Executive Summary:
Escalating medical costs continue to burden employers and employees alike as health benefit plan prices rise at dramatic rates year over year. The ability of health plan managers to mitigate risk, reduce cost and improve healthcare outcomes for those covered by plans is dependent on access to accurate and timely information about key trends in targeted populations. In this report we examine the role played by the effective analysis of aggregate prescription drug (Rx) claims data.


It is the opinion of this report that access to and proactive management of Rx information is a superior data source for healthcare performance management (HPM) initiatives, even though medical claims data are more commonly used today. Rx data provide healthcare plan managers with a near real-time view of trends and developments within the population covered by the health plan. Access to accurate, timely data enables plan managers to gain insight into the risk levels to which employer-sponsored health plans are exposed, and facilitates prompt mitigation of risk that not only will reduce costs, but also improve the quality of healthcare delivered to those covered in the plan.


Specifically, effective Rx analysis provides an opportunity for employers to work with ancillary health and wellness service provider organizations to identify “at-risk” plan members and intervene before the risks manifest themselves as detrimental – and expensive – health events. It is important to note that the HPM business processes of analyzing and managing Rx data are possible to implement in full compliance with HIPAA and other applicable employment and privacy laws.


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