Population Health Pharmacy: Using Claims Data to Find the 5% Driving 50% of Spend
- 0:00 Why The 5% Matters
- 8:00 Claims Data You Need
- 18:00 Separating Signal From Noise
Practical shifts you can apply this week
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Identify Persistent High-Cost Members
Spot which members are likely to stay costly versus those tied to a one-off shock claim.
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Compare Segmentation Methods
See which ranking approaches best surface spend, risk, and intervention opportunity.
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Evaluate Data Quality Limits
Catch linkage gaps, benefit blind spots, and other issues before they skew your list.
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Design A Targeting Approach
Build a practical framework that blends spend concentration, risk, and modifiable drivers.
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Draft A Simple Measurement Plan
Leave with a clean way to track cost, utilization, and member outcomes without fooling yourself.
What we'll cover
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0:00
Why The 5% Matters
A quick reality check on spend concentration, persistent cost, and why averages send teams astray.
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8:00
Claims Data You Need
The fields, linkages, and benefit context that make ordinary claims data useful.
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18:00
Separating Signal From Noise
How to tell chronic patterns from shock claims, benefit artifacts, and random spikes.
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27:00
Segmentation That Drives Action
Compare ranking methods across spend, clinical severity, trajectory, and modifiability.
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39:00
Intervention Priorities By Cohort
Match the right action to the right members, from adherence outreach to specialty management.
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49:00
Measuring Value Credibly
Build a business case with baselines, comparison groups, and outcome measures that hold up.
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56:00
90-Day Plan And Q&A
Recap the framework, outline first steps, and leave time for audience questions.
Questions people ask before registering
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It is built for working professionals in pharmacy, population health, analytics, managed care, and benefits strategy. If you work with claims data or intervention design, it will feel practical.
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No. We will use plain language and concrete examples. Familiarity with claims data helps, but you do not need to be a data scientist to apply the framework.
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Yes. Registered attendees will receive the replay after the session, so you can revisit the examples or share them with colleagues.
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No. Specialty is part of the story, but we will also cover adherence failures, therapy churn, polypharmacy, and cohorts where lower drug spend hides higher avoidable cost.
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Yes. The session ends with a simple 90-day operating plan: one population, one claims extract, and one intervention hypothesis. Small enough to start. Useful enough to matter.