At an online event on June 20, hosted by Cheers Cary In collaboration with U.S. Medicaid Health Plans (MHPA)In a statement, the MHPA said industry experts discussed innovative pharmaceutical strategies and the latest in technology to close care gaps in Medicaid populations. According to the MPHPA, “By 2025, healthcare will generate 36 percent of the world’s data volume.” “Barriers to utilizing this wealth of data often include insufficient human or clinical resources and the inability to convert raw data into actionable insights in a timely manner.” In the online discussion, panelists discussed how Medicaid individuals can be efficiently identified based on their health profile.
“We have a lot of data,” said José Díaz-Luna, PharmD, director of pharmaceutical policy and government affairs at CareFirst BlueCross BlueShield. “You have to go through all these different steps to get something into some kind of semi-useful data, and you still have to manipulate the data once you put it in,” she added.
“Of course,” said Ryan Steadman, Pharm.D. and senior vice president of Pharmacy Care Source“I’ve been through all the pain points,” and then added: “I would say some of the biggest pain points we face as a pharmaceutical industry are being reactive instead of proactive.”[G]“Gathering the data in one place,” Steadman emphasized, is key.
“[I]”If you have external partners in the community or even within your own organization, you’ll want to know how successful your outreach efforts are,” Steadman said. “You need to be able to reach out to these vulnerable Medicaid patients,” Steadman said.
Miranda Law, a doctor of pharmacy and director of clinical services at CaryHealth, agreed that it seemed like they were running around to get data, especially when reports were delayed and did not include medical information.[T]“The person giving you that report doesn’t have all the components that need to be considered within that population,” Law shared, “they’re only getting half the picture.” Law believes telehealth holds a solution.
Diaz-Luna said data preparation means consolidating all the data into one platform and making it usable. “In my past experience with Medicare,” Diaz-Luna said, “we built the healthcare program to be able to serve frequent users and we found that those patients were disconnected from any healthcare for many reasons.” If we have all the data in one platform, she explained, we can step in and feed it into a pharmaceutical care program and track that, as well as clinical and financial outcomes.
“We work with our care management team day in and day out as an interdisciplinary team,” Steadman added. This shows the patient that we are looking at them holistically, she said. He noted that the entire patient profile depends on efficient and timely data.
From a technology perspective, Mathew Hawkins, chief technology officer at CaryHealth, commented that we are talking about reliable, up-to-date data that provides a comprehensive view of the patient and the population at large. This, he said, will provide the opportunity to investigate further.
Regarding technological advances, such as Generative Artificial Intelligence (GenAI), Hawkins said: “I think in general there has been a lot of skepticism around GenAI; “It is often seen as a barrier between a patient and a healthcare provider.” Instead, Hawkins added, I see it as an opportunity to reach more people. “AI will give us the ability to analyze a lot more information and find those outliers that we need to interact with to find those very specific patients who have a particular condition or a particular metric that we want to capture and identify.” AI will also help streamline communication, Hawkins said.
“What we do here at Carey is take the algorithms provided by these companies, who are spending billions of dollars and enormous amounts of infrastructure to train those models,” Hawkins explained when asked about AI training by humans and whether different healthcare providers and patients are included in the focus groups. “We bring in our own expertise or our own data sets completely separate from those larger models,” he responded.
“I think it brings a great solution to healthcare, especially when building programs,” Diaz-Luna agreed when asked about AI. “As an industry, we shouldn’t be afraid of it,” Steadman added. “It gives us more time to spend with members and patients.” “We’ve been using automation and machine learning (ML) for years,” Steadman reminded the audience. “There will be industry standards… best practices.”
“[A]“At the end of the day, it’s about being able to know who needs help and being able to get it right away,” Law said. Being data-ready helps streamline patient care, she added. “There’s a lot of things we can do, having all the data in one place and starting to interact with a provider to reduce those administrative costs,” Diaz-Luna said. “Pharmacy is the fastest-growing expense in healthcare.
