WHITE PAPER

Patient and member identity

intelligence: A healthy dose
of identity data, analytics and
security for pharmacy
MAY 2018
 In healthcare today, it’s not just who you know, it’s what you know about them.
Identity matters, and identity intelligence is at the center of it all—providing
pharmacy with insights required to protect health data, optimize health outcomes
and patient safety, minimize costs and, in general, manage all the covered lives
that are part of the healthcare system. Along with pharmacy and medical data,
socioeconomic and demographic details about patients and members are the
building blocks of identity intelligence, and ongoing access to updated data is
critical to success in pharmacy.

As a Pharmacy Benefit Manager (PBM), specialty pharmacy or

retail pharmacy:
• Do you know your patients and members? Are you able to verify they are
who they claim to be every time there is a transaction?

• Are you confident you can match all your prescription and other records
back to the right patient every time? Do you have a sophisticated system
for assigning a universal patient identifier?

Identity checks are the first step to success. The next step is
elevating identity management to identity intelligence.
• Are you able to support your patients throughout the changes in their
lives? Do you have all their latest contact information, such as after
a move?

• Do you understand their social determinants of health and how they can
impact their adherence and other health outcomes?

A comprehensive, integrated approach to managing patient and member identities

is critical to successfully executing pharmacy’s central role in healthcare. Pharmacy
organizations must integrate new patients and members, minimize exposure to
identity-related risks and improve health outcomes by managing compliance. To do
so, pharmacy must strive for identity intelligence by leveraging data from traditional
and brand‑new sources and turning that data into actionable information with
precision analytics.

A healthy dose of identity data, analytics and security for pharmacy 1

Increasing demand for
medication and expansion into
services offers opportunities
“ Today’s pharmacies
are offering expanded
healthcare services and
This is an era of the kind of
chaos-creating structural change
are ideal locations to
in healthcare that propels some raise disease awareness
organizations to the top—the ones
that manage the challenges and turn
and deliver educational
them to their advantage—and sends information. They are
others scrambling for solutions. The
pace of pharmaceutical discovery becoming destinations
keeps increasing and there are for consumers seeking

”
more drugs available to treat more
conditions than ever before. In healthcare solutions.
addition, the consumer market
for pharmaceuticals continues to
grow; the more people who have
health insurance, the more who
will have affordable access to
prescription medication.

Medication is only part of the picture because services are now provided at
pharmacies that have a greater impact than ever on overall health. Customized daily
medication packaging, wellness programs, 24-hour live chat programs, a wider range
of immunizations and injections, onsite clinics, self-tracking kiosks and integration
of self-tracking devices for activity level, blood pressure, weight and body mass
index are just some of the items on the growing list of services available today.1 As
pm360online.com noted, “Today’s pharmacies are offering expanded healthcare
services and are ideal locations to raise disease awareness and deliver educational
information. They are becoming destinations for consumers seeking
healthcare solutions.”2

Managing privacy and access to information

There exists great opportunity for pharmacy as it pivots to a stronger position as a
healthcare services provider and increases its clinical role, but only if PBMs, specialty
pharmacies and retail pharmacies can keep track of all the covered lives and verify
their identities each time they access a healthcare system or otherwise seek service.

Privacy issues loom larger than ever. The pharmacy sector must reach new and
existing members and patients, and manage their medications without revealing
inappropriate information to outside sources; that’s especially challenging when
enrolling patients and members in programs like patient portals that face strict rules
for using Protected Health Information (PHI) under the Health Insurance Portability
and Accountability Act (HIPAA). Medical identity theft is the fastest-growing type
of identity theft, at 22% annually, and 64% of patients cite privacy issues as a key
concern when accessing health information online. The numbers also reveal that

A healthy dose of identity data, analytics and security for pharmacy 2

…medical identity
21% of patients withhold information from doctors out of
theft is the fastest- concerns over data security; maybe that’s because medical
growing type of identity theft victims pay an average of $13,500 to resolve
the situation.3
identity theft, at
The penalties for inappropriate use of patient information,
22% annually… whether that’s accidentally allowing unauthorized
access to patient data, simply misidentifying and thus
miscommunicating with a plan member or outright illegal use
of PHI, are increasing in number and in severity. Constantly
refreshed identity data coupled with sophisticated patient matching and linking
technology provide the solution: They help pharmacy organizations validate
members’ and patients’ identities to secure their privacy and protect the specialty
pharmacy, retail pharmacy or PBM from the fallout from privacy-related missteps.

Mobility makes identity management more difficult

The mandate to protect patient and member privacy is complicated by the fact
that patients move, and marry, and do things like sign some documents “John Q.
Public” and others “J.Q. Public.” Knowing where all those patients and members are
and how to contact them allows pharmacy organizations to keep track of patient
populations and saves money and time on correspondence campaigns. Returned
mail drags down operations and wastes valuable resources, including charges
from the U.S. Postal Service, so smart pharmacies and PBMs use carefully managed
member demographic data to better communicate.

That helps in another key area, too. Right now, a huge majority of healthcare
organizations still rely on direct mail outreach to improve adherence, which is a
potential problem with patients or members who are hard to track down.4 Easy
access to well-managed and maintained contact information on patients and
members makes patient engagement more effective, and that’s the key to driving
better medication adherence and outcomes.

Without adherence, even the best care management efforts fail

With the overall shift to value-based care in the healthcare market driven by
government regulations and consumer demand, pharmacy must be able to
determine the members who need help, weigh their motivation to change and
then provide them with the tools they need to do so. Social determinants of health
(SDOH), including information on relatives and associates, assets, trends over time,
neighborhood and household characteristics and more, can be utilized to improve
care management and risk stratification activities. SDOH insights can predict who
is likely to adhere to their medications and who is motivated to care for their own
health. Additionally, and what will be truly transformative, is SDOH can provide
insights into the types of barriers individuals have to being adherent so they can
be addressed.

A healthy dose of identity data, analytics and security for pharmacy 3

 Research by the American Society on Aging (ASA) and the American Society of
Consultant Pharmacists Foundation (ASCPF) reveals that “low literacy, lack of health
insurance coverage, poor social support, family instability and homelessness” are the
most consistently listed reasons for non-adherence.5 Home delivery helps, upping
adherence by almost 20%, but you have to know where patients and members live
before you can ensure their meds arrive on time—or at all.

ADHERENCE

SDOH BARRIERS

NON-ADHERENCE

LOW LITERACY HOMELESSNESS

LACK OF HEALTH INSURANCE FAMILY INSTABILITY

POOR SOCIAL SUPPORT

The stakes are simply too high not to make adherence a priority. It’s a key factor
in certification from the Electronic Healthcare Network Accreditation Commission
(EHNAC) which pharmacy organizations often seek6; Healthcare Effectiveness Data
and Information Set (HEDIS) measures and the Medicare Star rating system also
consider medication adherence rates. Up to 30% of prescriptions are never filled,
wasting one dollar out of every nine spent on healthcare7; in addition, more than half
of people missed a dose in a 12-month survey period and 30% couldn’t remember if
they did or didn’t take their medication.8

A healthy dose of identity data, analytics and security for pharmacy 4

 Traditional data must be enhanced with new sources
Maximizing potential while minimizing risk requires data—lots of it—and not all of it
from traditional sources. Knowing what medications patients are taking and whether
they’ll respond to efforts to improve their compliance allows pharmacy to target its
efforts at medication adherence, but prescription history alone often is insufficient.
Carefully selected socioeconomic data that’s been turned into information with precisely
focused analytics can help pharmacy organizations better engage with patients to
encourage compliance and improve health outcomes. The addition of updated contact
information for patients can help those interventions reach the right person.

SOCIAL
DETERMINANTS
OF HEALTH ECONOMIC STABILITY
CATEGORIES Address Stability,
EDUCATION
Assets, Income, Liens, Level, Quality,
Professional Licenses, Area of Study
Bankruptcies

NEIGHBORHOOD AND
HEALTH AND HEALTHCARE BUILT ENVIRONMENT
Proximity to Healthcare, Household Demographics,
Proximity to Primary Care Housing Types,
Crime and
Income Indexes

SOCIAL AND
COMMUNITY CONTEXT
Accidents, Crimes,
Weapons and Sporting Licenses,
Voter Registration,
Relatives/Associates

Pharmacy is starting to realize the need for data to help better know patients and
members. In a recent study, not even 10% of health plans were using analytics to
identify the need for adherence-related interventions, but well over half said they
planned to in the future. That could be a factor in that just 67% view their medication
adherence efforts as “moderately effective.”9

A healthy dose of identity data, analytics and security for pharmacy 5

 The tools that specialty pharmacies, retail pharmacies and PBMs need
The LexisNexis® Health Care Identity Intelligence Suite features patient- and
member-focused tools for better validation, communication and engagement.
It’s built on vast stores of data, from approximately 10,000 different sources of
proprietary and public data, and predictive analytics tools designed to solve the
problems pharmacy faces.

3
Identity
2 Insights

Identity
1 Management

Identity
Checks

Identity Checks facilitate the authentication, verification and resolution of identities engaging
with an organization; helping to provide information security, identify possible identity theft
risks and compliance issues, and allow for point-of-need identity information searches. That’s
accomplished with tools such as TrueID,® Device Assessment,® OneTime® Password,
InstantID® Q&A, Instant Verify, Bridger Insight® XG and Accurint® for Health Care. The LexID®
also provides a sophisticated approach to applying a universal identifier so each record and
transaction can be appropriately linked to the right patient.

Identity Management tools leverage a systematic approach to maintaining, enhancing and

augmenting member and patient identity profiles with current contact and demographic
information such as updated addresses, phone numbers, emails and deceased flags. The
main product is MemberPoint.® A variety of custom data outputs are available.

Identity Insights help customers better understand individuals and their social determinants of
health, so they can predict who needs help, positively impact patient engagement and improve
medication adherence by leveraging unique socioeconomic factors and analytics. Specific
solutions include Socioeconomic Health Attributes and Socioeconomic Health Scores.

A healthy dose of identity data, analytics and security for pharmacy 6

 Challenges present opportunities
The environment that specialty pharmacies, retail pharmacies and PBMs operate in will
only get more complicated; at the same time, opportunities for pharmacy to participate
in patients’ health will continue to increase. Pharmacy organizations should act now
to gain access to the data and analytics they’ll need to protect privacy, prevent identity
theft, meet compliance requirements, deliver messaging to the intended recipients, up
patient engagement and boost medication adherence and overall outcomes. It’s a matter of
survival and an opportunity to excel, and all it takes is the right partner to make it happen.

For more information, call 866.396.7703 or visit

risk.lexisnexis.com/healthcare

About LexisNexis® Risk Solutions

LexisNexis Risk Solutions harnesses the power of data and advanced analytics to provide insights that help businesses and governmental entities
reduce risk and improve decisions to benefit people around the globe. We provide data and technology solutions for a wide range of industries
including insurance, financial services, healthcare and government. Headquartered in metro Atlanta, Georgia, we have offices throughout
the world and are part of RELX Group (LSE: REL/NYSE: RELX), a global provider of information and analytics for professional and business
customers across industries. RELX is a FTSE 100 company and is based in London. For more information, please visit www.risk.lexisnexis.com
and www.relx.com.

Our healthcare solutions combine proprietary analytics, science and technology with the industry’s leading sources of provider, member, claims
and public records information to improve cost savings, health outcomes, data quality, compliance and exposure to fraud, waste and abuse.

1
http://www.consumerreports.org/cro/2014/08/new-pharmacy-services/index.htm
2
https://www.pm360online.com/the-pharmacys-new-role-in-providing-healthcare-services/
3
http://www.experian.com/healthcare/patient-portal-security-authentication-id-proofing.html
4
http://aishealth.com/archive/ndbn082214-04
5
http://learning.rxassist.org/adult-meducation-improving-medication-adherence-older-adults-asa-ascpf
6
https://ehrintelligence.com/news/how-can-predictive-analytics-improve-medication-adherence
7
http://lab.express-scripts.com/lab/insights/adherence/the-high-price-of-low-adherence-to-medication
8
http://www.ncpa.co/adherence/AdherenceReportCard_Full.pdf
9
http://allazohealth.com/mco-adherence-study

Identity Intelligence Suite provided by LexisNexis is not provided by “consumer reporting agencies” as that term is defined in the Fair Credit Reporting Act (15
U.S.C. § 1681, et seq.) (“FCRA”) and does not constitute a “consumer report” as that term is defined in the FCRA. Identity Intelligence Suite may not be used in
whole or in part as a factor in determining eligibility for credit, insurance, or employment or for any other eligibility purpose that would qualify it as a consumer
report under the FCRA. Due to the nature and origin of public record information, the public records and commercially available data sources used in reports may
contain errors. Source data is sometimes reported or entered inaccurately, processed poorly or incorrectly, and is generally not free from defect. This product
or service aggregates and reports data, as provided by the public records and commercially available data sources, and is not the source of the data, nor is it a
comprehensive compilation of the data. Before relying on any data, it should be independently verified. LexisNexis and the Knowledge Burst logo are registered
trademarks of RELX Inc. Other products and services may be trademarks or registered trademarks of their respective companies. Copyright © 2018 LexisNexis.
All rights reserved. NXR11437-01-0518-EN-US