Using Data to Make Your Next Benefit Decision

Nov 1, 2017
Delivering actionable insights to clinicians and patients help avoid future costs and lower health risks.

Rochelle Article

By 2020, 83% of employers will offer a consumer-directed health plan (CDHPs). These plans are characterized by cost sharing between employer and member, where high deductibles and out of pocket limits are the tradeoff for lower premiums and tax benefits.

As consumers find themselves responsible for a larger portion of their healthcare bill, Express Scripts is committed to protecting patients by improving health outcomes while driving down costs. We do this by leveraging vast data insights that individuals can actually act on.

How Big is Big Data?

Pharmacy data are often considered the best predictor of a patient’s health. Unlike medical claims data, which may appear weeks after the healthcare action and only a few times per year, pharmacy data come in real-time upon each prescription fill. To understand its depth, data scientists describe big data through the five V’s: variety, velocity, variability, volume and veracity.

  • Variety – More than 3,400 external and internal sources provide Express Scripts with variety in the type of data we receive.
  • Velocity – With more than 35 million daily claims, Express Scripts’ acquires data every millisecond.
  • Variability –As large amounts of data come in quickly, we have the capabilities to integrate and enhance the ever-changing data to create exponential value.
  • Volume – Express Scripts sources nearly 22 petabytes of data. To put this into context, if you converted 22 petabytes to mp3s and hit play, you wouldn’t hear same song twice in 44,000 years.
  • Veracity – The quality of data is chiefly dependent on governance. Express Scripts domains allow for governance focused on quality to produce clean data feeds.

Even with a wealth of big data, healthcare executives feel unprepared to act on this data. At Express Scripts, we believe data should be viewed as another tool in the clinician’s toolbox.

Leveraging predictive analytics, we can predict medication nonadherence at 94% accuracy and provide tailored interventions to help each individual remain adherent to their treatment plan. We are also applying predictive analytics to new frontiers, which helps members better manage his or her spend in an era of continuously rising drug prices. With prescriptive analytics, we are able to identify the probability of an individual being diagnosed with a chronic disease or having an adverse health event within specific period of time and identify the actions necessary to mitigate the risk.

Actionable Data in Practice

Pharmacy data paired with medical data can be even more powerful to recommend individualized clinical interventions. For example, Express Scripts data scientists identified a patient with diabetes, depression and chronic pain. The data showed this patient has not checked her A1C in the past year. Plus, enrolled in a consumer-directed health plan, this patient was shouldering more healthcare costs, but lacked information to proactively manage these costs.

Using data to track patients’ risk levels over time allow us intervene before costly and negative health events occur. Our data led us to recommend specific actions for this patient to improve outcomes and lower costs. We counseled the patient to work with her physician to measure her A1C, which is leading indicator of well-managed diabetes. We highlighted clinically-equivalent generic medication options that may be more affordable to the patient. And finally, we shared tips for better adherence to treatment plan, which prevents downstream health costs like ER visits and hospitalizations.

Advanced analytics and big data are not intended to replace clinical expertise or automate diagnosis. Rather, advanced insight allows prescribers and patients to optimize clinical care. This helps save patients money, lower plan costs and – most importantly – avoid future health risks to ensure better outcomes.

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