How Carve-In Pharmacy Strengthens Population Health Management

11/29/2021 News

New Research from Certilytics Shows the Power of Carve-In Rx Data for Health Plans, Employers

Do carve-in pharmacy benefits help strengthen population health management?

If your gut tells you “yes,” you’re right – and new research from Certilytics’ data science team helps explain how and why.

The team worked with a large national insurer to research the impact of carve-in pharmacy from a fresh angle: testing the hypothesis that carving in the pharmacy benefit leads to higher quality Rx data and, importantly, to more accurate downstream analytics.

As part of the research process, our data scientists also developed an innovative, quantitative measure of pharmacy (Rx) data quality – a way for health plans and other stakeholders to assess Rx data quality to help inform decisions about carve-in vs. carve-out pharmacy benefits.

The new model for measuring Rx data quality means that previously monolithic swaths of data can be accurately segmented based on the value they provide. Pharmacy data in general tends to be timely and clean, but Certilytics’ research uncovered striking differences in the measured quality of carve-in (vs. carve-out) Rx data.

These clear differences were further shown to impact the accuracy of clinical quality measure (CQM) eligibility and compliance – and the accuracy of clinical and financial risk predictions.

What does that mean in practice? A new, better way to distinguish gradations of quality in pharmacy data – so that health plans and other stakeholders have a way to validate the basis for any conclusions they draw from that data.

Interested in learning more? Schedule time to talk to our team of experts about our research and receive the e-book, How Carve-In Pharmacy Strengthens Population Health Management.