Horizon Healthcare Using Near-Real-Time Analytics to Identify High-Risk Members for Targeted Interventions

June 7, 2019
Partner Aetion’s platform uses predictive modeling, machine learning

Horizon Healthcare Services Inc., New Jersey’s largest health insurer, is leveraging near real-time data analytics to identify high-risk members and implement targeted formulary and drug adherence interventions to improve outcomes.

Partnering with healthcare technology company Aetion, Horizon is using medical and pharmacy claims data to optimize treatment pathways across nine therapeutic areas. The evidence they generate will support case management interventions and the development of value-based agreements with pharmaceutical companies for specific patient populations.

Building on an initial study performed in 2018, Horizon is beginning an initial intervention program targeting 1,500 members with type 2 diabetes, which it estimates will yield $5 million in savings per year, as it extends the approach to additional therapeutic areas. 

Aetion’s platform combines data from claims, electronic medical records, patient-reported outcomes, patient registries and other sources. In the initial study, Aetion analyzed Horizon’s population with type 2 diabetes, developing a predictive model that identified which patients, at the member level, were most likely to have increased utilization over the following year. By analyzing medical and pharmacy claims data together and applying machine learning, Aetion determined the optimal treatment pathway for this high-risk cohort.

The recommended interventions included adherence programs and conversion to SGLT2 inhibitors as a second-line therapy — which proved most effective for this cohort, despite being more expensive than other second-line drug classes. Horizon is now implementing pharmacy case management interventions and engaging with pharmaceutical companies on opportunities to structure value-based agreements for their high-risk members living with type 2 diabetes.

“Aetion’s rapid turnaround time is critical, as is the fact that these analyses are based on our membership,” said Saira Jan, M.S., PharmD, director of pharmacy strategy and clinical integration at Horizon and professor at Rutgers University’s Ernest Mario School of Pharmacy, in a statement. “This enables us to quickly engage with providers and health systems to improve outcomes for our specific patient populations.”

Horizon and Aetion will now analyze additional therapeutic areas over the next two years, including for inflammatory bowel disease, immunologic diseases, COPD and asthma. 

Earlier in 2019, Horizon became an  investor in Aetion, joining the company’s series B funding round. Based in New York City, Aetion is backed by investors including New Enterprise Associates, Flare Capital Partners, Lakestar, Town Hall Ventures, McKesson Ventures, Sanofi Ventures, Amgen Ventures, UCB, and Horizon Health Services.