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The use of data and analytics is helping to define the future of pharmacy care services. Drawing on vast and deep data sets, OptumRx is using cutting-edge analytics to better understand the most challenging problems in healthcare. We sat down with OptumRx VP and Chief Analytics Officer Andrea Marks to get her thoughts about how to transform data into insight, insight into action and action into results.

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Creating Connections Through Data


ANDREA MARKS: We're not sitting back


and watching the healthcare

system fall apart,


we're actually shaping

what the healthcare system


is going to be in the

future, and that's exciting.


Data in and of itself is

not going to be useful,


you need to be able to take

data and turn it into action.


And we at OptumRx, are really focused


around mining the data and

putting it into action.


We have predictive models

that are put in place


to be able to identify

who needs the right type


of intervention at the right time.


All of our algorithms are built not only


within pharmacy data,

we incorporate a number


of different types of data sources


to be able to get to the right outcome.


The data we have access

to at OptumRx comprises


over 250 million lives and 20

years of longitudinal data.


But also a deep set of clinical

data, information from EMRs,


information from lab results,

behavioral health information


to really provide us with

a very comprehensive set


of information that we can mine.


Synchronization is critically

important to our clients


as well as to our members.


It provides them a single

touchpoint to be able


to engage members at the time


that they are also engaging with us.


When a member calls in and

we have the opportunity


to be able to talk to them

at that point in time,


we wanna make sure that

we've presented all


of the the opportunities that

we have for that individual


so that we can coach them through things,


connect them to the right pieces,


connect them to the

right parts of healthcare


so that we can affect the

overall outcome of that patient.


Success for our clients

is really no surprises.


They wanna make sure that they understand


what happened in the past,

what's happening now,


but then also what's gonna

happen in the future.


We can partner with them to

be able to identify new ways


so that we can actually change

the course of the future.


  1. How would you describe your role at OptumRx?

    At OptumRx, I am accountable for demonstrating the value of our products and services, and helping our clients understand the opportunities for cost and clinical outcomes through data insights. I’m focused on outcomes and using data in novel ways to drive positive changes enabling improvements in health for the members we serve.

  2. Why are data and analytics important to pharmacy care services?

    Healthcare is changing dramatically – and pharmacy more rapidly than other areas. We have new drugs being introduced every year that have the ability to have a profound impact on people’s lives. People who couldn’t be treated before now have access to new medications that can help them to live better lives. And as a result, many are achieving better outcomes.

    But often, those advances come at a cost. Many new drugs are coming onto the market anywhere from $20,000 to over $100,000 per year for one person’s treatment. We use data and analytics to develop solutions to help our clients manage some of those costs, and we also use data and analytics to ensure the members are taking their medications as intended to get the best clinical outcome possible.

  3. What makes Optum’s approach to data and analytics unique?

    Optum’s data is vast and deep. Now, others can say that they also have a lot of data. But we are taking data and analytics to a completely new level of scope and scale. We have collected data covering over 250 million covered lives in our overall repository. That’s spread out among claims data and clinical data over 20 years of longitudinal experience, coupled with other ancillary data sources that enrich our insights. It’s one of the largest data sets in the market place today that is curated to solve healthcare’s biggest problems.

    But data in and of itself isn’t enough. Here at Optum, we put our data to work. We do that by creating the connections within and among all of the data that lets us identify new patterns, build out predictive models and machine learning, and use these to gain new insights into what does and does not work in healthcare. We have over 130 billion rules and algorithms that we apply on the data with application well beyond just pharmacy. We have the capability to integrate all of the different data types and data sources –medical, pharmacy, and lab. This means we can impact cost and clinical outcomes at the client level, but also down to the individual person and transaction detail.

  4. How do you make sure the outcome of your modeling is relevant to a specific client?
    You have to dig deeply into their data. Insights do not come from merely evaluating trend or spend. You have to get very personal with the data. What are the nuances? How is the data behaving, and what stories is it trying to tell? Where are those opportunities to be able to tweak their benefit? You have to go into each individual drug, and drug category and look at the interrelationships of the data, as well as dig into the population itself to be able to understand what’s driving the changes or differences in that particular population. No two clients are exactly alike – and the data will tell you how.

    It’s also extremely important to present information to a client in a meaningful way. We’re the data whisperers. Ultimately, we translate the client’s data and tell them a story about who they are and what is actually going on within their population. As they see the data story unfold, the opportunities for making changes or adopting new strategies become apparent.

  5. Once you have conveyed this information to clients, are you able to measure real-world impact?

    Our work isn’t done as soon as we’ve delivered our analytic insights and recommendations. Once the client’s new strategies are in place, we’re ready to mine for outcomes. We’re really focused on figuring out what works in healthcare which requires building the outcomes and learnings that can be fed back into the date inputs.

    We call this an analytic learning system. It’s ever-changing, and it represents how the real world works. The real world is constantly changing, so is the data, and then the resultant strategies need to change as well. Beyond that, it’s evaluating all of our strategies in a real world setting. Whether it’s understanding the total health outcomes of a new drug that came to market, or the long term impact of a utilization management strategy, we have the power to understand what works, and bring the best strategies to our clients by looking at the total healthcare picture.

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