Surescripts Analysis Reveals Billions in Potential Savings for Health Plans, Patients & Employers

Our analysis suggests that health plans will save more than $648 million by investing in medication history for population health—and that’s before we get to how much patients and employers save.

Medication History for Populations simplifies the medication review process with dispensed medication data, which we’ve written about here and here. These stories explain how health plans can use real-time insights to deliver data-driven value-based care, for example, by enabling their care managers to assess medication adherence.

And the benefit of these data-driven insights flows to patients and employers, too.

This scenario*, based on an analysis performed by our in-house experts, suggests how much health plans, patients and employers can expect to save.

As health plans know all too well, member turnover at the new year (and throughout the year) means having very little data—or none—on new-to-plan members. That makes it difficult to identify higher-risk members who need additional outreach and support in chronic disease management programs, resulting in care gaps and higher costs.

In this scenario, U.S. health plans save more than $648 million in the form of cut medical costs, higher revenue from more timely and accurate risk adjustment, and higher Star ratings, with a $1.56 PMPM (“per member per month”) financial impact that scales very well with 5% of members enrolled.

Importantly, our analysis also reveals a significant benefit to patients themselves in the form of reduced healthcare spending and fewer days of missed work, for an estimated savings of $1.88 billion among all health plan members nationwide (and an estimated savings of $1.23 billion for members’ employers) over a three-year timeframe. All told, that’s more than $3.76 billion in savings by giving care managers access to patient medication history.

Listen to the webinar below to learn more about how Medication History for Populations helps inform e-prescribing, assess adherence, reconcile medications and reduce the likelihood of adverse drug events.

Listen to the episode

Improving Cost & Quality Outcomes

*The analysis includes projections of future experience based on reasonable assumptions. The assumptions used in the modeling of prepared scenarios are reasonable, both individually and in aggregate. Results may vary from these projections based on the emergence of actual experience.