Employer Health Benefits, Worksite Clinic

RxStewardship: R is for Results

Week 8 – R X S T E W A R D S H I P


R is for Results

Seeing or hearing advertisements proclaiming results is commonplace for most of us. Promotions frequently tout the biggest sale of the season, unsurpassed warranties or life-altering results. My new personal favorite is an ad proclaiming that a particular product is guaranteed to last a full 24 hours but quickly reminds consumers that they need to use said product twice daily!

This bravado has carried over into the health care industry and more specifically pharmacy services. Claims of being the one and only provider of certain services, decrees of maximum cost savings and promises of full transparency are becoming the norm. And while this may reflect an industry that continues to evolve product and service delivery, it does beg the question – outside of all of the hype – do you understand the result of the investment your organization is making in your pharmacy benefit program?

Truly understanding results requires a working knowledge of at least foundational terms and concepts within the industry. A few examples include average wholesale price (AWP), average cost index (ACI) and maximum allowable cost (MAC). Even terms that are believed to be simple and commonly understood may need to be double-checked as working definitions have evolved over the past few years. Beyond simply understanding terms, do you understand how fees, cost sharing and rebates are actually calculated? If your organization is told it is receiving 100% of earned rebates, is there clarity for how that is measured? Is there visibility into the impact on overall costs? From a clinical perspective, is there agreement on which metrics are being measured? Perhaps most importantly, is there a quantifiable positive impact on real life health outcomes?

Receiving results even as independent points of data can be a step forward in the quest to craft a high value benefit plan. However, if that information is disconnected, not placed into the proper context or distracts attention from the overall picture, the information may not be as helpful as perceived. As an example, when exploring the use of migraine medications, a report may show high generic, formulary and medication adherence percentages. At first glance, all three of those metrics are positive. However, they may obscure insight into members who are using migraine rescue medications week after week or month after month without using any medications for preventing the migraine in the first place. If this is the case, not only are those members not receiving the best care or outcomes, it is likely that absenteeism, productivity and overall benefit dollars have been negatively impacted – clearly not the desired result.

As you contemplate designing your organization’s plan to measure data and gain better insight into the true outcome impact of those metrics, you will likely find value in incorporating a few Lean Six Sigma (LSS) concepts into your planning and execution. The use of A3’s and smart goals can help create a road map for program implementation, data collection and impact measurement. Having these quality improvement tools in place can be of tremendous benefit for organizations seeking to maximize the value of their investment.

Northwind is committed to helping your organization achieve its outcomes and impact goals. We can provide LSS Black Belt support throughout your journey and our advanced analytics, data reporting and clinical blueprints are all designed to help you gain insight into your data, influence trends and behavior and impact health outcomes for those you serve.

Next week’s blog is entitled D for Diabetes and will explore the positive financial and clinical outcomes achieved as the result of implementation of a clinical blueprint as part of a collaborative effort between an employer, a health center provider and Northwind. We are very excited to share these results with you. In the interim, if you would like to explore ways to help your organization achieve the results you desire – true measurable and impactful outcomes, please reach out. Let’s have a conversation!

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Betsy Bigler | Mar 7th, 2024
INDIANAPOLIS, March 7, 2024 – Northwind has announced the addition of Tony Purkey as Senior Vice President, Client Strategies. “Demand from our self-funded employer and union clients is driving rapid growth,” said Phillip Berry, CEO. “Tony Purkey joins Northwind at a time when we need high-integrity leaders with expert knowledge in employer-sponsored health and the … more »

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Voices Lost in the Noise

Phillip Berry | Jan 31st, 2024
In the health benefits world, the mad scramble toward January renewals/starts has subsided and attention has turned to the annual cycle of review necessary to gauge progress. How did we do? The plan review process generally centers on analytics to gauge progress or regress and to identify “areas of opportunity.” Good. The right data with … more »

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