Express Scripts, Inc.

Express Scripts Strategic Development, Inc.

Robert F Nease

David Alfredo Tomala

Katherine Harini Sundararaman

Seda Aydin Follis

Dhanur S Balagere

Reethi N Iyengar

Steven B Miller

Heather D Sundar

Sharon Glave Frazee

Tina L Bauman

Krista Lynn Theby

Tina Lynn Bauman Butcher

John T Reid

Tina L Bauman Butcher

Barrett Toan

Methods and systems for pharmacy modeling are described. The risk adjusted pharmacy predictive model is created from member data, claims data, and population data. This model can be used to compare the actual pharmacy performance to an expected actual pharmacy performance value, which can be used to identify pharmacies at risk or not performing to an acceptable level. The model can be used for adherence and generic drug utilization ratings of pharmacies. The pharmacy can be judged on a therapy class by therapy class basis with factors that reflect the demographic, socio-economic, location, benefits attributes, etc. that actually affect the performance of the pharmacy and may assist in determining the quality of care by a pharmacy.

Methods and systems for pharmacy modeling

Methods and systems for determining drug trend and drug inflation are described. In one embodiment, an index sample may be selected including an identification of a plurality of drugs. A weighting factor associated with each of the plurality of drugs in the index sample may be calculated. A first weighted price of for the plurality of drugs may be calculated for a first time period. A second weighted price for the plurality of drugs may be calculated for a second time period. A price index may be calculated for the second time period based on the first weighted price and the second weighted price. Other methods and systems are described.

Methods and systems for determining drug trend and drug inflation

Weight loss methods and systems are described. In one embodiment, behavior modification program data indicating participation in a weight loss behavior modification program is recorded. Drug therapy program data indicating drug fulfillment of a weight loss drug therapy program drug is recorded, in which the drug fulfillment of the weight loss drug therapy program drug occurs after participation in the weight loss behavior modification program. Whether a weight loss surgical program criterion has been met is determined based on analysis of the behavior modification program data and the drug therapy program data. The weight loss surgical program criterion is based on the participation in the weight loss behavior modification program and the drug fulfillment of the weight loss drug therapy program drug. A surgical weight loss program approval is generated based on a determination that the surgical weight loss program criterion has been met. Additional methods and systems are disclosed.

Weight loss systems and methods

A system and method for improving adherence to therapy programs, in particular to adherence to medication therapy and/or to healthcare therapy, that includes medication therapy. Methods of the present invention may also be used to improve compliance with and/or adherence to other wellness and/or health care programs. Methods and systems of the invention may include methods of identifying patients who are at risk of non-adherence, non-compliance, or likelihood of cessation with a therapy program, predicting a basis for such noncompliance, and targeting interventions directed to patients who have been identified as likely to be non-compliant, wherein interventions take into consideration the predicted basis for noncompliance.

Methods and systems for improving therapy adherence

Methods and systems for improving therapy adherence are described. In an embodiment, a disease state associated with a member is identified. A member classification of the member is determined. The member classification may be based on past therapy the member received to treat a condition associated with the disease state. A diagnostic loop is selected based on the disease state associated with the member and the member classification. The diagnostic loop may include a plurality of operations. At least one of the plurality of operations of the diagnostic loop is performed. Other methods and systems are described.

Methods and systems for member messaging

Methods and systems for scheduling wellness based meetings are described. In one embodiment, meeting data associated with a meeting is accessed. A meeting type designation is received. The meeting type designation designates the meeting as a walking meeting, a standing meeting, or a sitting meeting. Updated meeting data based on the meeting data and the meeting type designation is stored. Other methods and systems are described.

Methods and systems for scheduling activity level based meetings

A computer-based system and method to enable a benefit plan sponsor to design benefit plans for a given participant population by enabling the plan designer to select the plan design options that maximize the perceived benefit to the participant population subject to a cost constraint. The system prioritizes plan design options of such plans according to the costs of these options and the perceived benefits of these options for the participant population. Estimates of perceived benefit are based upon survey data from a sample of the given population or from historical survey data from population samples exhibiting analogous demographic characteristics to the given participant population regarding potential plan design options or analogous benefit plan design options.

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St. Louis, MO, United States of America

Robert F Nease