Overall lower hospitalizations rate
Overall lower rate emergency depart visits
Less in medical costs PMPY1 on average
Integrating medical and prescription drug benefits provides a single point of contact for medical and prescription services, enhancing the value of efficiency and service, and providing:
- Better coordination of the customer experience and issue resolution
- A focused team approach, including clinical and analytic expertise
- Insights and recommendations to help improve plan performance
- More efficient data integration to meet health care reform requirements on combined accumulators
Members, specifically, have:
- A single point of contact for 24/7 customer service
- Enhanced clinical resources to help manage medical conditions
- One-on-one medication consultation for members with complex needs
- Access to a pharmacy network of both retail and local pharmacies
Members benefit from coordinated care between pharmacy, disease/case management staff, and other Capital Blue Cross teams.
Having real-time pharmacy data aligned with health claims data, our case managers can tailor their approach to assisting individuals. And, with insight into pharmacy history, Capital Blue Cross has the greatest opportunity to identify risk for specific conditions, allowing for early intervention and engagement. Pharmacy data may be the earliest trigger of a diagnosis, such as when a claim for oral diabetes medication precedes a medical claim with a diabetes diagnosis. Without pharmacy data, our ability to impact health is delayed, such as when a member is non-compliant with asthma medication, but medical claims do not signal the need for intervention.
Timely use of information can reduce adverse drug interactions, prompts earlier referrals for coordinated care of complex cases, and avoids gaps in care.
A pharmacy specialty team identifies members for medication counseling and education, further helping to ensure appropriate drug therapy and adherence.
Want to know what pharmacy coverage could look like for your clients?
Contact your Capital Blue Cross sales representative.