Challenge:
The client’s mission is to leverage data insights to reduce pharmacy costs and improve patient health. In building their core platform, they faced three main challenges:
- To aggregate data on group members of the managed health population, including risk level and all related medical and pharmacy data that impacts spend and patient outcome.
- To programmatically identify inefficient pharmacy spend and specific savings opportunities, and to surface actionable recommendations to a clinical team
- To produce client-facing reports that demonstrate the performance and value delivered by their platform.
Solution:
We took a three-pronged approach to building out the client’s core platform:
- Implemented and deployed an auto-scaling ETL workflow automation tool used to ingest and process real-time and bulk data updates, including pharmacy and medical claims, eligibility, formulary, plan benefit data, and drug reference data.
- Developed a rules-based decision engine to identify inefficient pharmacy spend in large health plan populations and produce a prioritized list of drug therapy change recommendations used by clinical teams to reduce total cost of care.
- Built a reporting framework that forecasts potential drug savings and validates captured savings for health plan members who make the switch to alternative therapies.
Transformation:
We began working with the client before they had secured their first customer. They were pitching smaller regional employers with relatively unsophisticated internal benefits management teams and were still figuring out how to price their product.
Within 9 months of working with our team, our client was able to successfully onboard multiple health plan populations onto their platform and close their Series A funding. In the final quarter working with our client, they closed and onboarded a large national employer with a savvy benefits management team led by a known thought leader in the benefits industry.
After having fully handed off the project to the client team, they continue to utilize the tools to empower their current customers and to streamline their sales and onboarding process for new customers. They are now pursuing customers managing health populations that are 10- to 100- times larger than their first customer.
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