Making Big Data Actionable

Oct 10, 2013
Big Data becomes actionable if ready at the point of a health decision. Actionable data improves patient decisions and leads to healthier outcomes.

What can data do? Can it help patients make better decisions about their care? Improve health outcomes? Can it save a life? 

At Express Scripts, we believe data can do all those things if – and only if – it is actionable at the moment when a health decision is made.

We collect 160 quadrillion bits of data from the more than 1.4 billion prescriptions we administer each year. This spans pharmacy claims for 100 million Americans, and integrates pharmacy and medical data equivalent to 100 million life years. We put this data to use every day to help patients make better decisions about their health outcomes.

Every 22 miliseconds, our system checks for 3,200 drug rules, including potential drug interactions, overdosing and therapy duplication. In the same amount of time, 2,203 medical rules are verified to identify potential contraindications and allergies. Every second, we close 20 therapeutic gaps by laser etching refill-related messages tailored to specific patients on prescription bottles.

It's this sort of instantaneous, informed action that makes Big Data useful in healthcare.

When Health Decisions Are Predicted, Interventions Are Targeted

Leveraging our data, our advanced analytics team has deployed more than 40 predictive models. These models provide early detection of several key factors, such as:

  • If a patient is likely to stop taking his or her medications
  • Which communication mechanisms are likely to be most helpful for a specific patient
  • If a pharmacy should be investigated further for potential fraud related to prescription drug abuse

By implementing this predicting technology, we are able to identify consistent patterns and tailor the most effective interventions for those patients most at risk. We plan to deploy an additional 80 models next year.

Evidence-Based Research, Turning Insights Into Solutions

Our Clinical, Research & New Solutions team mines this data to generate insights, pilot programs and national solutions that help reach our goal of greater health and zero waste. For 20 years, our Drug Trend Report has been providing the industry’s most detailed analysis of prescription drug costs and utilization, and our research has been published in more than 100 peer-review journals.

Our research provides timely, relevant and objective documentation to support decisions about the pharmacy benefit, delivering better value for our clients, better health for our patients, and better guidance for state and federal policymakers.

Solutions Based on Actionable Data

ScreenRx®: We leveraged our predictive models in ScreenRx, which considers more than 400 known variables about the patient, physician, disease and prescribed therapy to identify who is most likely to stop taking their medications so that we can intervene early with a solution tailored to each patient. ScreenRx models have demonstrated up to 98% accuracy in predicting nonadherence one year in advance — nearly nine times more accurate than what patients self-report.

RationalMed®: RationalMed is an evidence-based patient safety program that integrates medical claims, pharmacy claims, and lab data to identify safety and health risks effecting greater changes in therapy and treatment. As a result, we are closing gaps in essential care, and we are preventing unnecessary and costly medical complications and hospitalizations.

ExpressAlliance®: For patients with multiple complex conditions, ExpressAlliance provides coordinated care by bringing together teams of nurses, physicians and specialist pharmacists to review real-time, actionable patient healthcare information in order to address potential gaps in care.

ExpressPAthTM: ExpressPAth is an online physician portal that leverages terabytes of actionable data to encourage optimal prescribing decisions and ensure that every dollar spent is appropriate for the patient’s treatment.

Fraud, Waste & Abuse: Our industry-leading Fraud, Waste & Abuse program uses proprietary advanced analytics to identify patterns of behavioral red flags that could be indicative of potential fraud or abuse.

Alongside clinical specialization and our application of the behavioral sciences, our actionable data help form the foundation for a unique, innovative approach to pharmacy benefit management. It is our commitment to the use of Health Decision Science, to the understanding of how health decisions get made and to the creation of ever better solutions for patients and clients.






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Lab Staff
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