Express Scripts: Using actionable data to predict patient health

What if you could predict which patients were likely to develop adverse health issues, like diabetes or heart disease, within the next two years and intervene before it happens?

Questions like this fascinate Tom Henry, Vice President of Knowledge Solutions for Express Scripts. And he’s in a unique position to try and answer those questions in his role managing data and advanced analytics for the nation’s leading pharmacy benefit manager. He shared his unique experiences and perspective with us.

The expense of genetic testing makes the goal of personalized medicine still out of reach for most patients. But at Express Scripts there’s a different kind of personalized medicine at work, one that can not only predict the potential of adverse health events occurring at the individual patient level, but also recommend and implement appropriate preventative actions.

“We make the use of prescription drugs safer and more affordable for tens of millions of Americans, and we do that through specialized, personalized care that is driven by the industry’s most robust set of actionable data,’’ says Henry. “By taking the data we’ve collected, we’re able to have forward-looking insights that significantly improve patient outcomes and control client costs.” Henry is leading the charge to translate the vast amounts of data Express Scripts produces into predictions that can keep people healthier, reduce costs and eliminate fraud.

Using high-powered analytics to quickly crunch vast amounts of data, Henry’s group analyzes patients so effectively they’ll soon be able to alert health care workers to serious side effects before a medication is prescribed.

This could have profoundly positive consequences for health:

• A health care provider would know before writing a prescription for painkillers whether the patient is at high-risk to become dependent. A different treatment plan or more careful monitoring could be selected.
• Prescription filling behaviors, psychosocial information and other medical data could point to the development of a chronic illness – or one that hasn’t yet been properly diagnosed.
• Adherence to medication regimens post-hospitalization can predict the potential for re-admittance within 90 days. Providers could take action to avoid the re-admittance.

“Through our innovative predictive models, we make it more likely to avoid unnecessary treatment costs and improve patient outcomes,” says Henry. “Big data is good to have, but it’s meaningless if you can’t put it into action. That’s what we do. By being proactive, we’re driving better decisions and healthier outcomes.”

The key to these abilities are big data platforms that used to seem far-fetched. Henry says they’re a reality with capabilities that create value. At minimum, there is a huge potential to spot and eliminate fraud – especially as it relates to controlled substances.

As detailed as the Express Scripts database is, Henry says that more breakthroughs will come through collaboration among health care providers. “We have some significant opportunities to share our insights with others who are working toward the same outcome – better patient care.”