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As healthcare continues to shift toward value-based care, Pharmacy Benefit Managers (PBMs), Managed Care Organizations (MCOs) and health systems face growing pressure to improve quality, reduce costs and deliver measurable outcomes. Standing out requires moving beyond traditional benefit management to solutions that strengthen engagement, optimize medication use and boost Star Ratings performance.
Here are three strategies leading organizations are embracing to differentiate and succeed:
- From Transactions to Meaningful Engagement
Managing claims and prescriptions is no longer enough. The real differentiator is member engagement. By combining omnichannel outreach and human-centered approaches, PBMs, MCOs and health systems can connect with hard-to-reach patients, resolve barriers to adherence, and improve outcomes that drive quality scores.
- Turning Data into Action with Predictive Analytics
Data is only valuable with it drives action. Predictive analytics surface at-risk patients and medication gaps before they escalate into avoidable costs. With these insights, organizations can prioritize interventions, allocate resources more effectively and support stronger results under value-based care contracts.
- Applying Behavioral Science to Drive Adherence
Clinical expertise alone can’t overcome every barrier to adherence. Behavioral science—like tailoring communication, simplifying choices and celebrating small wins—makes outreach more effective. When layered onto clinical strategies, it transforms patient behavior and delivers measurable improvements in adherence, care gap closures and overall health.
The Bottom Line
Organizations that integrate predictive analytics, clinical expertise and behavioral science aren’t just containing costs—they’re advancing value-based care. By embedding these capabilities into existing infrastructure, PBMS, MCOs and health systems can differentiate in the market, strengthen partnerships with health plans and achieve better outcomes at lower cost.
