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UnitedHealthcare Pharmacy

Faster engagement to help close gaps in care

Our clinical synchronization goes far beyond the industry standard of a monthly data feed. At the heart of the system lies the eSync platform which receives a daily feed of claims data that synchronizes with dozens of clinical and coverage programs – we can engage members earlier to influence decisions, avoid health risks and lower costs.

Through eSync, our Optum nurses have visibility into a member's complete health care picture and can identify gaps in care, safety concerns, or lack of compliance with treatment plans – and take action with the member. The eSync platform constantly scans for health and savings opportunities.

68% of of eSync health and saving opportunities are driven by pharmacy


1. Better, Faster Information

Daily feeds from lab, clinic, pharmacy provide comprehensive member view.

Daily feeds from lab, clinic, pharmacy provide comprehensive member view. »

2. Proactive Identification

One platform constantly scans for all health and savings opportunities. Daily synchronized pharmacy is critical since 68% of all health and savings opportunities are driven by pharmacy.

One platform constantly scans for all health and savings opportunities. »

3. Faster Engagement

Utilizing daily pharmacy data as an early warning system, our sophisticated analytics generate alerts for one care team of:

Utilizing daily pharmacy data as an early warning system, our sophisticated analytics generate alerts for one care team of: »

How it works:

Roger: Heart Attack

Roger is home recovering from a heart attack. In a routine welcome home call, the nurse immediately identifies an opportunity. The nurse sees a prescription for a tier 3 drug to lower blood pressure – however there is no prescription for a beta-blocker which is often used after experiencing a heart attack to prevent additional heart attacks and even death.

The nurse consults with a pharmacist who reviews Roger's prescription history as well as his prescription drug list. A pharmacist intervention at this point can help avoid events which could result in emergency room visits and increased chance of hospitalization. At best, with typical carve-out PBMs, this may not be picked up for over 30 days – clearly a safety issue.

In addition, the nurse or pharmacist can educate Roger about lower cost alternatives to Diovan that can cut the member's copay in half.

Cheryl: High Cholesterol

High cholesterol runs in Cheryl's family. This year, during her annual exam, Cheryl's doctor wrote her a prescription for simvastatin. Because Optum nurses can immediately see when a member is prescribed a cholesterol lowering statin, the nurse followed up with Cheryl to address potentially dangerous drug interactions as well as drug food interactions.

For example, Cheryl was not aware that drinking grapefruit juice or eating grapefruit while on certain statin medications may lead to toxic blood levels of the statin. This can lead to serious adverse events such as liver problems, leg cramps and muscle breakdown which may lead to emergency room visits if not addressed early.

The nurse's timely follow up helped to prevent a potentially dangerous drug/food interaction.

Benita: Asthma

Most of the time Benita's asthma is a minor nuisance – but there are occasions when it interferes with her daily life. For people like Benita, it is common to be prescribed both a long-acting (maintenance) inhaler and rescue inhalers for short-term strenuous activity.

If a rescue inhaler script is not filled – so Benita has one on hand for emergencies – a nurse can immediately engage to get her on the right course of therapy.

This can help avoid 911 calls and emergency room visits associated with severe asthmatic episodes. Without our integrated system, this prescription gap may not be noticed for at least 30 days – which could be a potentially dangerous situation for Benita.