Connectivity as a lever to reduce waste, lower costs

The pandemic accelerated digital health care. We have been investing heavily in digital connections with members for several years. Members benefitted from this during the pandemic because we were able to stay connected and engaged with them.

A graphic with two parts. Part one: we have visibility to about 70 percent of all specialty patient EHRs. Part two: 85 percent of members signed up to receive digital communications.

We are also tightly connected with prescribers. Our connectivity enables us to check the member’s diagnosis information in their electronic health records (EHRs), and therapy selections are based on rigorous clinical criteria. This means members start therapy with certainty and treatment decisions are unlikely to be overturned on appeal, delivering lasting savings for clients.

A graphic with two parts. Part one: 4.1 percent higher final denials rate with EHR connectivity. Part two: 50 percent of prior authorizations approved without additional prescriber outreach.

Connectivity also enables us to reduce waste throughout treatment. Using data-driven precision to prevent just one unnecessary prescription in a year, for a member who is compliant with their medication regimen, can translate into savings. For a large employer client with a subset of members for which this could happen, it’s significant.

$1,200 savings per targeted patient in first 10 weeks from managing over-supply*


* PA requests submitted using data from EHR and aligned to Specialty utilization management criteria

** Targeted patients make up less than 2 percent of all specialty patients