung 01:46
Thanks. I’m really excited to be here.
Fred Goldstein 01:48
Yeah, it’s really a pleasure to get you on. Obviously, we met at the AMCP NEXUS forum, and you had this interesting poster up there. But before we get into the poster, why don’t you give our audience a sense of your background?
Caitlyn Tung 01:59
Yeah, so I grew up in San Jose, California, and moved to Seattle, Washington to complete my undergraduate degree at University of Washington, and I’m still here, doing my pharmacy doctorate degree also at University of Washington School of Pharmacy. This is my last year. I’m doing rotations right now. And this is actually my fifth year in pharmacy school because I completed my dual degree MBA program in 2020. I met Fred while this is a long story, but just to provide some context, I completed a 10-week internship through AMCP Foundation that was funded by Pfizer and my site was at Cigna. Through this internship, I was assigned to do a capstone research project that turned into a poster presentation at AMCP Nexus. And while I was off getting some food, I walked back to my poster and saw Fred taking a picture of my poster. So, I was just so honored, and you know, happy to see someone actually appreciating my work. So, I stopped him and thanked him for appreciating it. And that’s why I’m here today.
Fred Goldstein 03:15
That’s great. Thank you for putting that in. Caitlyn. So why did you decide to go into pharmacy?
Caitlyn Tung 03:21
Yeah, so both of my parents are in healthcare. My mom’s a nurse. And my dad is a clinical lab technician. And they’ve both worked at Kaiser Permanente for as long as I’ve lived, literally. So I’ve always just been surrounded by health care. And I wanted to do something that impacts patients, but kind of at a larger scale. So that’s why I kind of got interested in managed care and industry. I do have some experience as an inpatient pharmacy intern. And I also worked at Safeway for a few years, but really just homed in on my interest in managed care and industry. So, I’ve been pursuing those kinds of roles. And I’m actively applying for fellowships right now as well.
Fred Goldstein 04:02
That’s great. And congratulations, by the way on the MBA in combination with the PharmD. That’s quite the accomplishment there. Yeah. So, let’s, you know, as I was walking around, you know, the hall I walked by every one of the posters I did every row, which was good. I got in a bunch of steps. So anyhow when I saw yours, and I thought, wow, you know, it’s on COVID. We’re doing some work around COVID. And this is showing some interesting stuff, and really fascinating from a payer perspective. And your poster was called the Impact of COVID-19 on the Initiation of Statin Therapy in Persons with Diabetes and Implications for Star Rating Measures. So, tell us why did you pick that topic first, and what did sort of significance? The significance of statins and diabetes?
Caitlyn Tung 04:45
Yeah, so first off, we were given a few topics to work with me and my preceptor Christopher Powers, who is the who is the main Star Ratings person at Cigna, and we didn’t really like any of those topics, because, you know, he, he has always wanted to do something research related in the payer side. But none of them were particularly immediately relevant to the situation. And he also wanted to do a project that was, you know, relevant for his work. And obviously, I was, I’m not new to manage care, but I was new to Stars, and so that was really interesting to me as well. So, we kind of put, you know, something, we tried to find something that was related to the pandemic, and related to Star rating measures. And then we decided to focus on statin initiation in persons with diabetes, because that’s kind of a that’s kind of a measure that can kind of be swept under the table in terms of prescribing just because it’s not an immediate illness. There’s no visible side effects always. And you know, there was, there’s just always so much going on in terms of prescribing, and especially in the elderly population, and the Medicare Part D population. So that’s kind of how we came about the idea, we just wanted to do something that was immediately immediately applicable to the Medicare Part D, part to the stars piece, and then something that isn’t immediately prioritized in a clinic setting.
Fred Goldstein 06:18
So let me ask you this question kind of out of left field. Gregg and I have been in this managed care healthcare stuff for 30 plus years, you’re a relative newcomer Stars his put out as this quality metric to measure health plans. What’s your sense when you look at Stars? And look at it in this area? Is it something you think that is giving valuable information to the individuals who receipt who are using it to score health plans?
Caitlyn Tung 06:42
Yes, definitely. I think it’s really useful, especially if you’re a patient that has a certain chronic illness that is, you know, taken into consideration by stars. It’ll definitely help the patient or member figure out which plan is right for them what plan is right for their chronic illness? What will help them save money in the grand grand scheme of medications?
Fred Goldstein 07:06
So, when you look at this, how, what did you ultimately look at? And then what did you find?
Caitlyn Tung 07:14
So we looked into Cigna Medicare Advantage members who were fully enrolled from January first 2018, to December 31, 2019. And then January 1, 2019, to December 31, 2020. So those are our two cohorts, the 2019 cohort, and then the 2020 cohort. So, we included anyone that was aged 40 to 75 years old, who had at least two paid claims for diabetes medications during the evaluation year, and had no paid claims for any statin within the past 12 months. And those are just following the inclusion and exclusion criteria for the SUPD or Statin Use in Persons with Diabetes measure.
Fred Goldstein 08:00
And, and so how large was the study?
Caitlyn Tung 08:04
The study, we looked into 11,322 members for the 2019 group. And then for the 2020 group, we thought we identified 9,807 members.
Fred Goldstein 08:18
Right? And in those in the study, you found that so you looked at baseline and then you looked at the first year for each of the two groups looked at whether or not they had a statin prescribed in that second year. Is that right?
Caitlyn Tung 08:31
Yep, definitely. And then we also looked at other member demographic information, such as Low-Income Subsidy or LIS status, whether they had two or more paid claims for diabetes medications in the baseline year, type of diabetes, geographical region, risk score and total medical cost in the baseline year.
Fred Goldstein 08:53
And so, what were your findings? I mean, everyone’s wondered what how COVID is impacted people who maybe were being treated for other conditions. And this is one of those classics, it’s a chronic disease, what’s going on? Did they get access, what did you find?
Caitlyn Tung 09:05
Yeah, so the unadjusted rate of statin initiation as in not really evaluating the other demographic information that we looked at the rate of sound initiation in 2019, was 46.8%. And then in 2020, it was 40%. And then once you incorporate all those other variables, we found that the likelihood of statin initiation in 2020 was 24.2%, lower than 2019. And that was statistically significant.
Fred Goldstein 09:37
Wow. So, these were people who should have been getting the prescription, but didn’t for one reason or another. Hmm,
Caitlyn Tung 09:43
yep.
Fred Goldstein 09:44
And then when you think about that, over the longer term, what are some of the possible impacts of that to the individual?
Caitlyn Tung 09:51
Yeah, so modern high-intensity statin use is generally recommended by the American College of Cardiology for individuals age 40 to 75 with diabetes in order to reduce the risk of atherosclerotic thero sclerotic cardiovascular disease. So, in the grand scheme of things, these patients are at higher risk of getting heart disease. You know, they’re, they’re not as healthy as they should be. They their risk score might increase over the years. So generally down the line costs will increase, they’ll spend more money on more medications, or even hospital visits.
Fred Goldstein 10:29
And obviously, their health then might be poor, and they’re living with other disabilities or things associated with that.
Caitlyn Tung 10:35
Exactly.
Fred Goldstein 10:36
Interesting. And I also know, you sort of teased out some subgroup information in that, what else did you find?
Caitlyn Tung 10:43
Yeah, so this might not come as a surprise to anyone. But we found, we found that the southeast region actually had the lowest likelihood of the other regions, we compared it to where Mid Atlantic, Midwest and the Southwest. And
Fred Goldstein 10:59
go ahead. No, I’m just laughing, because Greg and I were specifically discussing that issue before you came on and, and essentially saying, well, there’s no surprise there. But you then have validated once again, this issue we face in the southeast?
Caitlyn Tung 11:12
Yeah. And I think it’s definitely a great area to start, you know, trying out initiatives and seeing what can increase medication adherence in that area.
Fred Goldstein 11:25
Do you have any sense for why the numbers dropped, why the prescription refills dropped?
Caitlyn Tung 11:31
I think that it might have dropped because there were higher priority issues, obviously, COVID was a huge, you know, huge issue during 2020. And I think when people were going to the doctor, were getting their telehealth visits, they were mostly, you know, trying to figure out solutions to their more chronic and priority issues. As opposed to you know, your HB1c’s low, you might need to take a statin.
Fred Goldstein 12:06
And you talked a little bit about possibly, you know, an idea, maybe you’re trying to focus on the southeast United States, what would you as an assumed to be PharmD. Think about doing? What are some of the ideas that might be used to address this issue?
Caitlyn Tung 12:23
Yeah, I think a great way to address this issue is through social media, because everyone is on social media these days, everyone is using Facebook, which is soon to be called meta with just target targeting, targeting those individuals that use social media a lot would be great. And you know, just incorporating little educational pieces on why heart health is important, you know, talk to your doctor, if you think you may need a statin these are the these are the inclusion criteria for needing a statin. If you’re a diabetic, you know, these are some things that could help you in improve that or improve your overall health. And then also, I think one thing that isn’t adequate or isn’t communicated enough to patients is like we want, we don’t want to just solve the immediate problems, you know, we want to help them get their overall health better. So just, you know, trying to find some educational piece that will remind them that down the road, what we’re trying to do right now is going to help them live a better life, live a longer life live a healthier and happier life.
Gregg Masters 13:37
And if you’re just tuning into PopHealth Week, our guest is Caitlyn Tung, a fourth-year student at the University of Washington School of Pharmacy for more information or to learn more about the School of Pharmacy at UW go to www.sop.washington.edu or follow them on Twitter by at @UW_pharmacy.
Fred Goldstein 14:01
In terms of Caitlyn not just focusing so much on the on the patient, which is obviously critical. But is there a role to be played in focusing on the providers themselves?
Caitlyn Tung 14:10
Oh yes, definitely. I mean, even just sending around my poster to the southeast region prescribers and showing them like you guys are you guys are falling behind all the other regions, you need to do something to catch up. That’s definitely a good idea, too.
Fred Goldstein 14:27
So, are you talking to any of the funders of this study or the health plan about sending your poster out?
Caitlyn Tung 14:35
Yeah, now the internship has ended. I haven’t. I haven’t done too much on the poster. But that’s we have been in the talks of potentially getting a manuscript out there. So maybe that way to help increase awareness.
Fred Goldstein 14:51
That’s That’s great. And I know there were a couple limitations to the study. It’s always important to point those out. What were some of the limitations to your study?
Caitlyn Tung 14:57
Yeah. Oh, firstly, the results are based on administrative claims data. So, it might not always show the full clinical picture. Definitely, there were some variables that we could have looked into. But it was at risk of introducing a little bit of collinearity, or no statistical significance. And then secondly, CMS added new exclusions to the SUPD measure and 2021, such as history of myopathy. And those weren’t included in our study because we were trying to include as many patients as we can, and that measure wasn’t, or that ruling wasn’t introduced until 2021. So just our data might include beneficiaries who have or had contraindications to statin use.
Fred Goldstein 15:45
Right. And And another interesting point you found in that was your low-income group. And what did you find with that?
Caitlyn Tung 15:54
Yeah, we found that the group receiving low-income subsidies were more likely to start a statin than the group not receiving LIS and that was consistent across both cohorts. That was interesting. And we were kind of thinking it might be because the medications are more affordable, they’re more willing to pick up their medications. But another limitation there is we don’t actually know if they’re still, if they’re actively adhering to the medications, we just know that they’re picking up.
Fred Goldstein 16:24
They feel that that’s always been the problem and adherence. But we know they picked it up, we just don’t know if they actually got ingested. So definitely an issue. What, what else? What did this teach you? What did you learn yourself?
Caitlyn Tung 16:40
Yeah, I just wanted to mention one more interesting,
Fred Goldstein 16:42
please go ahead.
Caitlyn Tung 16:44
That was my, that was my favorite point, actually, that I meant to bring up. But it was, so we broke down the age into three buckets, younger than 65. So, 40 to 65 years old, then 65 to 70 years old, and then 71 to 75 years. That’s the whole age that fits in the SUPD measure. And we found that that middle group was actually more likely to start a statin than the younger than 65, or the 71 to 75 age group. And that was really shocking to both me and my preceptors. Because, like, if you’re older, why aren’t you just getting prescribed all the medications that you need. But then after taking a step back and thinking about it, we realize that if you’re younger than 65, you might not be fully into your chronic illness, like you’re not experiencing that many side effects. So, there’s less of an urgent need to the statin. And then if you’re older, there’s definitely a risk of over-prescribing polypharmacy. And again, the issue of identifying identifying diseases that need immediate treatment, as opposed to one that’s kind of occurring in the background is definitely something to think about as well.
Fred Goldstein 18:02
Yeah, hearing it should be an interesting one to look at. And we’ve discussed it off on the show. Really well aware of it. I’m wondering if people going in for their first annual Medicare wellness visit might have had it brought up at that point, you’re looking at that 65 to 70 year age groups. And that might be their first one. And maybe it’s getting a little more attention early because of that.
Caitlyn Tung 18:23
Yeah, actually, definitely.
Fred Goldstein 18:25
So well, really, really neat stuff. And and getting back to the question, I really appreciate you bringing up that the different age groups because that is a fascinating issue. The older people, polypharmacy, they’ve been in Medicare for a while the doctor probably knows them, those kinds of things you would think would make it more likely. So So what did you learn from this? Or what was the experience like?
Caitlyn Tung 18:48
It was definitely a really, really fun experience. Chris Powers is so intelligent and so passionate, and always he was always so supportive, and I was so glad to be able to reach out to him at any time of day and just ask him a question. And also, he was really knowledgeable in SAS software. So, he was able to help me, you know, figure out how to crunch the data, how to make it presentable and easily digestible. So, I think my main takeaway from this was how to you know, this started as a do a Capstone Research Project, that’s all I got. And just to turn that extremely loose requirement into something impactful, and, you know, easily talked about and relevant, and that serves as a template for if we ever find ourselves in a pandemic, again, God forbid, is truly rewarding and I do not regret this experience at all.
Fred Goldstein 19:51
That’s fantastic. And I would assume if we looked at something like this, given the the broad impact of the pandemic on the health care system, we’d probably find similar issues associated with other adherence measures or chronic disease management approaches. Have you thought some about that?
Caitlyn Tung 20:10
Yes, I have, I would definitely think that the ones that are, you know, either are dealing with chronic illnesses where, you know, it’s recommended but not mandated to prescribe a medication for that illness, those measures would definitely also probably see similar results.
Fred Goldstein 20:33
So, what do you think about this, too, you talked about some of the ideas that educating patients or providers providing? What role could pharmacists play in improving this?
Caitlyn Tung 20:45
Yeah, pharmacists plays such an important role in this. And I feel like it’s hard for patients and even providers to understand the role that we play. But we are able to, you know, conduct this kind of research, one, study the impact of change and access, and the pharmacist would be able to effectively strategize and prioritize ways to provide health care to those who need it, especially, and like I was saying earlier, the event and other health pandemic occurs
Fred Goldstein 21:18
with your soon to completed PharmD, I guess is what you finish up maybe early next year, next year, mid-year,
Caitlyn Tung 21:25
graduate, June 2022.
Fred Goldstein 21:28
Well, congratulations an early congratulations for a successful PharmD degree here.
Caitlyn Tung 21:34
Thank you
Fred Goldstein 21:35
Great. So now you’ve got this under your belt, the degree you’ve got your poster, a unique study pandemic, you’ve worked a bit in Cigna, what do you plan to do with your degree? Where are you going next? But what are your thoughts about that?
Caitlyn Tung 21:48
Yeah, I am currently applying to industry fellowships, I have found that I really enjoyed designing the poster, designing the communication piece. So, I’ve chosen the functional area, we’ll see how that goes. I’m like I was saying earlier, I’m currently doing a rotation. This one is work from home, which so I’m lucky to be able to sit from the comfort of my home and take a break from rotations and talk to you today. But yeah, just applying to fellowships, hopefully, that will land me a career in industry. And I can continue to, you know, do impactful research and find gaps in healthcare access.
Fred Goldstein 22:30
Well, so you’re thinking of going into sort of maybe the managed care side itself, or so I get to do research within those organizations or another place.
Caitlyn Tung 22:39
I was thinking more on the industry side. Yeah,
Fred Goldstein 22:43
got it. And are there any particular areas of healthcare, cardiac, some find most interesting or you plan to try to work in?
Caitlyn Tung 22:54
Yeah, I have actually found that oncology is the most interesting for me at this point, just because I was, I was doing a PowerPoint presentation on non-small cell lung cancer. And I realized that I had no idea how to read the NCCN guidelines. I, it was so complex. And it was just super challenging for me to figure out but also extremely fun. So going into the oncology space would, you know, I feel would continue to challenge me. And it’s such an exciting space to work in, because there’s always new drugs coming up in the pipeline, and just the culture of more oncology-focused biotechnology companies. I feel it has is place for me.
Fred Goldstein 23:41
Wow. So, you’d look to do research within an oncology-based Pharma organization?
Caitlyn Tung 23:47
Yeah, like market research, or access and analysis. Yeah.
Fred Goldstein 23:53
Oh, interesting. So, you’re more interested in what the outcomes might be or where you take this, etc.? versus the actual research on the product drugs themselves, things like that?
Caitlyn Tung 24:03
Yeah, I think it’s great. I really enjoyed working part-time as a market access analyst for a small consulting firm in San Diego. I think their work was really cool. Like just you know, supporting a drug through launch, and figuring out what services are needed to support a patient through their difficult oncology journey that has been really interesting for me. So, I would like to continue a career with that.
Fred Goldstein 24:29
You said you also guess this was through the AMCP Foundation.
Caitlyn Tung 24:33
Yes, definitely.
Fred Goldstein 24:34
So how did that work? And what was that experience?
Caitlyn Tung 24:37
Yeah, so I was heavily involved in our in UW’s local AMCP Chapter. I participated in a few P&T competitions, and you know, join the ISPOR for happy hours and I came across the AMCP Foundation internships, and basically you apply and I think specifically For this role I had to submit, like a sample and a small letter of intent. And then interviewed with the company, loved it, and, and got the role. And then when I went into it, I was I wasn’t really sure what I was expecting, but I absolutely loved managed care. I love working for Cigna, it was, they are so sweet and really supportive. And, you know, anything I wanted to learn, they would just be like, okay, here, go attend this meeting, learn about this. And they also gave me an I mostly worked in Medicare, but I also had an opportunity to experience the commercial side of, of the company. And that was also really interesting. And then on the Pfizer side, I had one mentor, Eric Carta, he was so good. He was like, what do you need to learn about industry? Let me walk you through everything. He’s a medical outcome specialist. So he’s really knowledgeable, you know, account management and manage markets. So overall, it was just such a rewarding experience. I have never learned so much in 10 weeks, which is funny to say, because I went to pharmacy school for five years.
Fred Goldstein 26:17
That’s amazing. And just a quick comment. We have about a minute left or so here. What were your thoughts of AMCP Nexus?
Caitlyn Tung 26:24
Oh, it was so fun. Obviously. Number one thing was you and getting the opportunity to record this podcast? Uh, no, I promise it has been on my bucket list. I’m so excited to be here. And then just you know, networking and getting to meet every all my fellow interns, the AMCP Foundation interns in person that was really great. And then also meeting my Cigna preceptor in person, just meeting everybody in person was the best part.
Fred Goldstein 26:54
Yeah, I think that in-person thing was really unbelievable. So that was just great. Well, Caitlyn, I want to thank you so much for coming on PopHealth Week and discussing your study, and I wish you much success in your future endeavors.
Caitlyn Tung 27:07
Thanks, Fred. It was great being here.
Fred Goldstein 27:08
And back to you, Gregg.
Gregg Masters 27:10
And thank you, Fred. That is the last word for today’s broadcast. I want to thank Caitlyn Tung, a fourth year student at University of Washington School of Pharmacy for her time and insights today. For more information or to learn more about the School of Pharmacy at UW, go to www.sop.washington.edu or follow them on Twitter by @UW_pharmacy.