December 05 2017 | 0 Comments | 262 reads Average Rating: 3

Providers & Payers: Getting By with a Little Help from Their Life Sciences Friends

by John Pagliuca in Life Sciences

Providers and payers don’t know what they don’t know. As these organizations look at drug utilization and patterns, they only see what happens among their own patients or members. And, while valuable, such insight often comes up short.

Life sciences companies can help by working with payers and providers to offer much needed insight into the bigger picture. Because their commercial data spans across multiple healthcare organizations at a macro level, life sciences companies can employ next-generation predictive analytics to help payers and providers become aware of issues before they become costly problems. More specifically, life sciences companies can help payers and providers gain the insight necessary to:

1. Identify patient/members in need of some extra TLC.

For example, when life sciences organizations analyze diabetes medication sales, prescription or claims data, then impose those data on to a geographical map, they can determine where diabetes “hot spots” exist. In addition, by bringing in Zip+4, demographic, and socioeconomic data into the analytics, and using it to create patient personas that represent segments of the overall population who share similar attributes, they can help payers and providers target who should be given extra attention around diagnosis and possibly preventive treatment before diabetes can develop. For instance, the analytics can identify areas with a high concentration of Hispanics, who have a higher incidence of diabetes. Payers and providers can then use their population health management mechanisms to encourage undiagnosed patients/members who fit the persona and are at high risk, as well as those in that group already known to be trending toward diabetes, to come in and have their HbA1c levels checked on a more regular basis.

2. Provide a perspective on performance.

Life science companies can become true partners to healthcare providers and payers by leveraging data and analytics to demonstrate just how effective certain medication are in terms of managing or mitigating conditions specific to a patient population. Having these analytics in-hand will also help commercial effectiveness teams drive growth – especially if they can demonstrate that their organization’s medications have been proven more effective at managing or mitigating conditions specific to a given area or population.

3. Recognize needs that are bubbling under the surface.

Analytics show higher-than-normal opioid use in an area. As such, payers and providers might want to consider putting programs in place that will promote medications that are designed to wean patients/members off of opioids.

Such insights can help payers and providers get out in front of the curve – which is especially important as these organizations are being asked to take on more risk under value-based care models. What other issues could life sciences companies help payers and providers get up to speed on?

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John Pagliuca
Vice President, Life Sciences

John is responsible for leading the commercialization efforts of SCIO’s SaaS solution suite and advanced analytics within the US Life Science vertical. He has more than 15 years of sales, marketing and technology experience, with particular expertise in quantitative analytics and SaaS solutions for Life Sciences.

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