The engine that drives program optimization is integrated pharmacy and medical analytics. Monitoring data is vital and monitoring it across both medical and pharmacy is where the most valuable opportunities exist. But it’s not simple. That’s why technologies like Artemetrx are so important.
Integrated analytics allow employers to be proactive with their benefits strategy, anticipating the impact of change and proactively addressing these dynamics to reduce member disruption and unbudgeted costs.
Just like a sports team has offensive and defensive plays – actively managing costs and member experience requires both reactive and proactive strategies. Using data to design the best strategy for your business allows more informed and precise decision-making to occur.
Today, there is no shortage of data available to plan sponsors, but solutions that just warehouse data fall short. Savings opportunities can be achieved by gaining meaningful insights derived from data.
Examples of such insights are:
Roller coaster fluctuations in drug pricing have clouded historical trends. Benchmarking an organization’s plan performance against other organizations can help clarify expected versus unexpected shifts in spend and trend.
2. Duplicate and suboptimal therapy
The most expensive medication is the one the patient did not need, such as duplicate therapy. Duplicate therapy occurs when a patient receives two medications that “do the same thing.” This can be especially difficult to detect without technology tools when prescriptions are paid across pharmacy and medical benefits. Another example is identifying instances of suboptimal therapy, such as unneeded double-dosing of a specialty drug. The Artemetrx clinical rules engine evaluates over 1,000 unique parameters such as first-line therapy and diagnosis code to identify unnecessary medication spend.
3. Formulary strategies
With tens of thousands of medications on formularies and new super-high-cost gene therapies and specialty drugs flooding the market, it takes robust data and clinical expertise to ensure the formulary achieves the plan sponsor’s goal. Analytics can quickly identify the member impact of new drugs coming to market and the expected outcome of PBM formulary changes.
4. Spend and trend management
Far too often, plan sponsors face spikes in spend and trend without reliable insights into the driver. Integrated analytics can provide transparency to the entire drug management program, such as the top drugs, providers, and members driving spend. What’s more, analytics can identify outlier providers in the medical benefit that may be overcharging your plan.
5. High-cost member management
Virtually all plans have a small percentage of members generating a large portion of overall spend. Medication-based analytics can be instrumental in identifying and monitoring these members. For instance, identifying newly diagnosed patients for high-cost diseases and tracking the effectiveness of patients receiving high-cost medications can all be done through analytics.
Don’t set it and forget it.
Data-driven strategies will generate better financial and clinical outcomes. With a strong contract in place, let it work by finding new opportunities and efficiencies.
Download the 2022 PSG Complete Playbook to uncover more opportunities to strengthen your pharmacy strategy this year.