Enhancing the Pharmacy Care Management Model: How Analytics and Clinical Pharmacy Services Benefit Medically Complex Members

Across the country, the need for enhanced medication management for our medically complex patients is growing, and it’s growing at a rapid pace.

We know that Medicare Advantage enrollment is growing — increasing since 2004 from about 5 million to about 26 million — and along with that growth, we’ve seen an increase in the number of beneficiaries with special needs plans. The number of those beneficiaries has risen from about 1.25 million in 2010 to more than 3.8 million in 2021¹, which means the industry needs to adapt. Because if we don’t, millions of people could be at risk, with millions of dollars lost along the way.

Over the next ten years, there will be at least 4.6 million medication use-related hospitalizations of Americans 65 and older, with nearly 67 percent of those being patients who take five or more medications every day². In addition, suboptimal medication use costs the U.S. health care industry $528 billion every year.³

Ultimately, a new approach to pharmacy is required to address the needs of medically complex members. The combined strength of RxAnte and Mosaic Pharmacy Services offer that new approach.

With 13 million health plan lives under management, RxAnte has established predictive models to identify future risk of medication misuse and unplanned care utilization. We can orchestrate deployment of interventions to at-risk members, offer home-based pharmacy service for medically complex Medicare members and identify the best form of outreach for each member.

Our aim is to help health plans and their members get more from medicines by using our patented analytics and value-based pharmacy services.

We know that standard intervention strategies may not be enough to reach vulnerable members, and that seniors are particularly susceptible to consequences of medication misuse: Seniors on five or more medications are 88 percent more likely to seek care for ADE than those taking one or two, and nearly half of older adults take unnecessary medications.

These figures highlight the potential for a meaningful impact of value-based pharmacy services for medically complex and vulnerable members. Our patient-centric pharmacy care management services can help manage costs, improve adherence and close gaps in care. They can leverage clinical intelligence and behavioral insights to identify plan members experiencing suboptimal care. These areas are where Mosaic thrives.

We believe that our services have unlocked the path toward value-based pharmacy services providing optimal care while managing cost and member experience. And in the ever-changing landscape of health care and Medicare Advantage plans, RxAnte and Mosaic Pharmacy Services showcase the way ahead.

If you’re attending the  AMCP Annual Meeting this year, stop by booth #402 to learn more. Listen in on our Science and Innovation Theater Session on Thursday at 11:15am to learn about the Mosaic care model and to hear the latest outcomes—including cost of care savings, reduced rates of unplanned care, and increased member medication adherence—from our 6-month case study.