Magazine article Drug Topics

Express Scripts Takes on Pharmacy and Medical Data

Magazine article Drug Topics

Express Scripts Takes on Pharmacy and Medical Data

Article excerpt

What's new at Express Scripts is its entry into the world of integrated health claims data management. Among other things, this means the independent pharmacy benefit manager (PBM) has developed an ability to gauge the cost-effectiveness of drug therapies for patients enrolled in managed care organizations.

It also means that community pharmacists will be able to have more patient information at their fingertips to guide them in counseling patients, explained Barrett Toan, CEO of Express Scripts, St. Louis, Mo. "We are beginning to merge what is done on the pharmacy side with what's done on the medical side," he said. Basically, Express Scripts integrates its pharmacy claims data with the medical data gathered by a client managed care organization (MCO). In an exclusive interview with Drug Topics, Toan described his PBM's new data management capabilities and their implications for pharmacy and physicians.

Express Scripts has a subsidiary, Practice Patterns Science (PPS), which has developed an approach to health-care data analysis in terms of what are called episodes of care. An episode is a time line, starting with the diagnosis of a patient's disease and ending with its resolution. The time line may be long or short, depending on the nature of the disease.

For instance, an asthma episode begins with the diagnosis of a patient's asthma. The patient may be prescribed a drug. Later, there may be an emergency room visit. Then there may be a long period of time during which there are no more problems reported regarding that patient's asthma. After a predetermined period of time passes without any further medical incidents, the episode of care comes to an end, he said. One patient may have several different episodes under way simultaneously, he noted. PPS tracks a total of 950 different diseases, using ICD9 codes as identifiers. Having identified an episode of care for a patient, the drug therapy costs for the episode are compared to the associated medical costs, he said. "What we're finding is, in some cases, the drug costs are helping us control the overall costs."

What the capabilities of the integrated database mean for pharmacists is that pharmacists will be able to access much more patient information than they can now, Toan noted. …

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