Case study: Aetion and Horizon Blue Cross Blue Shield of New Jersey

As real-world evidence (RWE) plays a growing role in biopharma and regulatory processes, payers are also exploring how to leverage its insights to support care management in their populations. Horizon Blue Cross Blue Shield of New Jersey (Horizon), the state’s largest health insurer, employs RWE in a range of analyses to help design interventions, improve members’ health, and support outcomes-based contracting with biopharma.

In an effort to help Horizon manage costs in their type 2 diabetes population, Aetion performed rapid-cycle analytics™ to inform and improve case management for high-risk patients. Maya Tsukernik, Aetion’s Vice President of Growth, recently shared the project in a case study for Amazon Web Services (AWS)'s virtual HIMSS experience.

Members with type 2 diabetes made up only 20 percent of Horizon’s population, but drove about 80 percent of the costs—mostly from cardiovascular inpatient stays. Acting as the intermediary between the payer and a biopharma manufacturer, Aetion identified a second-line therapy that reduced hospitalizations, improved outcomes for patients, and resulted in $5 million annual cost savings.

This work, completed by Horizon and Aetion scientists, was published in the Journal of Managed Care and Specialty Pharmacy (JMCP). The article, “Actionable real-world evidence to improve health outcomes and reduce medical spending among risk-stratified patients with diabetes,” recently won the 2020 JMCP Award of Excellence.

Listen to Maya’s presentation to learn more about our work with Horizon—including how AWS enables rapid-cycle analytics in our platform.

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