Rx Care Nexus is a data-driven, pharmacist-led pharmacy care program we offer at CarelonRx. With this program, we leverage pharmacy, medical, and lab data to proactively improve your plan members' health outcomes. Our solution provides personalized care through pharmacist outreach, addressing care gaps with targeted interventions for those who need it most, and helping to reduce healthcare costs and improve outcomes overall.
Proactive care management
With Rx Care Nexus, we continually scan and analyze data to identify potential health risks and care gaps before they escalate. Our Clinical Rules Engine (CRE) comes into play here, as it helps identify and flag members with health risks and barriers to care across several chronic conditions.
This early detection means we can intervene promptly, preventing costly medical events and ensuring high-quality care for plan members. In fact, our CRE generates about 7 million pharmacy care gap alerts annually, and we have successfully closed 36% of these care gaps.1
Personalized outreach
Through personalized interactions and a choice of various digital touchpoints – direct mail, phone calls, text messages, and live chats – our CarelonRx pharmacists engage with your members directly. This encourages adherence to treatment plans and allows us to recommend the most effective therapies. By taking this individualized and proactive approach, we meet members where they are to help ensure they have the medications they need, and to offer the support they need to stick with them.
Improved medication adherence
We focus on enhancing medication adherence by providing your members with reminders and educational materials. For example, after an emergency room visit due to unstable blood sugar, one of our clinical pharmacists might reach out to discuss the importance of adhering to metformin and coordinating with their care providers. This level of personalized care helps maintain consistency with prescribed therapies and can directly influence better health outcomes for plan members.
Cost optimization
By leveraging our deep data insights, Rx Care Nexus identifies cost-saving opportunities, such as the use of generic medications and formulary alternatives, and connects pharmacy care with medical treatments. This approach not only promotes clinical safety and efficacy, but also optimizes overall healthcare spending. In fact, for members in plans with Rx Care Nexus, we have documented medical cost avoidance at $2.50 per member per month (PMPM).2 These measures collectively help you manage costs while prioritizing safe and effective care for your members.
Integrated support for chronic conditions
Rx Care Nexus is particularly beneficial for managing chronic conditions like diabetes, hypertension, and behavioral health disorders. We offer structured support that aligns with comprehensive treatment plans to ensure connected, quality care. For instance, our program can flag members with diabetes and hypertension who are not on ACE inhibitors and engage both the members and their physicians to improve their treatment plans effectively.
Fostering whole health with smart systems
Using the nation’s largest data ecosystem, we focus on greater member advocacy and better health outcomes while driving lower total healthcare costs for your plan. Our program emphasizes early risk identification to address care gaps proactively. This is supported by cutting-edge technology, allowing seamless integration with broader advocacy solutions that may be available to the health plan.3 This integrated approach provides a comprehensive view of a member’s whole health, fostering deeper clinical integration and enhanced member experiences.
1. CarelonRx Internal data, CY 2023.
2. CarelonRx Internal data, CY 2023, 2020–2021.
3. Contact your CarelonRx representative to learn which integrated programs are available to your plan.
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