Know the History, Affect the Future

Health plans can now support patient care with Medication History for Populations, which enables care managers to help keep members healthy over time.

Absolutely wonderful. That’s how I imagine Carrie feels knowing her work has made a real difference to someone’s health.

I wrote about Carrie, a fictional care manager, and Aaron, a fictional patient, in a story about what happened to get Aaron’s health back on track after his heart attack.

In that story, not only could Carrie identify Aaron as a higher-risk member, but she could track his medication adherence and proactively reach out to troubleshoot any issues with costs and side effects—and then use direct messaging to get in touch with Aaron’s doctor for a possible change of medication. Carrie could do this because she had insight into Aaron’s prescription history, along with other tools that allow for data exchange and interoperability.

At Surescripts, we believe that care managers have a role in delivering value-based care, and that is why we launched Medication History for Populations for health plans, which makes it much easier to deliver data-driven value-based care for members.

Population Health & Value-Based Care

Surescripts Expands Enhanced Visibility into Patient Medication Histories for Health Plans

What powers population health? The answer is dispensed medication data.

But this data isn’t easy to get. Health plans typically go through a manual, time-consuming process (a process that never really ends) to pinpoint higher-risk members and prioritize them for outreach to address medication adherence. To top it off, the process won’t necessarily reveal any insights into new-to-plan member risk, for example, not to mention that any given member’s health is always in flux.

“Having better visibility into a patient’s health information,” as our CEO Frank Harvey said when we launched Medication History for Populations, “can meaningfully improve medication adherence, support safer prescribing and deliver overall better quality, less costly care for patients.”

With Medication History for Populations, care managers get near-real-time notifications on prescription activity and the ability to communicate broadly and easily with connected providers.

Pinpoint Higher Risk Members—Automatically

Dispensed medication data enables health plans to pinpoint members who are at higher risk. Care managers can identify these members and prioritize them for outreach—without having to do so manually—helping keep members healthy over time by monitoring their medication activity with proactive prescription notifications.

• Close targeted care gaps: Track medication adherence to identify outreach opportunities in value-based care populations.
• Get high-quality data: Access members’ claims and pharmacy fill records—including cash-pay medications—from major pharmacies and pharmacy benefit managers (PBMs) nationwide and with our best-in-class Master Patient Index that covers over 99% of the U.S. population.
• Reduce readmissions & penalties: Comprehensive medication data lets care managers reduce readmission and CMS penalties—and maximize reimbursements. In other words, health plans can maintain their HEDIS measures and Star Ratings.

When care managers have the medication history—in the form of targeted data for specified member groups of any size, refreshed nightly—they can affect the future.