Program measures effects of interventions

Progressive Medical is taking its data analytics program that identifies potentially high-cost, high-risk opioid claims to the next level.

Through the use of enterprise and client data, the company has developed a process that enables intervention sooner.

"We identify high-cost, high-risk pharmacy claims by applying a multivariate log linear model," said Joe Anderson, director of analytic services for Progressive Medical. "We take pharmacy data from the claim to determine the claim's pharmacy risk."

CWCI: Compound drugs are more potent, costly (03/11/13)
State legislators to address controversial meds in workers' comp (03/04/13)
NCCI: Physician dispensing on the rise in most states (10/06/11)
Florida Legislature targets repackaged drug costs (01/30/12)
Workers' comp physicians not following guidelines for opioid use, study shows (10/25/12)

From there, the analysts determine which are the highest-risk claims based on any number of factors such as the high cost of medications in a particular part of the country. They then work with the clinical team on those identified to determine the appropriate intervention. The company is evaluating the impact of the data-clinical collaboration and working to determine the best way to leverage the knowledge and deliver value to payers.

November 12, 2012

Newsletter Sign-up