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Horizon Healthcare Services, Inc., Partners with Aetion to Improve Treatment Pathways Using Predictive Modeling and ML

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Using Rapid-Cycle Analytics™ to Identify High-Risk Members and Targeted Interventions, Partnership Anticipates Improved Outcomes for Patients

Aetion announced a partnership with Horizon Healthcare Services, Inc. (Horizon), New Jersey’s largest health insurer, to use 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.

The partners are leveraging near real-time data analytics to identify high-risk members and implement targeted formulary and drug adherence interventions to improve outcomes, building on an initial study performed in 2018 that will now extend to additional therapeutic areas. Horizon is embarking on an initial intervention program targeting 1,500 members with type 2 diabetes, which it estimates will yield better quality for members, and result in $5M in savings per year.

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“Horizon is dedicated to innovative partnerships that tap into the power of our data to help our members achieve their best health,” says William D. Georges, senior vice president and chief strategy officer at Horizon. “We started with a diabetes treatment pathway identified by Aetion and the success of that initiative has laid the groundwork to expand our partnership to new solutions that will improve care for even more patients.”

Aetion offers a technology platform that delivers the real-world evidence needed for biopharma and payers to engage in value-based care. Real-world evidence is generated from health data routinely collected outside of a controlled setting from insurance 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 to identify high-risk members. By analyzing medical and pharmacy claims data together and applying machine learning, Aetion determined the optimal treatment pathway for this cohort.

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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 turn-around time is critical, as is the fact that these analyses are based on our membership,” said Saira Jan, MS, PharmD, director of pharmacy strategy and clinical integration at Horizon and professor at Rutgers University’sErnest Mario School of Pharmacy. “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, Crohn’s disease, immunologic diseases, COPD, asthma, and hemophilia.

“This partnership has already produced insights that simultaneously improve outcomes and upend conventional wisdom around which interventions work best for which patients,” said Carolyn Magill, CEO of Aetion. “This gets at the essence of value-based care, illustrating the power of real-world evidence to transform how we think about treatment pathways.”

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