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A data-driven approach to member engagement can make sure that your telepharmacy program is much more than just a call center. Advanced analytics are crucial to support meaningful interactions with members to actually improve outcome.
Medication adherence is one of the most important predictors of positive outcomes for patient health – and overall health plan performance. With so much of the Medicare Advantage Star Ratings system directly tied to medication adherence, health plans have an imperative to ensure that their members understand their medications, have access to their prescriptions, and faithfully follow their regimens.
Increasingly, health plans have been turning to telepharmacy to complete medication reviews and reach out to members at risk of falling under the standard threshold of 80 percent days covered (PDC).
By conducting this targeted outreach to higher risk members, health plans can stay on top of their performance metrics and support ongoing adherence for individuals with a history of poor adherence.
In order to be effective, however, these interactions have to be more than just robotic reminders to fill lapsed medications. Telepharmacy staff need to establish meaningful, impactful relationships that empower members to invest in their own health and commit to lasting behavior change.
There is only one way to achieve this goal: telepharmacies must be equipped with accurate, personalized, data-driven insights about every individual. Plans will only be able to improve medication adherence metrics with advanced analytics to prioritize high-risk members, serve up targeted information about the member’s health history, and address the complex clinical and non-clinical challenges that often lead to poor adherence.
What does mean to become a truly effective data-driven telepharmacy? And what does it take to get there? How can health plans make the transition from a high-volume call center to a high-impact hub for proactive member engagement?
Understanding the data required to prioritize and engage members
Actionable insights are built upon rich, multi-source data that create a comprehensive portrait of an individual’s past activities, present circumstances, and future risks.
To assemble this view, health plans need to combine standard clinical, claims, and prescription drug data with less traditional data streams, including information on social determinants of health (SDOH).
If health plans can’t access complete, accurate, and reliable patient-provided information on SDOHs, they need to generate this data themselves. A telepharmacy platform with the ability to collect standardized data on common socioeconomic challenges can provide an invaluable understanding of why some members remain non-adherent even if they profess a willingness to follow their care plans.
Pharmacy experts can use this information to connect members directly to available health plan benefits, refer members to community-based resources through networks such as FindHelp.org, and prioritize these complex members for future follow-up to ensure their needs are being met. To maximize the impact, these resources should be integrated directly into the pharmacy workflow so staff can quickly and easily suggest solutions to members during the call.
Taking a holistic, data-first approach to identifying potential risks and challenges can personalize interactions, dissolve communication barriers, and dramatically boost member satisfaction with conversations that measurably improve overall quality of life.
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Moving beyond the limitations of all-purpose database tools
As medication adherence increases in importance for the Star Ratings and associated incentive opportunities, many health plans have gotten creative with the data they collect and the workflows they develop for member outreach.
Unfortunately, their efforts are often rooted in static data management tools, such as Microsoft Access and Excel. While these packages can effectively organize large volumes of data, they tend to come up short on clinically-focused analytics activities such as risk stratification and outreach prioritization. These activities must be automated, continuous and dynamic for the organized data to be actionable.
Health plans may also experience difficulties extracting detailed performance reports and incorporating newly generated data to create a continuously learning analytics engine – not to mention struggling to develop user-friendly workflows that surface only the most relevant and up-to-date information on each member.
These challenges will only increase as health plans grow their membership or expand their telepharmacy services. Instead of relying on tools that are not designed for the task, plans should consider switching over to an integrated telepharmacy platform that doesn’t require database gymnastics.
The right platform will automate the process of identifying high-risk individuals, allow plans to track interactions and record the results of the conversations, provide support to members in as few clicks as possible, and generate detailed reports on key performance indicators to stay one step ahead in the quality measurement environment.
Developing targeted, intuitive workflows that let all staff work efficiently and effectively
The mark of a truly data-driven telepharmacy is the ease with which staff members can navigate their workflows. From front-line technicians to licensed pharmacists, all members of the telepharmacy team need the ability to access organized, up-to-date, and accurate data at every point in the member engagement process.
This information must be presented in a manner that makes it easy to understand the health plan’s objectives (i.e. specific gaps in quality that must be closed during the call) and the member’s clinical and socioeconomic concerns.
Plans can accomplish this by tailoring the user experience to each team member’s user persona. For example, a first-level technician needs to know about a member’s clinical status, non-clinical challenges, previous interactions with the telepharmacy, and any gaps in care. This will allow him or her to educate the member on medication adherence and provide personalized support.
But if the member complains of unexpected side effects or other problems with their prescribed medication, that call may be escalated to a licensed pharmacist or nurse. The pharmacist might need access to additional details, such as the patient’s complete medical record and prescription history. This data should be accessible within a click or two for the team member who needs to take a deeper dive.
Creating a layered interface that is both easy to understand and simple to explore in depth can be a challenge for health plans, especially those that are new to telepharmacy or those working with inadequate analytics tools.
Getting to this ideal endpoint requires health plans to invest in making their telepharmacy programs data-driven from the ground up. Equipping telepharmacy staff members with rich, personalized insights and actionable tools for solving problems is essential for moving past the basics of routine medication reminders and perfunctory interactions with members.
The data-driven telepharmacy creates an environment where health plans and their members can share better experiences and work together to achieve lasting positive results.
