RationalMed: Closing Gaps in Patient Safety

Feb 21, 2013
Through RationalMed, Express Scripts coordinates across organizations to address otherwise unidentifiable safety issues related to prescription drugs.

How is it that people with heart failure receive prescriptions for diabetes medications known to worsen heart failure? Or women with a history of life-threatening blood clots can be prescribed estrogen products known to cause blood clots? 

Drug-disease interactions are a major safety issue and too often go undetected until it’s too late. Such medication safety issues can lead to serious – even life-threatening – side effects such as breathing difficulties, mental changes, heart attack and stroke. Combined with the waste generated from unnecessary and avoidable emergency room and doctor’s visits, diagnostic tests and hospitalization and the cost of undetected medication safety issues, the price tag really adds up.

Plan sponsors may feel falsely reassured that their members are protected against such risks by traditional clinical programs. However, many of these safety issues often go unaddressed mainly because their programs are not set up to detect these risks or are unable to do so quickly enough to prevent patient harm.

Increased Patient Safety Protection 

RationalMed®, Express Scripts’ advanced patient safety solution, is different. Through RationalMed, Express Scripts rapidly addresses these otherwise unidentifiable safety issues. We do so using a highly automated, three-step process.

First, RationalMed integrates medical, pharmacy and laboratory claims data to create a person-centered record for each member.

Then, RationalMed assesses these records by applying thousands of evidence-based clinical rules, created and honed over two decades, with the input of clinical specialists. RationalMed reassesses patient records whenever the underlying data is updated, including real-time processing of prescriptions. This allows RationalMed to identify patient safety and health risks missed by physicians, pharmacists and traditional clinical programs, which are highly concentrated among patients with multiple doctors involved in their care.

Once a risk is identified, RationalMed alerts the doctors about the patient’s health risks. Often, the doctor was unaware of the issue and immediately changes the medication, potentially saving the patient’s life.


Actionable Data Identifies Gaps in Care

RationalMed identifies critical errors and gaps in care for all members of clients enrolled in the program and provides timely, actionable data that enables pharmacists, providers and patients to make better health decisions and prevents unnecessary and costly hospitalizations.

RationalMed identifies potential risks in three key risk categories:

  1. Adverse drug interactions: These includes interactions between the drug and a patient’s diseases and medical conditions, interactions between different drugs, and excessive dosing and therapy duplication.
  2. Care coordination: This includes potential misuse/abuse and polypharmacy issues. This is important because prescription-drug abuse is a national epidemic that causes more deaths than cocaine and heroin combined.
  3. Omission of essential care: This identifies potential underdosing, omission of essential medication or drug-related testing and diagnostics, as well as adherence issues.

RationalMed Identifies Undetected Risks 

Today’s healthcare environment has grown increasingly complex and fragmented. Consider that about 32 million Americans take three or more medications daily. These errors and gaps in care can sometimes be fatal.

The RationalMed Difference

RationalMed’s ability to identify safety and health risks that would otherwise be missed makes it the most advanced patient safety solution in the marketplace.

In fact, nearly 65% of physicians who are sent an alert make a change in therapy based on the information provided by RationalMed, compared to 15% to 22% for any other comparable industry program. RationalMed closes a critical gap in patient safety and care, leading to better decisions for healthier outcomes.

Savings for Clients

In addition to making patients safer, RationalMed saves money for plan sponsors. Participating clients save up to four times the program costs in pharmacy costs and eight times in total healthcare costs.

Author Bio

Lab Staff
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