MANAGED CARE RISK

Because prescribers are the primary source of prescription drugs in a managed care network, any efforts to reduce prescription drug abuse must begin with them, and must identify, engage, and monitor prescribers. The PSI Score™ model in the Managed Care Network risk solution delivers a composite score that includes the following elements of risk:

 

  • For a specific prescriber

  • For all patients being treated by a prescriber

  • For all pharmacies at which treated patients present a prescription

  • For all other prescribers treating the same patients

IDENTIFY those whose prescribing behaviors may contribute to prescription drug misuse, abuse, addiction, and diversion and stratify them by risk severity using the PSI Score™ model.

  • PSI Score™ is a composite measure of risk

  • Calculated using a weighted combination of multiple risk factors

  • Scores computed monthly using automated data feeds

  • Identify demographic and geographic trends

  • Analyze changes in prescribing behavior over time

ENGAGE prescribers in an educational program designed to improve appropriate prescription drug prescribing.

  • Designed to effectively engage and educate each prescriber

  • Presents risk-class appropriate strategies to minimize abuse

  • Promotes appropriate prescribing and patient safety

  • Uses a Social Learning theory framework

  • Customized 1:1 interaction with each prescriber

  • Optimizes responsiveness and behavior change

MONITOR prescribing patterns to detect changes in behavior
and measure the effectiveness of the intervention program.

  • Measures prescriber behavior change over time

  • Feedback loop to improve intervention services effectiveness

  • Identifies prescribers who refuse to engage in the program

  • Identifies prescribers who are unresponsive to the program​

  • Triages resistant prescribers to other risk management functions