ANALY TIC S & H E A LT H CA R E
Although better medication
adherence can marginally
increase a payor’s cost per
patient, better outcomes
and cost savings from
preventable disease
exacerbations save money
in the long run. Analytics
play a major role in both
predicting patient cohorts
who are at risk of
non-adherence and the
kind of intervention that
works best for them.
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Providers who also have pharmacies need EHNAC
(Electronic Healthcare Network Accreditation Commission) certification, and medication adherence is an
important part of certification. The HEDIS (Healthcare
Effectiveness Data and Information Set) score that
measures medication management is another key
metric that payors pay attention to because it impacts
their health plans and ultimately their profits.
Payors who offer Medicare Advantage plans, for
example, are concerned about CMS provided-STAR
ratings for their plans because more stars mean a
higher bonus amount (tens of millions of dollars for
large plans). Medication adherence is a key aspect for
STAR ratings. Although better medication adherence
can marginally increase a payor’s cost per patient,
better outcomes and cost savings from preventable
disease exacerbations save money in the long run.
Analytics play a major role in both predicting patient
cohorts who are at risk of non-adherence and the
kind of intervention that works best for them. Analytic models can consider hundreds of different factors
in a patient population and improve accuracy of the
prediction.
Medication adherence is also a key component
of achieving effective population health management, so it makes sense for providers, payors or
accountable care organizations to apply predictive
analytics to address both problems at the same
time. Forward-looking health care organizations
such as Partners Healthcare, Baylor Healthcare
System, Kaiser Permanente and Intermountain
Healthcare have already done that. The next few
years will be a bit chaotic but exciting for the healthcare industry. Data and analytics will be harnessed
A N A LY T I C S - M A G A Z I N E . O R G
W W W. I N F O R M S . O R G