Study: RationalMed Improves Patient Outcomes
The greater visibility healthcare providers have into patients’ records and health history, the greater the opportunity to prevent adverse events and unnecessary medical costs. Working to provide this visibility has been key to many Express Scripts solutions, including RationalMed®, a program that has been improving patient outcomes for nearly 20 years.
As our complex and fragmented healthcare system becomes even more complex and fragmented, RationalMed becomes more critical in coordinating care across organizations to address otherwise unidentifiable safety issues related to prescription drugs.
To investigate the impact of the program, we examined cost and utilization for primary care physician, emergency room and inpatient visits for members before and after RationalMed was implemented into their coverage.
To assure we fairly compared utilization and cost changes, we matched client data for intervention patients who were enrolled in a clinical safety program -- which alerts health care providers to potential drug interactions or contraindications -- to client data for those patients who were not enrolled in the program.
We assessed cost and utilization of primary care physician (PCP), emergency room (ER), and inpatient visits.
- The average number of PCP visits increased in the intervention sample from 4.65 to 4.68, while the control sample decreased from 4.64 to 4.13; demonstrating increased provider responsiveness to RationalMed outreaches.
- The intervention group showed a larger net decline of 0.02 ER visits.
- Inpatient hospitalizations for the control group increased, on average, from 0.05 to 0.07, while the intervention group decreased from 0.05 to 0.04.
- The net decreases in average ER visits and inpatient hospitalization visits contributed to lower average associated net plan charged costs of $526 and $1,197 respectively.
How RationalMed Works
RationalMed integrates medical, pharmacy, and laboratory data to create patient-specific comprehensive profiles. Each integrated patient profile is passed through RationalMed’s clinical rules engine and reviewed against thousands of evidence-based clinical rules. This clinical rule engine has been created and honed over the past two decades with input from clinical specialists. Patient records are reassessed whenever the underlying data is updated, including real-time processing of prescriptions. This allows us to identify safety and health risks missed by physicians, pharmacists, and traditional clinical programs - which are highly concentrated among patients with multiple health care providers involved in their care.
For each safety issue identified, RationalMed alerts are sent to the prescriber describing the potential safety risk, including one or more literature citations containing the evidence upon which the rule is based. This often results in a change in treatment addressing the identified safety risk – indicating the provider was unaware of the potential error in care.
As our health care systems have become more disparate, these risks have only increased, inhibiting health care providers’ ability to identify and prevent potential adverse health events due to drug interactions or contraindications for a diagnosis made by another provider.
Utilizing a clinical rules based system in an integrated pharmacy, medical, and laboratory claims repository to identify and alert health care providers of potential safety issues and errors in care can improve health outcomes, decrease utilization of ER and inpatient hospital facilities, and decrease charged costs.