Three Steps to Improving Member Health and Controlling Costs

According to the Centers for Disease Control and Prevention (CDC), six in 10 U.S. adults have a chronic disease and four in 10 have two or more. These include conditions from heart disease to diabetes and are the leading drivers of the nation’s $3.8 trillion in annual healthcare costs.[1] Helping people understand their condition and treatment can lead to better adherence to their medications, improved health outcomes and reduced healthcare costs.

Population health has become a commonly used term in the healthcare industry and while the end goal is always the same, to improve the health of a given population, what it entails can be different. To eliminate gaps in care, improve patient safety and medication adherence, and thus health outcomes and costs, the following three components should be in the mix:

Step 1: Identify – Elixir uses predictive analytics to identify members who would benefit from population health solutions based on specific criteria and factors. Our analytics platform utilizes over 600 data points to identify individual socio-economic risk factors, clinical risk factors, receptivity and preferred communication channel. As a pharmacy benefit manager, we can also view a member’s full prescription claims history and can see trends, such as non-adherence, drug-drug interactions, contraindications and comorbidities that should be addressed in order to optimize treatment.

Step 2: Engage – Once a member has been identified, our specially trained Care Navigators, which include clinical pharmacists, registered nurses and certified pharmacy technicians, reach out to them and/or their prescriber using a variety of communication channels to improve the potential for engagement.

Step 3: Educate – When the member and/or prescriber engage, our Care Navigators educate them on their condition and treatment, explaining any potential gaps in care. This can lead to improved adherence and safety, and a reduction in healthcare complications, leading to a lower total cost of care.

Elixir offers a mix of personalized population health solutions that utilize these three steps to empower members to improve their health while reducing unnecessary healthcare costs.

A Look at Our Population Health Solutions

By following the three key steps of identifying potentially at-risk members, engaging them using their preferred communication channel, and educating them on their condition and treatment, we are improving the whole-being health of members while managing the total cost of care.

[1] Centers for Disease Control and Prevention. Chronic Diseases in America.

*This accreditation is held under the legacy EnvisionRx name and programs.

**Results may vary depending on client mix and population.