One of the long-standing promises of health IT proponents has been that new IT will dramatically reduce the time needed for necessary but routine processes like patient medication reviews.
A new program recently unveiled by Inland Empire Health Plan, one of the largest not-for-profit Medi-Cal and Medicare health plans in Southern California, may suggest the time has come for the promise to be realized.
The problem Inland Empire faced, Edward Jai, the organization’s senior director, pharmaceutical services and chief pharmacist, recently explained, was that comprehensive medication reviews were not being focused on the plan members most in need, and the review process was both time consumer and a significant drain on trained clinical pharmacist resources. Moreover, it was unclear if member outcomes were improving because of this program.
The solution the organization opted for involved outsourced its medication review process to Preveon, a specialty pharmacy focused on chronic disease management. The Preveon team served as the end users of a platform from Surveyor Health, an AI-enabled healthcare technology company.
“The Surveyor Health platform, which includes the MedRiskMaps and StratMaps applications, was proposed to make comprehensive medication reviews faster, better, more efficient and with full tracking, management and learning support,” Jai explained. “It was to achieve this by more precisely targeting members, based on medication risk rather than a simple count of meds taken by the patient.”
Once members in need are identified, they would then be reviewed using MedRiskMaps to help the clinical pharmacist reviewer better and more quickly understand the treatment trade-offs faced by the patient with their current drug regimen. The tool’s support for multidimensional analysis, information fusion, visualization, simulation, probabilistic AI prediction and automatic generation of clinical documentation were all focused on the problem, Jai explained.
“Surveyor Health integrated the platform with health plan claims processing systems and databases, the pharmacy benefits managers’ fill history, and time series labs and vitals data to provide a reasonably complete picture of patients and their care.”
Once the integration and workflows were tested and validated, user training was conducted, and management of specific data elements and attributes was finalized. Surveyor Health’s stratification of the health plan’s membership then populated an encounters pool in MedRiskMaps, identifying key members to review.
Now, Jai explained, Inland Empire Health Plan and Preveon clinical pharmacists can access a meaningful picture of membership data that is actionable. Moreover, review times have been cut in half, a substantial savings of clinical pharmacists’ time, not only without a loss of review quality and comprehensiveness, but with significant, measured improvements to both.