A national health payer was experiencing increasing spend and utilization among pediatric asthma members. Their current asthma management program was not yielding the desired results of reducing emergency department or inpatient utilization. The health plan approached AArete to conduct detailed analyses on the member population and to identify opportunities to improve their current pediatric asthma management program.
AArete utiliized multiple data sources, including medical and pharmacy data, to identify trends in asthma-related healthcare service spend and utilization. Our review included an analysis of prescribing paterns and member drug adherence, as well as identification of high-risk pediatric asthma members. Within this population, we identified the proportion of individuals currently receiving targeted case management and, selected a second cohort of members to engage in additional disease management efforts.
Our solution yielded annual savings of 30% to 50% through reductions in emergency department and inpatient utilization and spend, an increase in medication adherence and prescription consistency, and improvements in patient outcomes. Our analyses also provided the health plan with greater insight into one of their high-risk population pools and key metrics to leverage when analyzing this population in the future.