Considering the complexity of managing spend—made increasingly more complicated by a growing drug pipeline, novel therapies, changing treatment guidelines and CMS requirements—quality specialty reporting is an incredibly powerful asset for plan sponsors. Having access to sophisticated modeling tools and support systems is vital when it comes to making informed decisions around benefit design, channel determinations and drug preferences.
Good specialty reporting helps plan sponsors manage their cost and budget so that they can afford specialty drugs and provide a richer benefit for their members.
Good specialty reporting is a combination of retrospective and prospective analytics that provide timely feedback and consultation about what’s happening in a client’s population. These analytics should include population metrics, comparisons to peer data and drill down to the patient level. To provide true insight, data on patients and new drug launches should be refreshed daily, not quarterly.
It’s important to have a specialty reporting partner who can help interpret what all of these things mean for a plan sponsor. That means the reporting should be a consultative partnership with utilization trends, and qualitative information that adds credence to claims data. The more that plan sponsors know, and the sooner they can know it, the better they’ll be able to manage their spend and take care of their members.
Predictive modeling tools use machine learning to analyze massive amounts of data points and help calculate where spend is heading in terms of the current and future member populations, as well as emerging drugs coming to market. This machine learning isn’t just an algorithm—it’s an algorithm that has been painstakingly crafted and then interpreted and checked by subject matter experts. Some of these tools include:
- A recommendation engine, which looks at a client’s unique patient population and therapy utilization to help clients understand where they still have savings opportunities.
- Specialty plan design modeling that shows clients how they can save with different copay structures.
- A specialty trend and savings dashboard, showing savings, highlighting gaps in savings and projecting future spend based on current population.
- A gene and cell therapy forecasting tool that can help plan sponsors predict potential utilization and prepare their management approach by leveraging clinical expertise, literature, market intelligence and more.
Case management reporting can serve both plan sponsors and patients: plan sponsors are able to extract actionable data, which then leads to necessary patient interventions.
For example, at Accredo, patients with rheumatoid arthritis or psoriasis are routinely screened to monitor their current pain and itch levels on a scale from one to ten. This allows monitoring of current condition severity, response to therapy and outcomes of therapy over time. It may also trigger mitigation strategies, encouraging the patient to follow up with their prescriber, or—in the case of positive scores—continued monitoring. These scores can be reported at a patient level on a regular and continuous basis for use by the client’s case management team, which can decrease expensive emergency room visits and the use of more costly and aggressive therapies.
Accredo’s hemophilia web reporting is an excellent example of good specialty reporting in practice. Using the portal, plan sponsors can see their hemophilia community with personas and detailed information, broken down into population and sub-units of population. It also highlights their drug spend by therapy.
The reporting is more than just claims details—it conveys interpretive info with visually represented data. Plan sponsors can compare their utilization and spend to other clients, see patient-specific disease severity, journeys and trends through utilization, bleed history and more over a one-year period. This helps inform coverage, especially with emerging care options like gene therapies.
Ultimately, all of these reporting solutions benefit plan sponsors, patients and the overall specialty care ecosystem by:
- Helping plan sponsors manage spend
- Finding the best care for patients
- Paving the way for groundbreaking developments
The more that good specialty reporting is able to help clients connect the dots between large amounts of data, make smarter benefit decisions and help drive at the right solutions for their populations, the greater the outcomes for plan sponsors and for patients.