Methods and systems for member messaging

• US 8,799,204 B1
• Filed: 12/20/2011
• Issued: 08/05/2014
• Est. Priority Date: 04/19/2010
• Status: Active Grant

• Current Assignee: Express Scripts Strategic Development, Inc. (The Cigna Group)
• Original Assignee: Express Scripts Incorporated (The Cigna Group)
• Inventors: Nease, Robert F. Jr., Sundararaman, Katherine Harini, Sundar, Heather D., Theby, Krista Lynn, Butcher, Tina Lynn Bauman
• Primary Examiner(s): Holmes, Michael B
• Application Number:
  US13/331,171
• Time in Patent Office: 959 Days
• US Class Current: 706/50
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 70/60 relating to pathologies

Abstract

Methods and systems for improving therapy adherence are described. In an embodiment, a disease state associated with a member is identified. A member classification of the member is determined. The member classification may be based on past therapy the member received to treat a condition associated with the disease state. A diagnostic loop is selected based on the disease state associated with the member and the member classification. The diagnostic loop may include a plurality of operations. At least one of the plurality of operations of the diagnostic loop is performed. Other methods and systems are described.

Claims

1. A method comprising:

identifying, on a computer processor, a disease state associated with a member;

determining, on the computer processor, a member classification of the member, wherein the member classification is based on past therapy the member received to treat a condition and whether the member is as a new-to-therapy member classification or an experienced-therapy member classification;

selecting, on the computer processor, a diagnostic loop based on the disease state associated with the member and the member classification, wherein the diagnostic loop includes a plurality of operations that include a drug therapy operation related to a drug; and

performing, on the computer processor, at least one of the plurality of operations of the diagnostic loop.

2. The method of claim 1, wherein performing the at least one of the plurality of operations includes:

transmitting therapy adherence information and a therapy adherence offer to the member using the member classification,

wherein the therapy adherence information includes information to improve adherence of the member to a prescription drug and the therapy adherence offer includes an offer to improve adherence of the member to the prescription drug.

3. The method of claim 2, wherein performing the at least one of the plurality of operations further comprises:

identifying the prescription drug associated with the member, the prescription drug prescribed to treat a condition associated with the disease state;

determining the member is taking the prescription drug as prescribed; and

determining a pharmaceutical delivery channel associated with the prescription drug in response to determining the member is taking the prescription drug as prescribed,

wherein transmitting the therapy adherence information and the therapy adherence offer to the member is in response to determining the member is taking the prescription drug as prescribed and determining the pharmaceutical delivery channel.

4. The method of claim 3, wherein the pharmaceutical delivery channel is a retail pharmacy and the therapy adherence offer includes an offer to switch from the retail pharmacy to a mail order pharmacy.

5. The method of claim 4, wherein the offer to switch from the retail pharmacy to the mail order pharmacy includes a prescription drug switch offer to switch a different prescription drug of the member from the retail pharmacy to the mail order pharmacy.

6. The method of claim 5, wherein the offer to switch from the retail pharmacy to the mail order pharmacy includes a care coordinator offer to connect the member to a care coordinator to transition the different prescription drug of the member from the retail pharmacy to the mail order pharmacy.

7. The method of claim 3, wherein the pharmaceutical delivery channel is a mail order pharmacy and the therapy adherence offer includes an offer to automatically refill the prescription drug through the mail order pharmacy.

8. The method of claim 1, wherein performing the at least one of the plurality of operations of the diagnostic loop further comprises:

identifying a prescription drug associated with the member, the prescription drug prescribed to treat a condition associated with the disease state; and

determining the member is not taking the prescription drug as prescribed.

9. The method of claim 8, further comprising:

transmitting a not-taking-as-prescribed request, the not-taking-as-prescribed request

including a request for information describing why the member is not taking the prescription drug as prescribed in response to the determination that the member is not taking the prescription drug as prescribed; and

receiving a not-taking-as-prescribed response to the not-taking-as-prescribed request.

10. The method of claim 9, further comprising:

transmitting an offer to switch from a retail pharmacy to a mail order pharmacy in response to receipt of the not-taking-as-prescribed response, wherein the response indicates one of the member forgot to renew the prescription drug, the member cannot afford the prescription drug, and the member forgot to refill the prescription drug; and

transferring the member to a care coordinator in response to receiving the not-taking-as-prescribed response,

wherein the not-taking-as-prescribed response indicates the member has a question regarding the prescription drug, the member forgot to take the prescription drug, or both.

11. The method of claim 9, further comprising:

determining that the member forgot to take a dose of the prescription drug using the received not-taking-as-prescribed response; and

transmitting a pillbox offer to the member in response to determining that the member forgot to take a dose of the prescription drug.

12. The method of claim 11, further comprising:

receiving a pillbox offer rejection response; and

transmitting an offer to switch from the retail pharmacy to a mail order pharmacy in response to receiving the pillbox offer rejection response.

13. The method of claim 1, further comprising:

accessing pharmacy claims data associated with the member;

determining the member is refilling a different prescription drug at a retail pharmacy based on the pharmacy claims data associated with the member; and

transmitting an offer to switch from the retail pharmacy to a mail order pharmacy in response to a determination that the member is refilling the different prescription drug.

27. The method of claim 1, wherein performing, on the computer processor, at least one of the plurality of operations of the diagnostic loop includes selecting a first loop when the member has a new-to-therapy member classification and selecting a second diagnostic loop when the member has an experienced-therapy member classification, wherein the second diagnostic loop is different than the first diagnostic loop and includes past medication possession ratio as a factor.

14. A method comprising:

identifying, on a computer processor, a member associated with a disease state using targeting data;

determining, on the computer processor, a member classification of the member, wherein the member classification is based on past therapy the identified member received to treat a condition associated with the disease state and whether the identified member is a new-to-therapy member or an experienced-therapy member;

determining, on the computer processor, a probability of adherence to a prescription drug based on the identification of the member, the member classification, and the disease state associated with the member; and

selecting, on the computer processor, an intervention from a plurality of interventions for the identified member based on the probability of adherence.

15. The method of claim 14, further comprising:

accessing clinical data associated with the identified member;

determining the identified member has received a past therapy to treat a condition associated with the disease state; and

adjusting the selected intervention in response to determining the identified member has received a past therapy.

16. The method of claim 14, further comprising:

selecting a diagnostic loop based on the disease state associated with the identified member and the member classification, wherein the diagnostic loop includes a plurality of operations; and

performing at least one of the plurality of operations of the diagnostic loop, wherein the plurality of operations includes transmitting therapy adherence information and a therapy adherence offer to the identified member,

wherein the therapy adherence information includes information to improve adherence of the member to a prescription drug and the therapy adherence offer includes an offer to improve adherence of the identified member to the prescription drug.

17. The method of claim 16, wherein performing the at least one of the plurality of operations of the diagnostic loop further comprises:

providing the selected intervention to the identified member,

wherein the selected intervention includes one or more of a postal mail message, an electronic mail message, a text message, a transfer from automated messaging to a personal representative, a refill pill box, an auto-refill of the prescription drug, and a late payment plan.

18. The method of claim 14, wherein the probability of adherence of the identified member to the prescription drug is based on the age of the identified member, the gender of the identified member, the disease state associated with the identified member, and the member classification of the identified member.

19. The method of claim 14, wherein determining the probability of adherence comprises:

determining a probability of therapy cessation based on demographic data of the

identified member and the disease state associated with the identified member;

determining a probability of therapy compliance based on demographic data of the identified member and the disease state associated with the identified member; and

calculating the probability of adherence of the identified member to the prescription drug based on the probability of therapy cessation and the probability of therapy compliance.

20. The method of claim 14, further comprising:

arranging a member health screening based on the determination of the intervention.

21. A system comprising:

a processor and a memory coupled to the processor;

a disease state identification module deployed in the memory and executed by the processor to identify a disease state associated with a member;

a member classification module deployed in the memory and executed by the processor to determine a member classification of the member, wherein the member classification is based on past therapy the member received to treat a condition associated with the disease state and whether the identified member is a new-to-therapy member or an experienced-therapy member;

a therapy selection module deployed in the memory and executed by the processor to select a diagnostic loop based on the disease state associated with the member and the member classification, wherein the diagnostic loop includes a plurality of operations; and

a therapy outreach module deployed in the memory and executed by the processor to perform at least one of the plurality of operations of the diagnostic loop.

22. A non-transitory machine-readable medium comprising instructions, which when executed by one or more processors, cause the one or more processors to perform the following operations:

identifying, on a computer processor, a disease state associated with a member;

determining, on the computer processor, a member classification of the member, wherein the member classification is based on past therapy the member received to treat a condition associated with the disease state and whether the identified member is a new-to-therapy member or an experienced-therapy member;

selecting, on the computer processor, a diagnostic loop based on the disease state

associated with the member and the member classification, wherein the diagnostic loop includes a plurality of operations; and

performing, on the computer processor, at least one of the plurality of operations of the diagnostic loop.

23. The medium of claim 22, further comprising:

accessing clinical data associated with the identified member;

determining the identified member has received a past therapy to treat a condition associated with the disease state;

adjusting the selected intervention in response to determining the identified member has received a past therapy;

selecting a diagnostic loop based on the disease state associated with the identified member and the member classification, wherein the diagnostic loop includes a plurality of operations; and

performing at least one of the plurality of operations of the diagnostic loop, wherein the plurality of operations includes transmitting therapy adherence information and a therapy adherence offer to the identified member,

wherein the therapy adherence information includes information to improve adherence of the member to a prescription drug and the therapy adherence offer includes an offer to improve adherence of the identified member to the prescription drug.

24. The medium of claim 23, wherein performing the at least one of the plurality of operations of the diagnostic loop further comprises:

providing the selected intervention to the identified member,

wherein the selected intervention includes one or more of a postal mail message, an electronic mail message, a text message, a transfer from automated messaging to a personal representative, a refill pill box, an auto-refill of the prescription drug, and a late payment plan.

25. The medium of claim 22, wherein performing the at least one of the plurality of operations of the diagnostic loop includes determining a probability of adherence of the identified member to the prescription drug is based on the age of the identified member, the gender of the identified member, the disease state associated with the identified member, and the member classification of the identified member.

26. The medium of claim 22, wherein performing the at least one of the plurality of operations of the diagnostic loop includes comprises:

determining a probability of therapy cessation based on demographic data of the identified member and the disease state associated with the identified member;

determining a probability of therapy compliance based on demographic data of the identified member and the disease state associated with the identified member; and

calculating the probability of adherence of the identified member to the prescription drug based on the probability of therapy cessation and the probability of therapy compliance.