Moving The Reduction of Adverse Drug Reactions Into The Health Insurance Space

Situation

A large US-based health insurance payer was at the beginning stages of standing up a precision medicine initiative. The starting component of the initiative was a pharmacogenomics (PGx) program driven by the payer’s primary goal to reduce adverse drug reactions across its populations. Additionally, the insurance company saw the medical cost reduction, patient safety improvement, and member/customer satisfaction as being key benefits of its investment. Achieving these goals would position them as an innovative and competitive front runner in the precision medical insurance space.

COVERGENCE PROCESS

PHASE 1

Analysis

Strategy

PHASE 2

Implementation

Results

Solutions

Program management, design, build, and testing of the PGx lifecycle business processes supported by the member/patient and physician/pharmacist workflow interface system and operational data store
Communication alignment of included APIs and channels needed to communicate PGx testing results to the payer’s patients, pharmacists, and physicians

RESULTS

The program management and delivery drove the deployment of:

A PGx-based precision medicine operation ready for startup by the plan-year season, integrating users of the testing workflow inside and outside the payer.
An established landing site, able to handle volumes in the thousands, allowing the payer’s members to register for PGx tests.
The segmentation of member risk groups driven by certain PGx high risk factors, including specific drug names and chronic disease conditions.
The reporting data source for informing the payer of program testing progress with members and providers.
A successful first step in positioning the payer as an up and coming leader in the health insurance precision medicine space