Analytics Help Organizations Effectively Gauge Performance of Wellness and Preventive Medicine Programs
MILWAUKEE, March 28, 2013 /PRNewswire/ — TRICAST today announced the debut of its new Gaps in Care Analysis product, a set of analytic tools that enable any organization to gauge the effectiveness and performance of its wellness and preventive medicine programs.
What Are Gaps in Care?
Gaps in Care, sometimes referred to as Gaps in Coverage, are found by identifying the discrepancies between recommended best practice medical care, and the medical care that is actually provided to a patient. The gaps generally result from obstacles that prevent patients from implementing a physician's recommendations.
"TRICAST's Gaps in Care approach focuses on the key diseases linked to both high-cost medical programs and complex medical conditions. The value of the TRICAST analysis lies in our ability to proactively identify members who are receiving less than optimal treatment and then direct them to more active care management, or medical therapy management programs," says TRICAST President Greg Rucinski, R.Ph.
The Data Holds the Answers
TRICAST begins a Gaps in Care analysis by examining medical, pharmacy, and episodes of care data. After it ingests the data and uses its proprietary software tools to analyze these crucial components, TRICAST identifies and portrays diagnoses, procedure codes, and pharmaceutical treatments.
Disease State Profiles
Armed with this information, TRICAST can profile disease states and their associated costs by comparing the "best practice" treatment of a disease state to actual patterns of treatment. The reports that result define the gaps in care for these disease states:
- Diabetes
- Rheumatoid Arthritis
- Migraines
- Multiple Sclerosis
- Coronary Artery Disease
- Chronic Obstructive Pulmonary Disease with Asthma
Each disease state is profiled for total costs, as well as members identified with gaps in each one of those treatment modalities. Members having 10 or more gaps in each disease will be portrayed in the reporting system. TRICAST also defines and compares treatment gap patients with average costs per disease state to patients with no gaps in therapy to determine if the gap patients are increasing medical costs on a long-term basis.
"When we have these results, we can prioritize, or 'risk stratify,' opportunities for intervention and determine the best approach for closing the gap in care," said Rucinski.
Diabetes Case Management Gaps Discovered
TRICAST recently completed a pharmacy, medical, and lab claims Gaps in Care analysis for a state employee health program, providing best-practice algorithms run against a body of continuous data from 2010 and 2011. The analysis yielded some surprising results.
"We identified several situations where it was evident that diabetes case management was not being performed," says Scott Morgan, R.Ph., Vice President of Pharmacy and Clinical Services. "We were seeing patients being prescribed diabetes-related medications, and having diabetes-related office visits, who were not getting Hemoglobin A1c or Microalbumin testing done," he continued.
"These tests are a key part of the best practice guidelines for the diagnosis and treatment of diabetes, and it raises some concerns if they're not being performed. After a pharmacy claims review, we also discovered instances of members with both pharmacy and medical diabetes claims who were not having annual testing performed. These were clear cases of gaps in compliance," Morgan concluded.
About TRICAST
TRICAST, Inc. is a leading pharmacy data, analytics, and consulting firm founded in 1997. TRICAST has leveraged more than 25 years of technology and claims processing expertise, extensive client insight and a team of industry experts to offer forward-thinking, full-scope pharmacy benefit oversight solutions to our clients.
We provide audit services as the core of our business, and have assessed multiple types of pharmacy programs. Our broad experience across payors of widely differentiated size and type, combined with our focused experience in pharmacy, enables us to deliver a comprehensive assessment of pharmacy programs. Visit www.tricast.com to learn more.
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