Thomas Henry, senior director of corporate systems, Express Scripts Inc.

Thomas Henry, senior director of corporate systems, Express Scripts Inc.

Features

Case Study: Express Scripts Inc.

Rewriting Healthcare

Express Scripts lowers costs and improves health through analytics.

For Express Scripts Inc. (ESI), the bottom line is not the exclusive measure of success. The company also strives to reduce costs for its client groups while enabling its tens of millions of members to achieve better health outcomes.

At a Glance

Express Scripts

 

 

The Company: Express Scripts Inc. (ESI) is a leading pharmacy benefits manage­ment company that delivers safe, convenient and afford­able prescriptions, research and analytics services to clients such as public and private employers, managed-care plans, and labor unions.

The Challenge: To better aid its client organizations and their tens of millions of mem­bers in a highly competitive market, ESI sought to pro­vide deeper, more extensive pharmaceutical and behavioral analysis and business intel­ligence (BI).

The Solution: By con­solidating information on an upgraded data warehouse solution from Teradata, ESI enabled powerful new analyt­ics capabilities through its Beacon application.

The Results: ESI’s solution decreases costs. For example, anti-fraud efforts alone gener­ated enough savings to pay for the solution in less than 12 months. It also allows clients and their members to make smarter choices about their prescription drug benefits and enhance health outcomes.

"Our mission is to align our ser­vices with the needs of mem­bers and our plan sponsors,” explains Thomas Henry, senior director of corporate systems at ESI. “In doing so, we help consumers find the most cost-effec­tive, safest prescription drug options. It’s a socially conscious solution to the challenges facing the healthcare industry.”

Since its founding in 1986, ESI has worked with managed-care and insurance providers, employers and third-party administrators, and sponsored benefit plans for public sector, workers’ compensation and union organizations. The company provides phar­macy benefits management for these clients, as well as direct mail pharmacy services to their members.

ESI recognized that it could better assist members and clients by providing deeper, more extensive pharmaceutical and behav­ioral analysis that could empower them to eliminate wasteful spending, achieve better health and maximize value.

Deliver New Value

ESI’s IT organization prides itself on creating innovative business solutions that deliver new value to the company. To do this, a variety of IT systems and business intelligence (BI) software had been used to deliver essential historical information. These legacy systems required analysts to track down all of this informa­tion before conducting any analysis—a time-consuming process that effectively limited the amount of analysis that could be performed.

Expanding the company’s vision for member and client support would require more information about members, includ­ing medical conditions, history, market segment, past pharmaceutical usage and behaviors. And the organization would also need to assess data about various pharma­ceuticals, drug interactions, generic formula­tions and industry usage trends. This could only be accomplished through an upgrade and consolidation of the data environment.

Diagnosis: Fraud

One Express Scripts Inc. (ESI) analyst recognized fraudulent prescriptions being written under the name of a deceased physician. By using the data warehouse to identify similar malfeasance, waste and abuse, ESI generated significant savings—enough to pay for the Beacon solution in less than 12 months.

“We had siloed solutions that did not sup­port mixed workloads and struggled to meet our needs,” Henry says. “Our new strategy required analytics solutions that would allow us to provide historical and predictive data. To do that we needed to shore up our foun­dation so that we could provide consistent, reliable analytics across the organization.”

As ESI set out to strengthen its data infrastructure and create an integrated view of its members, industry and enterprise data, it also sought to deploy sophisticated BI tools that would enable self-service without buckling under the company’s continued growth. Finally, ESI planned to establish an effective governance model.

“We wanted to create a community that would share ideas and train best-in-class analysts so that we had an analytics environ­ment that would differentiate us from our industry peers,” Henry says.

Therapeutic Solutions

During the initial deployment, ESI included only two subject areas and three applications in the data warehouse. As the solution matured and the company grew to rely on the new analytics capabilities, it increased the amount of data cap­tured and began reusing the data where appropriate. In just three years, the solution had grown to comprise nine subject areas and 45 applications.

“Teradata provides best in class analytic and BI solutions that are used to create significant value for our business.”

—Thomas Henry,
senior director of corporate systems, Express Scripts Inc.

One of those applications, Beacon, has self-service features that enable ESI members and clients to acquire the information they need to enhance decision making. With Beacon, members can access data on past prescriptions, potential drug interac­tions and the efficacy of generic medica­tions. Role-based security features protect their privacy.

The data ecosystem Beacon is built upon transforms huge volumes of complex data into actionable business insights, all delivered through an intuitive dashboard. Clients can use Beacon’s savings estimator tool to model the impact of proposed plan changes—such as generics utilization pro­grams or mail-order medication delivery. A menu lets them select program changes they wish to model, and a graph calculates the projected benefits over one to three years.

Powerful Insights

The integrated data analysis features provided by Teradata allow ESI’s analysts to work faster and smarter. The company estimates that analysts are 33% more productive than before.

What’s more, Beacon lets analysts execute on a closed-loop step therapy process that can lead to improved health outcomes for members as well as increased financial value to clients. ESI uses integrated analytics to review a member’s medical history and recommend the most appropriate next treatment steps. The analysis also suggests steps to promote member compliance, improving clinical outcomes. The system can also monitor participants’ health and return the data for continued analysis and management.

“Beacon gives clients a rich source of data that enables them to make better choices, reduce their costs and provide better care.”

—Thomas Henry

“These capabilities put plan sponsors in control,” Henry says. “Beacon gives clients a rich source of data that enables them to make better choices, reduce their costs and provide better care to their members. It’s an innovative way to empower our clients.”

Healthy Improvement

Although quantifying the full benefits of the integrated data environment is difficult, Henry is certain the value is significant. By supporting extensive data reuse and expanding access throughout the organiza­tion, the Teradata system delivers innova­tive technical excellence and essential business value.

“Our operating model is founded on providing high-quality, rapid service to meet client and member needs,” explains Henry. “By giving our analysts the tools they need to ask the right questions, get faster answers, and dive even deeper for greater insight and understanding, Teradata provides best in class analytic and BI solutions that are used to create significant value for our business.”

In the future, ESI plans to move to a dual-active configuration of its Teradata solu­tion that will support industry-differentiating analytics capabilities. “Ultimately, we want to provide speed-of-thought analytics,” Henry says. “The speed of busi­ness continues to grow, and people want information now. Our IT team is highly focused on making the business as nimble as possible.”

Yet Henry recognizes that business value is never just about traditional metrics. “Our primary goal is to enable our business,” he says. “But the value of our Teradata solution is not just in the impact on our enterprise. You can’t put a metric on preventing a catastrophic drug interaction.”


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