In today’s new healthcare environment transformed by the COVID-19 outbreak, the patient’s needs have inherently changed, making care management more critical than ever before. At present, it’s estimated that 1 in 4 Americans live with multiple chronic conditions, making the need for patient support between healthcare encounters, essential.
In our continued mission of value-based care management, patient communication needs to be available beyond the physician’s office. In a perfect world, the ideal healthcare continuum involves a system that addresses not only the patient’s lifestyle, socioeconomic determinants, and physical conditions but also consists of a system in which providers and health plans play an equal role in care management.
This would allow chronic patients to be treated based not only on their clinical needs but would at the same time, provide them with personalized health education to improve their overall lifestyles.
With smarter technology, a better experience, and a higher standard, Abarca delivers a better care management method. We built Darwin™, the industry-leading PBM platform, from the ground up to be fully integrated, cloud-based, and unimaginably user-friendly. Darwin™ delivers advanced analytics and reporting that empowers users to provide innovative clinical programs and patient care solutions.
Darwin™ integrates claims processing, pharmacy network, prior authorizations, clinical programs, Medicare and Medicaid compliance, rebate management, and other critical PBM work streams into a single, fast, and friendly interface. Even amid unprecedented natural disasters, Darwin™ has been able to serve its clients without interruption.
- Darwin RxTarget™ is a predictive analytics tool that enables plans and providers to target members for proactive intervention with the most useful resources. Using proprietary clinical decision-making algorithms, RxTarget™ draws on more than 40 data elements to rank members by the risk of non-adherence and the likelihood that they will respond to intervention and deliver results in a customizable dashboard.
- We have also created an innovative pay-for-performance pharmacy program that has been proven to extend the adherence curve. This program gives pharmacists the tools and technology they need to keep up with the health of their members in real-time, while at the same time helping health plans improve their CMS Star Ratings.
The Ideal Future for Care Management
We can all agree that care management simply cannot live in a vacuum. Payers and providers must work together to leverage data in order to manage costs, quality, and outcomes, and care management is the perfect place to start. Further, while ownership of care management may reside with payers for now, the better way forward for patients is a system in which payers and providers work together toward delivering the best possible care.
This blog was written by Ana M. Rivera, PharmD, Clinical Programs Manager at Abarca.