Analytical Services

Situation

A Pharmaceutical client was marketing a statin that was less expensive but designed for patients requiring a lesser reduction in their cholesterol.

Challenge

Show MCOs that the integrity of the plan could be maintained and they could save money if specific sub-populations of their members were switched to the lower cost statin.

Solution

• Use NIH Data to show prevalence of lipidemia among MCO's members - categorize them by levels of reduction required (according to ATP)
• Use prescription benefit data to characterize determine the distribution of statins being prescribed
• Demonstrate that a large segment of members are using statins that are stronger than necessary (being overmedicated)
• Calculate the overall savings if only a small percentage of members are switched to the less expensive statin

Situation

A home infusion company felt they were superior to their competitors when performing home infusions. They knew they saved the payers money and could demand better reimbursements if they could prove this to them.

Challenge

Illustrate to MCOs that the all of the factors influencing the cost of a home infusion, mainly readmissions and associated sequela are reduced when they use our client's service.

Solution

• Design a study that would report, review and analyze, in a fair way, the performance of various home infusion providers
• Work with home infusion personnel to present the study to the medical directors at various managed care organizations to convince them to let us perform this retrospective study with their data.

Note: study was to be paid for by our client (home infusion company)

• Go to MCO site, work with IT personnel and create the study for their use, with their data.

Note: had to do onsite for security/privacy reasons.