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Artificial Intelligence to Forecast and Predict the Impact of Specific Factors on Population

    Our programs are unique in that they:
  • Combine integrated data sets of pharmacy, medical, laboratory, eligibility, Workers' Compensation loss runs, etc.
  • Analyze data sets for as small as 1,000 lives, and up to 1.5 million or more total covered lives.
  • Use Artificial Intelligence (AI) data sets across multiple data formats using Pharmacy Benefit Management (PBM), Third Party Administrators (TPAs) and health plan data sets for over 20 years.
  • Produce reports and outputs which illustrate key issues for financial and operational research and review.

    Forecasting & Predictions Utilizes:
  • Biotech Modeling
  • Predictions of the impact of specific factors on the population
  • BIM medical and specialty pharmacy with customizable financial, demographic & clinical impact
  • Market Share Analyses
  • Cost accounting of every dollar spent including discounting and utilization
  • Pharmacy spend for patient count, prescription count & metrics for budget
  • Treatment Calendar
  • Artificial intelligence rule sets applied to integrated data to identify and trend complex clinical problems
  • Trend Management
  • Oversight of financial trend and clinical usage

Forecast & Predictions at Work

Problem: How do you get current and predicted trends at your fingertips? Forecasting and Predictions are not mathematical voodoo. They are the frequent request of our clients. Clients also request how to manage trend to their prearranged targets. For example, keep trend at national averages, OR keep trend 1-3% below national averages, or what is the trend for Specialty Rx versus traditional medications?

The answer to clients is frequently trend predictions predicated on supportable, and measurable, methodologies! Trend models are supported, among other things, by cost accounting, unit cost and utilization increase, provider performance metrics, medication category impact, new entrant impact, age/gender movements, and projections for future growth. These analyses are aggregated and provided in our cloud-based solutions. So, how is trend predicted, and then managed?

Methodology: First, what is the trend that is associated with predictions? Trend calculations based on PMPM (per-member-per-month) are commonly composed of the ingredient cost, utilization, and new entrant components. Each of these PMPM components are calculated monthly and summed. The result is compared to prior period trends. Second, what are the drivers that contribute to each element of trend? Drawing from cost accounting of every dollar spent on medications and the period-over-period price increases, two elements of trend are readily available. New entrants and price trend analyses contribute the third element. Summing the results of these elements and comparing to prior periods is the trend prediction.

Aside from the actuarial models that Pro Pharma/ProData Analytics supports, the next problem is to manage trend throughout the year in order to reach targets. Analytics at your fingertips can help with monthly calculations and trends to identify components that require interventions. How do you manage Trend? Linking all elements of trend to their respective driver reports provides:

  1. 1. Medications incurring the largest price increases for formulary management
  2. 2. Financials for utilization trend leads to therapeutic category expansion/new PA targets/formulary planning
  3. 3. Provider performance for Comparative Price Sheets and Comprehensive Medication Reviews
  4. 4. Age/gender movement period-to-period impact the denominator of PMPM
  5. 5. Financials for new entrants provides a budget impact.

Outcome: The results are trends, and the elements necessary to manage the trend to your target. The result -- lower paid PMPM, lower budget PMPM, and lower trend.

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