Leverage predictive modeling and data analytics in limb health management

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Erika Glenn, Sales Division Manager, Care Management, CVS Health, discussed some of the latest innovations in predictive modeling and data analytics her organization leverages in the management of patients with chronic conditions at Asembia 2021 Specialty Pharmacy Summit in Las Vegas.

In managing the care of patients with chronic conditions, who account for 90% of all health care expenditures and costs, there are several feasible interventions that can help close gaps in care, provide recommendations on the site of care and even reduce the cost burden.

Focusing on predictive modeling and artificial intelligence, speaking during a session at the Asembia 2021 Specialty Pharmacy Summit, Erika Glenn, Division Head of Sales, Care Management, CVS Health, focused on notable cost contributors, predictive modeling and artificial intelligence, and how these innovations can positively influence members’ decisions in choosing more efficient care options.

Notably, 30% of health care expenditures related to chronic conditions are attributed to avoidable emergency department visits, with issues such as health literacy potentially contributing to these admissions.

Adopting a personalized strategy for each member informed by data analysis, Glenn said his organization compiles prescription requests, medical inquiries, lab results and data on social determinants of health.

“All the different pieces of data that we can potentially find on those members. We basically take them and consume them in an engine,” she said. “What makes us a little bit different about what we do is the risk stratification…We seek to understand for each individual member how we specialize in the care they carefully create if you wish for that person .”

As more information is fed into the engine, it adopts a machine learning approach that creates an integrated experience tailored to each member’s preferences.

“We really want to consider all the data points and data elements that we can, understand what those risks are, try to group them into segments, and figure out what we want to pursue first.”

Glenn said CVS Health offers patients a variety of different care options that can help identify risk and provide low-cost interventions. During an individual patient-pharmacist visit, called a pharmacist panel, patients can get a comprehensive health check-up, with other additional features, such as Clinic Minute and Health Center, supporting a holistic care approach. holistic health for members with chronic conditions.

“We are also looking at where some of these behavioral changes occur. We are doing tests to learn this by individual member. So lots and lots of studies around individuals and making sure that we’re getting all of that data into the hands of clinicians to help all of those members.

Understanding not only the right channel to deliver care, but also the right message that resonates best with individual members can help improve patient outcomes, Glenn added.

“The other piece of this is that as we move into specialty terms, CVS Health thinks it’s very important to reach out to every member, not just the top 25%, not the top 25. best sickest specialty members,” she concluded. “Really trying to step back and look at all the different ways we can understand payers, understand that behaviors are changing, and make sure we’re getting results.”

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