Algorithms for Pharma

Express Scripts- New Program to Contact and Predict Patients Who May Not Be Taking Their Medicine Based On Ingenix Algorithms

Pharma is also facing the challenge of pay for performance (P4P). 

Ingenix started selling its diabetes-prediction service in February to insurers andemployers, one more way they make money.  I would think information this vital and helps with compliance could be open source or at least free so further analysis studies could be made.  This is part of the profit area of United Health Group.

The company Monday will announce an initiative intended to predict in advance who's most likely to discontinue a medication regimen, and keep those people on their drugs with interventions such as letters or phone calls. This is an effort to encourage compliance and offer help such as mail-order prescriptions.

It's one of a growing number of efforts to forecast and prevent costly health problems. New initiatives from UnitedHealth Group Inc.'s Ingenix unit and WellPoint Inc. seek to pinpoint those expected to develop medical conditions such as diabetes. CVS Caremark Corp., the big drug store and pharmacPharmacy-benefit manager Express Scripts Inc. is unveiling a new program that aims to contact people who fail to take their prescription drugs—before they actually stop.

The company Monday will announce an initiative intended to predict in advance who's most likely to discontinue a medication regimen, and keep those pey-benefit management company, has researched how to predict drug compliance, and next year plans to start using the results to target certain customers with strategies to encourage adherence.

The predictive initiatives are one part of a far broader category of programs by insurers and pharmacy-benefit managers, or PBMs, that delve into enrollees' medical information to identify gaps in existing care, such as recommended medical tests that aren't being performed. The companies then typically inform patients and their doctors.   CVS Caremark Corp., the big drug store and pharmacy-benefit management company, has researched how to predict drug compliance, and next year plans to start using the results to target certain customers with strategies to encourage adherence.

In the past pharmacies would often call their customers to remind them their prescriptions are ready and ask if they want their medications,

Recently I joined a Medicare Advantage Plan. I received an introductory telephone call detailing the additional benefits I would receive with their advantage plan. I later received another call, this time from the PBM asking about my medications and if I understood their uses, side effects, and other options in lieu of what I am using.

The predictive initiatives are one part of a far broader category of programs by insurers and pharmacy-benefit managers, or PBMs, that delve into enrollees' medical information to identify gaps in existing care, such as recommended medical tests that aren't being performed. The companies then typically inform patients and their doctors.

These new algorithms will focus resources on probability and possibilities as a segment of population health, to predict who might not take their medicine.

While this would be beneficial it also is designed to maximize ROI and profit.