Issue

In the last decade, the pharmaceutical industry changed the strategy to impact people. Nowadays, it has three main pillars that provoke interest in different segments of the population. High quality, low costs, and better patient experience are what manufacturers and distributors of drugs seek to comply with.

Such a transition takes multiple forms, including Medicare penalties for excessive hospital readmissions, reimbursement programs, a savings program for accountable care organizations (ACOs), and bundled payments from public and private payers. However, some providers of pharmaceutical products are taking a full risk for patient treatment. To succeed in this market, all the organizations that distribute the medicare must apply accomplished analytic tools to their data so they can manage care within a budget without sacrificing the quality. Here comes a population health management, a designated strategy to enhance health and reduce the cost of remedies for population. However, it also requires clinical analytics to improve the quality of drugs and reduce avoidable admissions. As of now, the targets of analysis is to deliver care and reduce waste and inefficiency of drugs.

Purpose

The purpose of this project is to help people understand the main types of clinical and financial analytic tools. And, to show how those tools are used to manage risk.

Framework

Pharmaceutical and clinical analytics have the next instruments aiming to spot even the smallest risks:

  • care gap identification;
  • forecasting modeling;
  • performance and outcome measurements.

Forecasting modeling is integral when dealing with population health management. For instance, around 30% of patients are now at high risk of being sick due to various reasons such as infections, lack of vitamins, and so on. Thus, this modeling will help to yearly identify people who are likely to become ill in the nearly future, and fastly turn on the services that may help them to overcome ailments. In this case, it will serve best for online pharmacies that should have enough drugs in stock to meet the clients’ demand.

Besides, pharmaceutical organizations may turn to analytics to measure performance at the organizational, site, and individual provider levels. Such approaches will include process measures and outcomes such as mortality, wellbeing status, disease prevalence, and client experience.

Then, the next target is to identify the golden mean concerning the price. Financial analytical tools will encompass all the data obtained from payers. It can be payment agreements or risk contracts. Such a measure contributes to a company’s full understanding of the cost structure, revenue, expenses, and loss. Moreover, online pharmacies may stay within their budgets and produce savings. A good example is the Loyalty program that allows patients to get bonuses and save money when buying products.

On the other hand, a company may face a few obstacles when conducting this analysis. For example, pharmacists may tend to push back against performance profiling and the pressure to follow guidelines, suspecting that they are designed to cut costs rather than improve quality. In this case, the executives should use change management that involves the alignment of provider incentives with the incentives of the organization. To master a robust analytics strategy, pharmaceutical organizations should set goals tied to their anticipated payer contracts.

Working with recognized pharmaceutical experts and researchers from a range of backgrounds and perspectives, a team will be focused on identifying practical and effective analytics-based strategies and tools. The dedicated group will provide insights and recommendations in a variety of formats for industry consideration.