Medication Adherence 360: AI & Analytics for Payers to Improve Outcomes and STAR Ratings

Medication adherence is a cornerstone of effective healthcare delivery. It is a critical determinant of patient outcomes, influencing disease management, recovery timelines, emergency visits, readmissions, and mortality rates. For health plans, non-adherence remains a persistent and costly issue. It directly affects: • Clinical outcomes • Member satisfaction • CMS STAR Ratings • Healthcare costs

EXL has a strong track record of partnering with leading healthcare plans to improve medication adherence through a comprehensive, AI-driven strategy.

EXL’s Proven Approach

EXL leverages advanced analytics, machine learning, and generative AI to help payers address this challenge with measurable results. • Early Intervention with Real-time triggers: Refill reminders, appointment auto-scheduling, and remote monitoring. • Proactive Outreach: Predictive analytics to identify at-risk members, personalized recommendations, incentives, and seamless communication.

Over the years, our solutions have delivered measurable impact for payers, helping them: • Boost STAR Ratings: Improve adherence metrics tied to CMS quality measures. • Reduce Avoidable Costs: Lower ER visits, readmissions, and medication-related complications. • Enhance Member Engagement: Deliver personalized, proactive outreach that improves satisfaction and retention. • Maximize ROI: Optimize resource allocation with data-driven intervention strategies.

How It Works? • Our team of AI and Domain experts collaborate with key stakeholders to assess data readiness, define business goals, and identify challenges. • We define the scope, timeline, and cost estimates upfront and follow a milestone-based delivery model to mitigate risks and ensure cost efficiency. • Our offering includes a prebuilt set of KPIs, dashboards, and models, enabling a structured approach that accelerates implementation. • The solution is seamlessly deployed in the client’s environment, giving them full control and flexibility to customize it to their needs.

EXL Medication Adherence 360 Analytics to Next Best Action is a Microsoft Azure based solution that includes three modules -

Targeted Member Impactability & Intervenability Models - EXL’s proprietary Impactability and Intervenability models identify the right members and the right time for engagement • Utilizes proprietary AI models to pinpoint members most likely to benefit from interventions, enhancing both clinical outcomes and cost-effectiveness • Predicts member-level adherence patterns and the likelihood of a positive response to specific outreach strategies. • Considers access-to-care barriers, channel preferences, and optimal outreach timing to tailor interventions. • Optimize resource allocation by balancing intervention costs with expected returns.

These models are EXL machine learning models used as accelerators that are further fine-tuned in customer’s data to customize the model predictions using Microsoft Azure AI | Machine Learning Studio. The models are deployed as APIs that are accessible as batch or real-time APIs for integration.

Next Best Action via AI-Infused Workflows • AI-driven member journey orchestration enables dynamic experiment design across cohorts, channels, and messaging strategies. • AI-powered messaging and chatbots deliver personalized, multi-channel communication to drive member engagement. • Automated approval workflows leverage intelligent decision-making to improve turnaround times. • Generative AI tools streamline operations, enhance communication, and support real-time adherence monitoring.

This is a custom EXL next best action accelerator that is deployed in Microsoft Azure environment that can be integrated with member engagement platforms as downstream applications to trigger member focused interventions. This accelerator is designed to onboard not only Medication Adherence program but can onboard additional use cases for customer.

Performance Monitoring & Measurement • Automated reporting tools streamline measurement of outcomes, adherence, and ROI across cohorts, channels, and interventions. • Real-time analytics dashboards provide visibility into key performance indicators (KPIs), enabling proactive adjustments to campaigns and workflows.

EXL has pre-defied list of metrics and Mircosoft Power BI based wireframes that provide baseline medication adherence based program monitoring. The dashboards are further customized to meet client needs. This offers an acceleration in speed to value.

Why Choose EXL? • Proven Results: Trusted by leading health plans to improve adherence and financial performance.

• Full Control: Deployed securely in your Microsoft Azure environment—ensuring compliance, scalability, and data ownership.

• AI-First Expertise: EXL’s deep healthcare domain knowledge and advanced analytics deliver actionable insights and measurable impact.

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