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State of Arkansas Employee Benefits Program
and informedRx, an SXC Company
Clinical Data Integration and Risk Prediction Program
Problem Identification
Former Governor of Arkansas Mike Huckabee created the Governor’s Healthy Arkansas Initiative in 2004. This initiative challenged residents of the state, commonly ranked as one of the unhealthiest in the country, to watch their weight, exercise more and quit smoking. The State of Arkansas Employee Benefits Division (EBD) embraced the opportunity to promote healthful lifestyles for its members through various programs and enhanced benefits. However, fragmented data limited EBD’s ability to assess the clinical needs of its members.
Objectives
Develop an approach to data integration and reporting that would enable the EBD to:
· Assess clinical needs of its members.
· Evaluate and implement benefit design changes to promote healthy behaviors.
· Analyze the impact of new and existing clinical interventions.
Target Audience
The State of Arkansas Employee Benefits Division (EBD), responsible for administering the health plan for state and public school employees, is the target audience of this initiative.
Solution
EBD partnered with the Integrail Division of informedRx to create a custom integrated data repository with medical claims data from four carriers, pharmacy claims data, risk prediction data, and patient-reported health risk assessment data. This patient-centric clinical data repository supports the EBD’s benefit design decision-making and care management priorities. Key features are:
- Cost and utilization information organized into episodes of care for analysis by disease state.
- Tools to enable case mix adjusted prescriber and provider profiling by disease.
- Assessment of patient morbidity using risk prediction models to accurately stratify the population based on current and future resource needs.
- Customized data summary for rapid drill-down to claim level detail.
These custom reports give EBD access to actionable information: demographic and expense summary to identify potential pockets of risk, disease summary report, high risk disease member extract (see table below), diabetes quality of care extract, and member summary report.
Results
The data repository enables many different types of analyses that impact EBD pharmacy and medical benefits, and support clinical intervention programs to improve the health status of Arkansas state and public school employees.
For example, EBD leveraged the data repository to:
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Evaluate the cost and benefit associated with copay waivers for diabetic medications and the future impact these waivers may have on medical and pharmacy utilization and cost.
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Analyze the impact of a weight loss management program on drug costs. It showed the overall number of medications and medication dosages decreased for members who had achieved a certain level of success. About half of them were placed on medication to prevent gall stones, increasing their short-term pharmacy costs by 25%. As member weight stabilized, these preventive medications were expected to be discontinued, decreasing costs.
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Measure the impact of all specialty medications – whether processed through the pharmacy or the medical benefit – and capitalize on opportunities to improve specialty pharmacy management. As a result, EBD has saved more than $200,000 on specialty medications and identified potential additional savings in excess of $500,000.
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Analyze the effects of patient behavior on pharmacy cost, e.g. smokers had 4.7% higher pharmacy costs than non-smokers; and members with body mass index (BMI) identifying them as obese had pharmacy costs 46% higher than non-obese members.
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