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How Express Scripts Uses Analytics To Improve Patient Outcomes, article in Forbes

Big data, process automation, multidisciplinary R&D: Gary Wimberly, the CIO of this $94 billion enterprise,  thinks of the company as a technology firm that happens to be active in the pharmacy benefit management (PBM) space.

by Peter High, published on Forbes.com

07/29/2013

I recently had the opportunity to tour Express Scripts Technology and Innovation Center in St. Louis. Express Scripts is a $94 billion pharmacy benefit management company (PBM), and as the company’s chief information officer, Gary Wimberly, likes to point out, it is a technology business that happens to be focused on the PBM space. The tour reflected that statement, as I had a chance to observe two key components of the company’s Technology and Innovation Center.

At the Express Scripts Pharmacy, one is struck not only be the size of the operation, but the relatively few people who are involved in fulfilling prescriptions. Computers and machines sort drugs into vials, label them, and pack them seamlessly. As Wimberly notes below, the Express Scripts Pharmacy is substantially more efficient and accurate in that fulfillment than traditional pharmaceutical retailers.

In the Research & New Solutions Lab, one witnesses a digital war room of sorts, as a diverse team drawing upon various scientific and business disciplines collaborates to help optimize patient care while reducing costs at the same time. Their insights ensure that this healthcare behemoth can still turn on a dime.

(This is a condensed and edited version of a Forum on World Class IT interview I conducted with Gary. To listen to it, please click on this link.)

Peter High: Gary, let’s start with a bit of background on Express Scripts, and IT’s role in the operation.

Gary Wimberly: Peter, we are a business-to-business company, and we manage the prescription spend for over 100 million Americans. The typical prescription fulfillment process is for customers to visit a pharmacy. In many cases, the pharmacy sends Express Scripts an electronic transaction, and we do 150 safety and eligibility checks on the transaction. Information is sent back to the pharmacy so that the pharmacist knows whether the patient will have an issue with a drug interaction, whether it is OK to fill the prescription ,and what the cost will be, and how much will be reimbursed for that transaction. That is done in about 0.6 seconds between eight and ten million times per day or about 1.4 billion times per year.

To do this, we have to focus on healthcare more generally. We think about behavioral sciences, focusing on actionable data, and how we focus on being able to manage the prescription spend.  Technology is integral to this business. I like to say that we are a technology business that happens to focus on the PBM space.

Additional topics covered in the article include:

  • A significant part of your team’s mandate centers on innovation. What are some examples of IT-led innovation at Express Scripts?
  • I know that data analytics is another area of focus for your team and you. Can you describe your approach to this and to big data more generally?
  • Express Scripts has also developed its own high volume filler pharmacy. For those of us who are used to going into our local pharmacy to fill a prescription, the Express Scripts version of a pharmacy is quite different. I was particularly struck by the relatively low number of people it takes to run and oversee the operation. Can you describe it?
  • Your Research & New Solutions Lab has been critical in hatching the innovations you’ve described. How does the company staff the lab?

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 To listen to a recent Forum on World Class IT podcast interview with Gary, click here.

 

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