Applying population health cost-reduction methodologies to pharmacy benefits

When pharmacy data is considered in risk stratification, employers can identify "red flags" that drive costs up.

Self-insured employers seeking to squeeze costs out of their health plans have taken savvy steps to target specific member sub-segments for supplemental care. The rise of programs specific to cancer, diabetes and heart disease, and musculoskeletal conditions like arthritis, attests to the recognition that reducing the costs of a few high users can have faster, greater impact on both overall costs and individuals’ health outcomes than addressing a broader population.

These population health efforts almost always focus on a specific condition or disease. It’s a solid step, and the efforts have made an impact–but self-insured employers are leaving cost-saving and member care opportunities on the table.

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