Category:  Population Health

How Analytics Can Help Payers Monitor Specialty Drug Costs

With the continued frustration over rising healthcare costs, the White House has made prescription drug reform a top priority. Thomas Beaton of HealthPayerIntelligence recently published an article which shares that payers are eager to see this effort succeed as they also search for ways to best address the high prices of certain medications. In 2016, the U.S. spent $450 billion on prescription drugs, with specialty drugs accounting for 1/3 or about $150 billion of U.S. drug spending. These numbers are staggering especially when you consider that only 2 percent of prescriptions in the U.S. are considered specialty. How can payers control these rising drug costs and take matters into their own hands? To start, they need to identify high-cost members and the prescribed medications to find opportunities for savings.

Gain a bigger view: Specialty drug therapies are managed across various benefit structures and can include different routes of administration. As a result, it’s important to look at claims processed under both medical and pharmacy benefits to understand when and where specialty pharmacy drugs are being obtained and at what cost.

Target high-risk members: Top conditions treated by specialty drugs include multiple sclerosis, rheumatoid arthritis, growth hormone deficiency, hepatitis C, cancer, hemophilia, and immune disorders. Analytics can help bring together disparate data sources to better identify the conditions most impacted by these drugs and opportunities to refine benefit structures, improve adherence and optimize care management programs – all of which can help decrease costs while improving outcomes.

Solutions like MedeAnalytics Healthcare Economics and Population Heath effectively links medical, pharmacy and other data sources to give payers a deeper understanding of specialty pharmacy utilization and costs.

St. Joseph Hospital, part of Covenant Health, was looking to cut overall costs within their employee health plan and found that more than half of their pharma spend came from specialty drugs. To better manage their overall pharmacy spend including both traditional and specialty drugs, they turned to MedeAnalytics.

With MedeAnalytics Population Health, St. Joseph Hospital gained insight into costs and could pinpoint patterns and correlations that revealed opportunities for drug savings, leading them to understand which areas of their pharmaceutical spend needed the most attention. By analyzing the organization’s pharmaceutical data, St. Joseph Hospital achieved their goal of reducing overall pharmaceutical costs. Interested in learning how analytics can help your health plan alleviate rising drug prices? Visit our Population Health solutions page, read the St. Joseph Hospital case study or contact us here.

No More ‘Death by ZIP Code’: Leveraging Old Data to Improve Population Health

When it comes to population health management, data is key. As we enter 2015, the challenge will be how to leverage existing data to make actionable decisions and predictions to improve the health of communities. Read more of MedeAnalytics' chief medical officer Terry Fouts' thoughts on how to apply this data below. 

Population health will continue to be a focus in 2015, but we should start the year off by looking at some new ways to leverage underutilized and overlooked data. We can see the shortcomings of population health initiatives particularly in the “death by ZIP code” pandemic across the country today. 

Where you live and what you do has more of an impact on your healthcare than anything else. Doctors have known for decades that that a person’s health outcome is determined largely by their behaviors and access to care, and less so by innate biology. 

Take a look at the 94101-94199 zip codes of San Francisco, one of the most affluent cities in the country with a high concentration of hospitals and healthcare facilities. 

Yet if we look at the same area and observe the incidents of asthma, we’ll see that the wealthy regions with a higher concentration of healthcare facilities in fact have higher ER rates. Clearly money and a high density of hospitals is not the magic recipe for health. 

Today, this information is just that – static information that lives on a color-coded graphic. What it needs to turn into in 2015 is action. 

Despite the troves of information we now have at our fingertips, the healthcare industry still does not have a way to rapidly and effectively identify, stratify and triage patients into cooperative multidisciplinary systems. Put simply, we are selling ourselves short and we need to make the leap and look at where people live and their behaviors. 

The electronic health record is a great first place to start. EHRs need to empower the doctor and make the demographic data determined largely by a patient’s zip code seamlessly available. In an ideal scenario, this should go hand-in-hand with a patient’s medical history. 

In addition to the EHR, clinicians also have first-hand knowledge of the patient from the patient themselves, information from family and friends, health risk appraisals, biomedical data and social data. 

Large pools of data covering every aspect of the patient add richness to the activity that is hard to match with single source anecdotal information. If, and it is a big ‘if’ but growing smaller, we could amalgamate all of the inpatient data with the ambulatory data, the personal data, and the claims data, healthcare providers could get an accurate, focused and timely view of where an individual is in their care cycle and identify needed interventions and support. 

Integrating more data into the EHR may take up more time and be another chore but it will be worth it. It’s no secret that EHRs and the current Meaningful Use incentive program present many time and workflow challenges for doctors. In a recent SERMO poll of 1,800 physicians across the U.S., 59 percent identified EHRs as their biggest technology challenge in 2015.

To read the full piece, visit Healthcare IT News

What Makes a Wellness Program Succeed or Fail? Behavior, Motivation, and Personality

Intuition and recent studies have proven that wellness programs, which actively leverage activity trackers, are great but one size definitely doesn’t fit all. This piece explores the history of activity trackers, how they play out in wellness program and an analysis of one global company’s wellness program participation data. Read more on the full MedCity News piece.