Health plans are grappling with rising costs and higher quality requirements simultaneously. Too often, the two are treated as separate problems, managed by separate teams, on separate lists.
Cambia Health Solutions knew this model had limits. Serving 75,000 Medicare lives across seven regional health plans, Cambia was running three critical programs – medication adherence, MTM/CMR, and quality gaps – but each operated in its own silo. The teams were engaged and working hard, yet without a shared view, members could receive multiple calls in a single week, and no one could confidently say which interventions were actually moving the needle on quality or cost.
The real gap, it turned out, wasn’t coordination. It was intelligence.
In our latest video, drawn from the PQA Quality Forum Webinar, Amy Truong, Director of Clinical Pharmacy Programs at Cambia, and Yoona Kim, PharmD, Co-Founder and CEO of Arine, tell the story of how that changed.
Cambia decided to bring everything into a single platform powered by Arine’s Medication AI. In doing so, it enabled its teams to finally see the whole patient – not just one measure at a time. Because the platform processes the full member profile, it surfaces more than adherence issues alone; it also flags some of the major (yet often hidden) drivers of unnecessary spend and hospitalizations: improper dosages, unnecessary duplications, and dangerous interactions.
The results in the first year speak for themselves:
As Amy put it, this isn’t a quality or cost conversation. It’s both – and the right platform, the right data, and the right prioritization can move Stars performance and cost of care simultaneously.