Celebrate Columbus Day! Register for FDA/CMS Summit for Payers by Monday & save $300!

Register for the following IIR event and receive $300 off*

Mention code COLUMBUSBLOG to save on the following:

Register here for IIR’s FDA/CMS Summit for Payers event taking place December 11-12, 2014 in Washington D.C., visit the website for full details.

Have any questions? Email Jennifer Pereira.

*This promotion is only valid October 10th-13th 2014. Offer cannot be applied retroactively to confirmed paying registrants and cannot be combined with any other discounts or promotions. All registrants and guests are subject to IIR approval.

AstraZeneca and Cigna in Evolutionary Partnership to Support Patients

Are you looking for an example of how data and technology are changing the healthcare delivery model? An innovative program announced June 2nd pairs Big Pharma with health insurer Cigna.

“Predictive Risk Modeling” is used to identify Cigna members who are most likely to benefit from treatment with the “aggressive LDL-C lowering” statin Crestor, a drug that is marketed by AstraZeneca.

When asked of the new partnership, Cigna said it is “the first of its kind” and represents a “targeted approach to helping high-risk patients with high cholesterol” receive value-based care.

Under the programs terms, Cigna said its member customers who are at increased risk for atherosclerotic cardiovascular disease – ASCVD – and need to aggressively manage their LDL cholesterol can be prescribed and receive Crestor “without requiring prior authorization.”

In a statement, Cigna said “As an integrated health services company, Cigna is able to use both medical and pharmacy information in predictive risk modeling to appropriately assess a customer’s overall health condition, this approach analyzes multiple clinical factors to identify customers most at risk for ASCVD related to high cholesterol. When a doctor prescribes CRESTOR, customers identified as being at higher risk will no longer be subject to “step therapy” – where a generic alternative is tried first…”

Philip de Vane, MD, AstraZeneca’s executive director of U.S. medical affairs, said this new arrangement represents “an evolutionary step in supporting patient health, and facilitating access to Crestor for high risk patients. Predictive risk modeling can be used to help support the right treatment for the right patient at the right time, and we are excited to be working with Cigna because they are the only insurance carrier or Pharmacy Benefit Manager (PBM) we have seen who has offered this capability.”

This new partnership is certainly worth watching, and is another example of how new thinking is creating new opportunities across the patient-pharma-payer spectrum.

Read the full Cigna news release here.

As an industry professional, do you expect more partnerships like this one to pop up? Or is this partnership model going to struggle for greater adoption?

Q&A with Bob Gladden of CareSource - A Speaker at IIR's Healthcare Data Insights

This June at IIR’s Healthcare Data Insights, Bob Gladden, Vice President for Decision Support and Informatics at CareSource will speak on a session titled “Taking a Persona-Centric, Not a Disease-Centric, Approach to Care Management & Engagement”.

Session Info:
The typical member management program entails profiling members based on their disease states without taking into account the patient as a whole. Beginning in the Fall of 2013, CareSource started using claims and enrollment data to segment their members into a specific persona, then began services to members based upon the persona in which they were identified. Learn how they build data driven personas and understand the results they’ve seen to date.


Q&A:

1. What does data driven decision-making mean to you?

To me it means that when possible, we eliminate the guess work component of decision-making.  There will always be a component to decision making that is not quantitative, but that should be by choice, not because the data isn’t available in a format that can be incorporated into the decision-making process.
2. How do data sets (EHR data, claims data, member feedback, etc.) to inform your business strategy?

As a Medicaid managed care organization, we use claims data extensively to help shape everything from care programs to business strategy.  Ongoing, our strategy continues to be to augment the claims data view of our membership with other data sets that can enrich our view of our members, and help us to identify their needs at the earliest possible moment.  As one example, we are currently working on a partnership with a state Health Department and a major university that will expand our view beyond claims data to include social/economic data. 

3. In general, how difficult is it to get internal buy-in to build out programming that’s based on data?

Actually, at CareSource the difficulty has been to build out the data to support and enhance programs fast enough to keep up with the requests.  Senior leadership here has for some time been asking for more data support to build all of their efforts.  Having leadership asking for this support goes a long way toward the success of having an organization focus decision making on fact and less on hunches.

4. How do you see your use of data evolving in the upcoming year? Are there new opportunities to use data to create more effective, innovative programming?

There are a number of changes that are coming. The most notable in health care is the provider base moving to electronic medical records. Many of these systems were first stood up just to meet requirements for enhanced reimbursement, but now the effort is to fully incorporate this information in work-flow and use it in a meaningful way.  To that end, there are more changes coming that could even eliminate traditional claims as we know them today. It is all part of many exciting developments that will change how we all do business to deliver far more effective and higher quality care.


To hear more from Bob, please join us at Healthcare Data Insights, June 23-25 in Chicago.

Register now and save an additional $100 off the current rate when using the code: XP1902BLOG

Reminder - Complimentary Revenue Leakage Webinar | Register Now

Revenue Leakage:  Industry Definition, Insight and Best Practices to Mitigate Risk
Join us for a Webinar on April 14th—space is limited!
Reserve your Webinar seat here.
Mention Priority Code: XP1911WEB

Understand what ‘Revenue Leakage’ means to branded pharma, start-ups, generics, and biotechs with IIR’s 2nd Annual Gross-to-Net Accounting Forum’s discussion group chairs! 
• Collective Industry Definition
• Customer Segment and Channel impacts
• Financial Statement impacts (accruals, cash flow, forecasting)
• The industry risk between adjudication and audit —the need for continuous improvement.
• Industry best practices and next steps for mitigating risk and continuous improvement.   

MODERATOR:
Jennifer Sharpe, Revenue Analytics Gross-to-Net, daVIZta

PRESENTERS:
From Big Pharma – Courtney Callihan, Finance Director, GlaxoSmithKline
From Small to Mid-Sized Pharma – Larry Breen, Director of Financial Planning and Analysis/Revenue Analytics, Sunovion Pharmaceuticals
From Generics – Roxana Santiago, Senior Finance Director, Gross to Net, Hospira Worldwide, Inc.

After registering you will receive a confirmation email containing information about joining the Webinar.

Keep the discussion going with our Chairs at IIR's 2nd Annual Gross-To-Net Accounting Forum

2014 Conference Highlights include:
• New tailored discussion groups to collaborate across Managed Markets, Commercial, Government Programs and Finance for Big, Small to Mid-Sized Pharma, and Generics
• First opportunity to get up close and personal with the AMP Final Rule at the pre-conference workshop
• Never-before-heard case studies on GTN automation and chargeback methodology, in addition to strategic forecasting panel discussions
• Quantifying approaches for the impact of Medicaid, 340B and Healthcare Reform

Register by 5/2 and save up to $400 off standard registration rates

If you have any questions about the agenda or event, please contact Ryan Geswell at rgeswell@iirusa.com or visit our webpage.

We look forward to seeing you June 17-18 in Philadelphia!


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