As Senior Director of Advanced Analytics for RxAnte, Dr. Stephen Jones leads a team of analysts that brings diverse knowledge and expertise from all corners of healthcare, including economics, statistics, biostatistics, epidemiology, and beyond. We asked Dr. Jones to shed a little light on how this collection of experts drives financial and quality results for national and regional health plan clients.

RxAnte: Tell us a little about what your Client Analytics team does.

SJ: We’re different than most analytics groups out there in that we are really the most flexible and diverse team you’ll ever meet. Combined, we have over 100 years of relevant career experience…we have experience in healthcare startups, academia, health plans, and hospital systems. We are unique in our ability to work closely with both internal customers and external clients. These roles are very different, but quite complementary, placing us in a special position that requires us to understand the entire lifecycle of analytic requests. It starts with sitting down with the client and hearing their interest/concern, to then translating what we hear into actual research questions/problems, and finally doing the actual statistical/analytic work to produce high-quality, consumable deliverables for a variety of audiences.

We often are asked obscure and rather loosely defined questions like, why did we see ‘this’ in the data? If we were to do ’this’ differently, how might that impact our results and business goals? If we keep doing what we’re doing, where do you expect we will end the year for a certain measure?

In addition to the rapid application development work, we have other, longer-standing studies that we work on. For example, we might have a client interested in knowing how effective a drug is in reducing adverse outcomes, what might be the best outreach strategy to implement in a low-income population, or how geography plays a role in medication adherence. We can offer our clients not just data analyses, but interpretation and application opportunities. We are unique in that we are in the weeds of research science and analytics, as well as account management and product development for the company.

RxA: How does having multiple roles benefit your clients?

SJ: I think it gives our clients the information they need to adapt during the year, maximizing their own strategies month-after-month and year-after-year. We are able to look at massive amounts of data and say with near-certainty what trends or outcomes clients can expect. So we examine things like, does better medication adherence actually lead to lower costs? Does it lead to fewer in-patient admissions or emergency room visits? We look at this across pharma companies and health plans, serving as an unbiased third party.

Seeing this come together for new clients is particularly rewarding. It’s like a lightbulb goes off when they see that first Star measure Forecast and are able to understand exactly what they need to do to actually change their Star Ratings.

RxA: What are some ways you’ve implemented this with your health plan clients?

SJ: One example that comes to mind is some collaborative research we did with one of our large PDP plans. The goal was to provide supporting evidence to show that plans with high volumes of low income status members should be properly risk adjusted when calculating Stars ratings. We designed a study, compiled a manuscript, shared with the client, and then we actually traveled to Washington and presented our findings to the Health and Human Services and CMS Directors. Ultimately, in partnership with our client, we were able to influence the course of how CMS looks at quality measures.

For another client, we investigated the impact natural disasters have on medication adherence. We later presented our work at a national healthcare conference in partnership with the client. CMS recently announced they were considering making adjustments to Star ratings for plans experiencing significant natural disasters within their populations. We were able to respond immediately to the call letter, showing support for this and making further recommendations for CMS to consider. In addition to collaborative research, we also serve as a testing ground for new product development. Many client inquiries regarding their performance and options to maximize their resources result in analyses that inform the need for new direct to member intervention offerings, or new intervention channel offerings such as provider outreach for Stars prescribing measures. We also leverage valuable client requests and partner with our product colleagues to enhance the standard offerings available to clients within our Client Portal for operational and performance program monitoring.

RxA: Within the context of what you’re currently doing with clients, what kinds of tools are there out there to help plans actually act on the information and insights you get from that kind of research?

SJ: RxAnte offers a suite of resources for clients, but the most used is a system we have that ties providers and plans together. We recently patented RxEffect, our tool that has the ability to deliver patient-level information to care providers to allow them to prioritize the patients they speak with. This is increasingly important because a lot of provider groups are now being held at risk for their patient population by the health plan. So that means that health plans are putting the onus on provider groups to maintain and improve the quality of their patient population. I don’t think that’s going to decline over time. If anything, that’ll increase, especially if recent CMS proposed rules are any indication of the impending implementation of value-based care. So you end up with a lot of things like IPAs, patient center medical homes, and ACOs. These are all just different indicators of at-risk provider groups, and there’s certainly a challenge in standardizing the tools that they use. But remember, it’s not just a viewing platform, it’s the analytics that are behind it, and I think there’s a tremendous need for that simply because more and more health plans are holding themselves and their providers at risk for their patient/member populations. That’s the art of what RxAnte is able to do.

We continually refine our internal visualization analytics dashboard so now we’re able to provide information to account management in real-time. They no longer have to put in requests for certain analytics. They can go directly to the dashboards that we’ve built, and we can focus on other questions that the clients are asking.

RxA: How do these tools and advanced analytics help the overall healthcare industry?

SJ: The first thing that comes to mind is windfall payments. Traditionally pay-for-performance programs would be set up that would pay providers based on quality improvement goals setup prior to the program launch. Many of those engagements would pay windfall payments simply because providers were being paid to do things that they were already doing, and without analytics, you really had no way to differentiate whether something was good or bad or indifferent. Just incorporating some simple trending and comparative analyses have given us the ability now to avoid a lot of windfall payments.

Analytics brought huge advancements in that way to benchmarking and goal setting. We have also been able to determine whether or not programs are working effectively, and not just waiting until the end of the year, but being able to know what works, what doesn’t work as the program progresses throughout the year. Again, advanced analytics in that area allowed us to begin to be more and more prescriptive in what we’re seeing and doing.

Predictive analytics has been obviously big in the last 10 to 12 years, and we’ve got a team here who have been involved in it from the start. So we are able to do more than just analyze, we can triage and prioritize based on what the data tells us will happen. We are not just reactive, we are proactive and prescriptive, and we help our clients to be the same.

RxA: What advice would you give to health plans who want to make the most of data when it comes to their Star Ratings strategies and business goals?

SJ: Remember there’s always going to be this modernization of analytics that we need to make sure we’re paying attention to constantly improve things like medication adherence strategies. But don’t be distracted or fooled by all the fancy bells and whistles of what many companies call analytics. Note that the ability to create a pivot chart in Excel doesn’t equal data science. Your analytics partners should be advanced enough to answer very difficult questions, while at the same time give you answers you can understand and provide guidance so you can actually implement those findings. Don’t settle for anything less than that.