No products in the cart.
CPAP Certification Program
Module 26: Data Analytics & Population Health in Utilization Management
From Individual Prescriptions to Population-Level Insights.
Beyond the Case Review: The Pharmacist as a Data Strategist
As a pharmacist, your expertise is rooted in the meticulous analysis of the individual case. You are trained to focus with laser precision on a single patient’s profile, a single prescription’s safety, a single therapy’s appropriateness. This one-on-one, patient-centric view is the bedrock of our profession and the core of safe medication practice.
This module challenges you to zoom out. In the world of managed care, the “patient” is often a population of millions. The “case” is a dataset of billions of claims. A PBM or health plan is, at its heart, a data-driven organization. The vast river of information generated by every prescription filled, every doctor’s visit, and every PA request is the organization’s most powerful asset. This data, when properly analyzed and interpreted, is a diagnostic tool for the health of an entire population. It reveals patterns, uncovers risks, and illuminates opportunities for intervention on a massive scale.
A pharmacist who can speak the language of data—who can bridge the gap between clinical expertise and statistical analysis—is an invaluable asset. This module is designed to provide you with that fluency. You will learn how to leverage your clinical knowledge to ask the right questions of the data, how to interpret the answers, and how to translate those insights into actionable strategies that improve the health of populations while managing costs. This is your evolution from a clinical reviewer to a clinical data strategist.
Your Guide to Population-Level Insights
This module will equip you with a foundational understanding of how PBMs use data to drive clinical strategy and demonstrate value.
Introduction to PBM Data Sources
Build your foundation by learning to distinguish between and integrate the core data types: pharmacy claims, medical claims, and the rich repository of PA approval and denial data.
Identifying Trends and Outliers
Step into the role of a data detective. Learn how to use data to spot providers with unusual prescribing patterns, identify geographic hotspots for high-cost drugs, and uncover opportunities for intervention.
Measuring Program Effectiveness
Learn how to answer the most critical question: “Is this program working?” Discover the metrics and methods used to determine if a PA program is successfully reducing costs and improving safety.
From Data to Action
Data is only valuable when it leads to change. Explore how rigorous data analysis becomes the catalyst for new clinical programs, targeted provider education initiatives, and strategic adjustments to PA criteria.
Reporting for Client Value
Understand the business of managed care by learning how PBMs use sophisticated data reporting to demonstrate cost savings, clinical quality, and overall value to their clients.
