Okla. Medicaid program is using AI to take on medication optimization

Oklahoma’s Medicaid program plans to use data analysis and artificial intelligence to monitor medication use and improve outcomes for its high-risk, high-cost members.

The Medicaid program, called SoonerCare, and Insure Oklahoma, which assists qualifying adults and small business employees in obtaining healthcare coverage for themselves and their families, have announced they are partnering with Arine, a healthcare technology company that combines data science with clinical expertise to ensure that patients are on the safest and most effective medications for their conditions.

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The program involves using Arine’s Virtual Pharmacist, a platform that aggregates and analyzes clinical and behavioral data to identify gaps in patient care, then uses AI to address and resolve them, according to the Oklahoma Health Care Authority (OHCA), administrator of SoonerCare and Insure Oklahoma.

The new medication optimization program will focus on the members with the highest risk from among the 814,606 Oklahomans enrolled in SoonerCare and Insure Oklahoma. OHCA’s move to include Arine’s medication management technology platform follows a pilot of the Virtual Pharmacist conducted this year in Oklahoma and Tulsa counties.

For the pilot, OHCA enrolled SoonerCare members with chronic conditions such as diabetes, cardiovascular disease, respiratory conditions and serious mental illness. Enrollees received personalized medication counseling, access improvement and treatment optimization services from clinical pharmacists, using Arine's Virtual Pharmacist platform. Arine worked closely with the members' care teams to ensure care plan changes were implemented, leading to improved quality of care and reduced costs, OHCA says.

Interim results from the demonstration project showed a 40 percent reduction in hospitalizations. It also revealed that primary care providers and specialists implemented 92 percent of suggested care plan changes generated by the Virtual Pharmacist; 94 percent of SoonerCare participants were willing to recommend the program to a friend.

"Arine has demonstrated a commitment to the citizens of Oklahoma by providing valuable drug-related services to the individuals we serve,” says OHCA CEO Kevin Corbett. “This program is an excellent example of leveraging technology to improve services to our SoonerCare members while controlling costs."

Jamie Billingsley from My Family Clinic, an Oklahoma City clinic that provides care to SoonerCare members, says Arine’s Virtual Pharmacist program provides value. “Some of our patients have personal issues that prohibit them from good medication management,” he says. “They find themselves mixing up medications with similar names, having their medications duplicated by their providers, and sometimes even stopping their medications just because they are unsure if they are supposed to be taking them.

“Arine plays the important role of 'medication overseer,' tracking our patients' prescriptions and alerting us when the patient may not be adhering to their prescribed medications or advising us on other medications available which may improve their overall health," Billingsley says.

According to Yoona Kim, co-founder and CEO of Arine, the AI company was able to demonstrate that Arine’s scalable, technology-enabled approach can deliver significant results. Results of the pilot contributed to OHCA's expeditious decision to expand the program. “We look forward to continuing to work in collaboration with existing services and providers in Oklahoma to improve the health of members, fulfilling our mission to reinvent medication management," she says.

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