4 Ways to Use Real-Time Alerting in Healthcare for PBM Improvement

Real-Time Alerting in Healthcare

Benjamin Franklin said, “An investment in knowledge pays the best interest.” Since using data to inform knowledge is not a novel concept, this remains a true statement. When treatment decisions are based on outdated information, stakeholders often face negative experiences. However, with real-time alerting in healthcare driven by current data, the payors, the patients, and the providers all score. Reduced costs, better resource allocation, and efficiently-managed outcomes combine to improve population health. Reap the benefits of automation based on real-time data by incorporating alerts into your 2022 PBM toolkit.

What is a Real-Time Alert in Healthcare?

Real-time alert software monitors healthcare events, triggering automated notifications to identified users immediately after the program detects a specific issue or opportunity. The alerts are designed to meet user-defined conditions that could indicate a meaningful change in a patient’s circumstances.

Alerts work on a per-result basis to keep system operators up to date and allow healthcare providers to take action without delay. For example, real-time alerts can help improve treatment outcomes by identifying medication non-adherence, such as when a patient neglects to fill a script.

The Value of Real-Time Alerting in Healthcare

The large volume of patient data available is a primary characteristic of modern healthcare. This data enables us to use predictive analytics, data modeling, artificial intelligence, and process automation to detect unexpected or abnormal conditions. These events trigger alerts that are then reported to the right person within seconds of being identified.

Real-time alerts are particularly helpful in circumstances when a patient’s situation can change rapidly, such as in the intensive care unit or emergency room. For example, suppose a patient receives a new medication for the first time. In that case, pharmacy professionals can get real-time alerts telling them that the patient has been diagnosed with a new condition and requires immediate assistance and education.

Using Real-Time Alerts in Pharmacy Benefits Management

Real-time alerts deliver significant value in pharmacy benefits management (PBM). Some of the advantages of deploying real-time alerting in healthcare for pharmaceutical use cases include:

  • Avoiding medication errors. With up to 98,000 American deaths resulting from medication errors each year, this is currently the 8th leading cause of death in the U.S. Errors range from overlooking stated allergies to drug-drug interactions.
  • Identifying areas of opportunity. By analyzing claims data, a system can deliver real-time alerts to keep clinicians and payors abreast of drug inflation and other trends impacting costs.
  • Monitoring adherence. Medication non-adherence is a massive problem costing the healthcare industry an avoidable $300 billion a year, and drug cost is a primary driver of this issue. Other reasons for non-adherence include the fear of potential side effects, transportation difficulties, lack of symptoms, and mental health issues like depression.

Automated, real-time alerts prompted by data and analytics can notify pharmaceutical professionals about drug availability, pricing changes, medication recalls, patient performance, and causes of pharmaceutical or financial waste.

A Perfect Opportunity to Improve Patient Care

Healthcare providers benefit significantly from using data-driven, real-time alert systems to track issues like medication adherence, adverse events, and drug cost inflation. Artificial intelligence (AI) identifies the challenges and opportunities for improvement and sends timely alerts to the right people. This early warning system equips pharmaceutical professionals with the knowledge and insights to pivot rapidly whenever a drug concern comes to light.

From adding alternative drugs to a formulary to monitoring reasons for non-adherence and creating opportunities to address them, the options show how real-time data can improve patient care, encourage adherence, and mitigate undesirable outcomes.

Here are four ways companies can use real-time alerting in PBM to achieve better patient care. 

#1: Providing Patient Assistance

When a patient gets a new diagnosis, real-time alerts enable providers to take immediate action to introduce medication and begin care. This opportunity helps to improve treatment outcomes and optimizes the cost of therapy.

Up-to-date information on pricing helps patients manage the usage of their plan benefits. Instead of exhausting their medication allotment because of high pricing, timely knowledge can help them make their benefits last longer, impacting their overall healthcare.

#2: Optimizing Disease Management

The CDC reports that 60% of U.S. adults live with chronic conditions, which places ongoing disease management high on the list of healthcare priorities. Real-time alerting in healthcare helps improve treatment outcomes by tracking patients’ medication adherence.

When a patient reports an adverse event or side effect, customizable alerts notify all stakeholders and enable a timely response. The earlier a clinician can stop administering a drug and begin countering the effects, the better the chances are of avoiding hospitalization and treatment for medication-related problems.

This benefit helps practitioners avoid preventable deaths, reduce costs and inconvenience, and improve treatment outcomes. Since the nation experiences 125,000 preventable deaths annually costing  $290 billion in avoidable healthcare costs, these factors deliver meaningful disease management and patient health advantages.

#3: Managing Drug Inflation

Drug cost inflation is a constant concern for all stakeholders in PBM. Managing health plan contracts effectively depends on the use of drug formularies. The multitude of formularies and payors active in the healthcare environment makes keeping track of cost changes challenging. However, data management systems are designed to handle the vast quantities of information needed to follow medication updates.

When pricing changes occur, automated, real-time alerts ensure pharma professionals get notified without delay. By using actionable data and prescribing medications for patients that their health plans cover, clinicians can help patients save $360 billion a year. Instead of patients being forced to choose between accepting higher costs or going without their medication, they have options such as consenting to generic drugs that the PBM approves.

#4: Customizing Alerts to Meet Specific Needs

When stakeholders can act immediately to meet new challenges, it becomes possible to both improve financial performance and enhance patient care. Getting the right data and analytics in real-time can impact decisions made at every level. Customized, real-time alerts allow users to track an unlimited number of metrics specific to every use case.

For PBM professionals, such automation and alert-based actions make it possible to keep abreast of developments as they happen. From monitoring individuals’ contract performance to following medication utilization, real-time alerting in healthcare enables payors to be better informed, support optimal patient care, manage issues such as readmissions, and improve their value to clients.

Real-time alerting in healthcare is a key function of the Xevant intelligent analytics platform. Discover how to make the best decisions for your company and clients with our AlertLogic solution, using data that identifies PBM issues and opportunities as they occur. Contact us to schedule a demo today.

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