Health Outcome and Evaluation Services

A recent analysis of nine million covered lives in five large states was performed, and we found a cohort of patients exhibiting patterns of extreme uncoordinated care. In the study, these uncoordinated care patients represented, on average, less than 10% of patients, but they accounted for an average of 46% of all drug costs, 32% of all medical costs, and 36% of total annual costs for the plan.

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  • Reduce unnecessary costs

  • Improve care delivery

  • Medication use management

  • Disease/care management

  • Identify problems

  • Solve problems

  • Measure success

Using your plan’s claims data, we provide an analytical process to identify specific patients with these patterns that create needless cost and poor care while providing actionable information to providers taking care of your beneficiaries to resolve these problems. We can further provide drug use review and management and other intervention programs to improve care and reduce cost through the activities of your group health plan. In addition, we can provide insights for value-based insurance design and changes to improve your plan’s performance consistent with new health care reform provisions.