We introduced a product called Therapeutic Resource Center at Medco in 2007/8. It was an extremely innovative product that was soon copied by most of our competitors.
Here’s a brief history of how we developed this product.
Medco consisted of two main businesses – the PBM business which basically was adjudication of a patient’s drug benefit – which drugs would be covered, what would be on the formulary, copay a patient had to cover out of pocket when filling a prescription, how much would a pharmacy be paid, what would we bill a payer for this transaction; the second was the mail order pharmacy dispensing business. Here we asked patients on maintenance medications, to fill their prescription at mail order. A patient would request their doctor to send their prescription to our MO pharmacy. We would then fill a 90 day prescription for the same copay as a retail pharmacy for a 30 day prescription.
In 2006, we were at about 100MM prescriptions at mail order and about 765MM POS adjudications annually. To drive efficiencies, we digitized incoming Rx’s to route them to the closest mail order pharmacy location for dispensing in the most cost effective way – so a patient on the west coast had their fill done from Las Vegas while a patient on the east coast would have our pharmacy in Tampa or Willingboro fulfill their order.
Once we had the ability to digitize Rx’s, we were also able to group, sort or route to the most efficient way of doing business. We had the same ability with customer service phone calls coming in – recognizing the ANI allowed us to know who was calling and whether they had an order with our pharmacy.
Since we also had a lot of patient data (Rx, medical claims etc.), we could stratify the patient population into various disease conditions, and if we used this stratification in routing prescriptions or calls, we had the ability to route all diabetics to a group of pharmacists that specialized in diabetes, or for neuropsych patients to the neuropsych TRC. Similarly we created the Cardiovascular, Oncology, Specialty and Women’s Health TRCs.
We then discovered that our interactions with the patients were a lot more meaningful, with our pharmacists and CS representatives becoming trusted advisors to these patients. It also meant that we were able to keep patients more adherant on taking their prescriptions as well as intervene on behalf of the patients to request a gap in care intervention when we saw a missing therapy or course of actions.
Using actuarial data, we were able to establish that while this intervention was more expensive than our regular cost effective dispensing and customer service operations, we were also able to improve patient health, bend the healthcare cost curve, reduce the adverse drug events and also introduce some new genetic testing as means of either avoiding certain treatments (using a genetic test (Abnormal CYP2D6 enzyme) before prescribing Tamoxifen for Breast Cancer treatments) or adjusting the dosage on some really poisonous ones (introducing genetic tests to regulate their dosage when a patient was first prescribed warfarin (a blood thinner)).
Given that our interventions were this effective and we had data to prove it, we introduced a product called TRC in 2007, which would entitle a client’s patients to our interventions, in return for a larger mail order penetration that drove our margins on the mail order side. This really helped both improve our margins as well as improve patient care.
Medco’s Product’s & Services:
Therapeutic Resource Center Business Model:
The above context diagram describes how our product worked, please do reach out if there are questions regarding how we designed this.
tickets early in the morning on Sunday June 17th, and the rest of the day went in team setup, practice runs and calibration & tuning the robotics programs.
goal from one of the teams.
A very fast paced soccer game with bots acting in coordination as one team against an opposing team. Here’s a video that shows how exciting this can be.
There were a number of other home setting 
challenges as well – for example unloading grocery bags and storing them in the right location/shelf in a home.
bots can be used in a hazardous situation for rescue. Challenges included navigating difficult terrains, opening doors, accomplishing tasks such as sensor readings, mapping a maze or path through the field etc. Some videos listed here are very impressive. These teams were mainly university and research lab teams. Do check out the following links.
It has made huge investments into robotics. It will be evident from the following videos that making these investments is critical to succeeding in the near future when we expect a lot of the mundane work to be automated and mechanized.
a huge difference in terms of resources and motivation from state sponsorship as was evident with the Iranian, Chinese, Russian, Singaporean, Croatian, Egyptian and Portuguese delegations.
learn from experience E with respect to some class of tasks T and performance measure P, if its performance at tasks in T, as measured by P, improves with experience E.”![\[\theta=(X^TX)^{-1}X^Ty\]](https://eli.thegreenplace.net/images/math/20baabd9d33dcd26003bc44c7d81ba39e1ad4caa.png)
) Refers to a set of simultaneous equations involving experimental unknowns and derived from a large number of observation equations using least squares adjustments.
brains (biological neural networks). Such systems learn the model coefficients by observing real life data and once tuned can be used in output predictions for unseen data or observations outside the training set. 