Data Segmentation to provide the best possible care

For many plan sponsors, managing effective clinical programs for diverse populations can be a challenge. Among any group, there can be wide variations in ages, lifestyles, medical conditions, and other factors that can influence costs and outcomes. Gaps in care can also emerge that could impact member health and a plan’s clinical rankings.

To overcome this hurdle and make care more personalized, PBMs and health plans are increasingly relying on data segmentation to create subgroups of program participants with similar characteristics.

For example, patients who have low adherence may require more frequent reminders about their prescriptions. So, rather than increasing the amount of outreach for everyone–which could be inefficient for clinical teams and inconvenient for other members–the PBM would use data segmentation to divide the participants based on their level of adherence, and determine the amount of follow up necessary for each group.

Along with creating a more targeted and comprehensive approach to member care, data segmentation results in a more efficient use of budget and resources, minimized member abrasion, and the opportunity to improve HEDIS performance.

However, a successful segmentation strategy cannot exist without access to advanced data and analytics, which is something that legacy systems often cannot deliver. That’s why Abarca built Darwin, our smarter PBM platform, from the ground up using modern technology to give our team and clients the ability to track, analyze, and utilize member data in real time.

At Abarca, we are constantly looking for a better way to approach our clinical services. By prioritizing member experience, and building our programs with Darwin, we will continue to leverage data segmentation to provide the best possible care.

This blog was written by Ana M. Rivera, PharmD, Senior Pharmacist, Clinical Programs at Abarca, based on sessions she attended at the BCBS 2019 National Summit.


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