The Panoramic View for Health Plans and Care Managers

With new interoperability solutions at their fingertips, care managers at health plans have the patient data they need. And they can now get the data in time to make a difference.

When a doctor prescribes medication for a patient, everyone figures the patient will simply pick it up at the pharmacy. That’s the default assumption.

But what if the medication is too expensive and the patient walks away? What if the patient can’t get to the pharmacy in the first place? On top of all that, what if the patient is a newly enrolled member with limited data?

Now we have a timing problem. The care manager at the health plan won’t know—for weeks, a month, or longer—that the patient hasn’t been taking their medication. It’s the very definition of a gap in care. The patient has been non-adherent and is possibly headed for a poor outcome.

Listen to the webinar below to hear more about new interoperability solutions that enable health plans to close gaps in care with historical data and ongoing notification management.

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Pinpoint & Close Gaps in Care 

Earlier we published the projected cost savings across stakeholders who use or could benefit from an interoperability solution like Medication History for Populations over the course of three years, and these estimates* were significant. What we didn’t publish then was an even greater projected cost savings when health plans enroll more members.

With just 5% of members enrolled, health plans could save $648.3 million from reduced medical costs and higher Star Ratings. But at 25%, that figure climbs to $1.25 billion. This represents nearly $448 million for large commercial health plans and more than $294 million for Medicare Advantage health plans.

These are the results we could see when health plans give care managers a panoramic view of medication adherence and care interactions.

*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 actual experience.