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In 2021, five percent of the U.S. population accounted for almost half of healthcare spending. These individuals tend to be older adults or people with poor health status.

With the high cost of care in the U.S. and the emphasis on this past decade, health organizations need to learn how to support those patients to improve their health outcomes and lower the related cost of care.

In this article, we’ll discuss the five following ways health organizations can reduce healthcare costs for their members at higher risk:

Identify patients at higher risk using a more holistic view

Patients at higher risk are patients who are more likely to experience negative health outcomes, higher rates of unnecessary healthcare utilization, and increased financial costs.

Patients are not uniform in their needs in terms of interventions to improve their health. Identifying patients at higher risk is crucial to help health plans better understand their patient populations, tailor their care to their needs, and lower their costs.

Even within the population of patients at higher risk, different patients may require different management. For instance, one study looked at patients with high needs which was defined as the subset of patients with high risk (three or more chronic diseases) who also have functional limitations. They found that patients with these high needs tended to have nearly three times higher healthcare expenses and twice the rate of hospital use than patients with multiple chronic conditions without limitations.

One of Arine’s clients, the Oklahoma Health Care Authority (OHCA), used Arine’s medication intelligence platform for the most impactable high-risk patients among its 1.2 million Medicaid members. These individuals were identified by analyzing social, behavioral, and clinical data parameters and using predictive models to pinpoint the individuals at greatest risk of medication-related problems such as non-adherence and emergency department (ED) visits.

These same data sets also populated patient profiles within the Arine Platform, providing care teams with a 360-degree view of each patient, enabling them to deliver individualized interventions to prevent those complications from occurring.

As a result of these timely interventions, OHCA achieved a 24% reduction in ED visits per engaged member per year and a 40% reduction in patient hospital admissions per member per year, with much of the positive impact seen within six months. Medical costs overall decreased by more than $1,500 per engaged member per year.

Engage prescribers

Another crucial step to lower costs for patients at higher risk is to engage healthcare providers effectively.

Decisions made during patient-physician interactions have a huge impact on overall healthcare costs. Yet physicians may not have a complete picture of what’s happening with their patients at the time of their interactions. The patient may be seeing different specialists who don’t communicate with each other. The patient may have had a recent hospitalization or an ED visit which led to a change of medications unbeknownst to their provider. A person may have stopped taking their medications due to undesirable medication-related problems and may be hesitant to share this with their care team.

Engaging providers to prescribe cost-effectively can help reduce medication-related costs. However, healthcare organizations need to go beyond that.

Healthcare organizations need to successfully engage providers and support them with relevant data insights to reduce inappropriate prescribing and healthcare costs.

Using Arine's Resonate solution, a health plan client was able to identify opportunities to optimize prescribing for its behavioral health population. The care team was then able to share these data-driven insights with prescribers in their network. Beyond just recommending a change in medication, the care team shared with each provider valuable context on each patient’s medical care, the medication-related problem, and why it was an issue, as well as information from clinical guidelines supporting the evidence-based recommendation.

As a result, the health plan significantly increased the prescribers’ adherence to the formulary and saved between $1,500 and $4,300 per member per year in total cost of care.

Connecting individuals at higher risk with their primary care physicians (PCP) can also lower healthcare costs.

U.S. adults who regularly see a PCP have 33% lower healthcare costs and 19% lower odds of dying prematurely than those who see only a specialist. Yet, between 2016 and 2022, about one-third of all patients who received medical care did not see their primary care physicians.

It’s estimated that each year, the U.S. could save $67 billion if everyone used a primary care provider as their principal source of care. Every $1 increase in primary care spending produces $13 in savings.

Patients not seeing their primary care physicians can be due to different barriers, such as lack of health insurance, language and low health literacy barriers, disabilities, inability to take time off work to attend appointments, or geographic and transportation-related barriers. According to a study from the American Academy of Family Physicians and the National Association of Community Centers, over 100 million Americans face barriers to accessing primary care.

Arine can support care teams in helping connect their patients at high risk to their primary care physicians.

One of those patients is Sarah, a 40-year-old female with mental health conditions. When the care team started to work with Sarah, she did not have a PCP. She had recently been discharged from the hospital for gastroenteritis and had a history of several hospitalizations for mental health conditions. Her anxiety and depression were untreated.

Using Arine’s medication intelligence platform, her care team was able to identify that she did not have a PCP, and worked with her health plan to connect her with one. They also recommended relevant interventions to prevent future medication-related problems:

  • The care team recommended starting a proton pump inhibitor for her gastritis.
  • They recommended a prescription for a nicotine patch and triaged Sarah to a smoking cessation program.
  • Her new PCP was made aware of Sarah’s untreated depression and anxiety and added venlafaxine to her medications.

Sarah’s new PCP adopted all the recommendations made by the care team, and Sarah didn’t have any additional hospitalizations. As a result, it’s estimated that Sarah‘s cost of healthcare was lowered by $1,820 over three months, which translated to projected annual savings of $8,120.

Improve care coordination

Beyond connecting individuals at higher risk to their PCP, it’s also crucial for healthcare organizations to improve care coordination for this population of patients.

Lack of care coordination can lead to poor quality of care, care inefficiencies, and increased healthcare costs. Improving care coordination can help close these gaps and lower costs for patients at higher risk.

Let’s look at the example of Joe. Joe is an elderly patient with a recent history of two hospitalizations and six ED visits for congestive heart failure, chronic obstructive pulmonary disease, and chest pain. Joe has significant transportation barriers and uses a walker. As a result, he hasn’t seen his PCP recently and hasn’t picked up his prescriptions in more than two months.

Using Arine’s platform, his care team transferred Joe’s prescriptions to a local pharmacy with free delivery. They referred him to a smoking cessation program and connected him to a transportation service to be able to go to his physician appointments.

As a result, Joe didn’t experience any additional hospital admissions. The estimated cost saving from the interventions was $4,310 over 3 months, which translated to projected annual savings of $18,690.

To observe the effect of care coordination at the population level, we can look at the case of the Gundersen Lutheran health system.

This health organization reduced its re-hospitalization rates by identifying its 1-2% sickest patients and providing them with an integrated model of care coordination. The model partnered with social workers and nurses to assess patients' social, emotional, and financial needs and help address them. As a result of the care intervention program, charges resulting from unscheduled hospitalizations and ED visits decreased by 51% in the first year. When patients were hospitalized, the length of stay decreased by 39% in the first year.

The average cost of the program was $2,000 per patient per year. For each $1 invested in care coordination, the health system saved $8 in health care charges.

Another example of a successful care coordination program is the one from Senior Care Options in Massachusetts. By coordinating the direct delivery of social support services for patients with chronic conditions and adults with disabilities, the program was able to lower its hospitalizations. As a result, hospital days per 1,000 members in the program were 55 percent of those generated by comparable patients not receiving the program's extended services.

In a study about the impact of care coordination published in the JAMA Network, authors found that care coordination had different impacts depending on the group of patients and the type of interventions. Researchers found that an acute care intervention (more focused on post-discharge care coordination) resulted in higher savings for Medicaid patients compared to Medicare patients ($4,295 vs. $1,115 per beneficiary episode). A community intervention (more focused on preventing hospitalizations) worked for Medicaid patients (savings of $1,643 per beneficiary per quarter) but had no impact on costs for Medicare patients.

Results like these highlight the importance for health organizations to understand their patients at higher risk better to provide them with individualized care coordination.

Optimize medications

Evidence shows that older patients at higher risk were more likely to be prescribed inappropriate medications. Non-optimized medications are another factor that can negatively impact health outcomes for patients at higher risk and lead to increased cost of care.

In 2016, the estimated annual cost in the U.S. of prescription drug-related morbidity and mortality resulting from non-optimized medication therapy was $528 billion. This includes preventable interventions such as hospitalizations, emergency department visits, and additional prescriptions.

Optimizing medications is an important step in addressing the cost of care for patients at higher risk.

In a review of evidence about medication optimization by the Get the Medication Right Institute, the authors summarized the results of different studies about the impact of optimizing medicines.

In one study, researchers found that adults with two or more chronic conditions receiving medication management services were more likely to receive better care for hypertension and high cholesterol. Medication optimization resulted in a 31.5% reduction in health care cost, about $3,700 less per person per year for patients in the medication optimization group vs those who didn’t receive medication optimization (p<0.001).

Another study looked at the impact of post-discharge medication optimization on patients at high risk. The authors found that the program enabled the health plan to save three dollars per member per month. These savings potentially translated to six-month net savings of $2139 in total costs and $1,723 in inpatient costs for patients in the medication optimization program.

One review evaluated the effect of pharmacist-delivered comprehensive medication management offered to patients with mental health conditions. Complex patients in this study had a mean of 13.1 medications and 10.1 health conditions. The total net cost savings from medication optimization was estimated at $586.55/patient.

By working with Arine to optimize their patients’ medications, health plans can see improvements in health outcomes and a reduction in health costs for their members. One client was able to achieve a 15% reduction in total cost of care in six months with Arine’s medication intelligence platform. This cost reduction was due to improved adherence to the formulary, a lower hospital admission rate, and a lower cost of chronic disease management.

Use AI to improve efficiency and reduce waste

The U.S. healthcare system wastes up to $935 billion per year through failure of care delivery, lack of coordination, low-value care, and administrative complexity among other things.

Artificial intelligence (AI) can help improve care team efficiency and curb this waste, especially for high-risk patients.

With predictive analytics, health plans can use their data to determine which high-risk patients may benefit the most from cost-saving interventions. That knowledge can allow health plans to design early and targeted interventions for these specific patients.

AI can also enable healthcare organizations to streamline administrative and non-patient tasks. It can help increase productivity, optimize performance, and lead organizations to be time and cost-efficient.

Arine’s AI-powered platform enables care teams to be more productive by automatically identifying and prioritizing gaps in care, medication-related problems, and cost-saving opportunities. It can also streamline workflows to allow team members to work five to ten times faster.


Health organizations can lower healthcare expenses by improving care for their most impactable members at higher risk. To reach this goal, health plans need to understand this specific population, learn how they utilize healthcare, and design targeted timely, and cost-efficient interventions. Arine's Luminate solution can help your organization reduce healthcare costs for high-risk patients.

Arine can help your organization reduce healthcare costs for high-risk patients. Schedule a demo with us today and discover the transformative potential of our comprehensive medication management solution.

Blog Posts
Post by Sandy Bonfin, PharmD, BCPS
April 23, 2024
Sandy Bonfin, PharmD, BCPS, is a clinical pharmacist. She writes about medication optimization, medication intelligence, and health equity.