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."
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
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