CarelonRx’s digital solutions improve member and provider experiences

Digital solutions and tools have the power to make whole health easier to achieve for members and providers. As its case studies demonstrate, Carelon business CarelonRx is relying on digital innovation to close care gaps, improve medication adherence, and reduce costs.

Healthcare is a team effort. It is common for a person to see many doctors, especially when they are sick or manage a disease that affects more than one part of their body. To help our members get the best care, CarelonRx is investing in digital solutions. Our innovative tools can strengthen connections between members, doctors, and pharmacists at key points in the healthcare journey, such as:

  • Visits to doctors and pharmacies
  • Communication between pharmacists and CarelonRx
  • Meaningful data collection, to create personalized experiences
Closing gaps in care

The growing presence of technology in our lives has not perfected access to healthcare; people still experience gaps. Communication between doctors is not standardized, and they may use different electronic medical record (EMR) systems. Once a drug is prescribed, there can be many reasons why a member may miss doses or refills.

With reliable access to clear information, doctors can better address barriers to care. CarelonRx encourages bidirectional information that can be shared between a member, doctor, pharmacy benefit manager, and health plan. Our EMR-enhancing solutions allow doctors to view pharmacy insights in the exam room. With bidirectional capability, doctors can view care gaps in their EMR system. They can do real-time pharmacy benefit checks to make sure the drug they want to prescribe is available, affordable, and effective for the member. If a drug is not the best fit, CarelonRx may recommend another option, such as a generic that works equally well. Doctors can send e-prescriptions and, in many cases, get instant electronic preapproval. This all happens before a member leaves the doctor’s office.

Once a prescription is filled, member-facing digital tools can help make sure the member takes their drug. Members who qualify may log in to a member website or app to set reminders, price drugs, or ask to change where and when they refill prescriptions. Certain members can also chat live with CarelonRx pharmacy care specialists about specialty drugs, home delivery, or general pharmacy issues.1

For members who are less comfortable with technology, machine learning and artificial intelligence can still improve experiences. Using lab, medical, and pharmacy claims data, we can identify when members’ behaviors may put their health at risk. Using each member’s communication preference, CarelonRx can reach out when they don’t take their medicine, miss refills, or overuse prescription drugs.

Reducing drug costs and utilization

CarelonRx case study 1: 2

  • Large, value-based care company started a program to lower use of high-cost drugs while maintaining health outcomes.
  • Engaged CarelonRx pharmacists and used our digital tools.
  • 33% decrease in high-cost drug use.

CarelonRx case study 2: 3

  • Large, multispecialty health system in the Los Angeles area started a program to lower use of high-cost drugs.
    • Provided materials to high-volume doctors to educate them on other options to highlight value and drive conversations.
    • 33% decrease in high-cost drug use, 42% decrease in drug costs.

CarelonRx 2020 medication review: 4

  • 34.9% care gaps closed.
  • 40.5% of members are more compliant with medications (any level of improvement).
  • $0.68 per member per month (PMPM) pharmacy savings.
  • $2.11 PMPM medical costs offset.

CarelonRx uses meaningful data to create personalized pharmacy care. While terms like “machine learning” and “artificial intelligence” can sound lofty, our goal is simple: using our ingenuity to improve the health of humanity. When members, doctors, pharmacists, and health plans can easily work together, our goal feels closer than ever.

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  1. Individual member portal and app features are subject to availability and may change over time.
  2. CarelonRx case study, Nevada, 2020.
  3. CarelonRx case study, California, 2020–2021.
  4. CarelonRx 2020 clinical and cost-of-care programs data for Enterprise and Commercial exchange business.

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We’re here to help you learn more about Carelon.