Course Description
This course covers three of the highest-impact technology domains in the MOC framework: detecting formulary inefficiencies and optimizing pharmacy spend, harnessing price transparency data for plan benchmarking and cost control, and building and deploying an AI strategy for employer-sponsored health plans. You will study specific pharmacy savings opportunities including generic equivalents, branded-generic alternatives, therapeutic alternatives, and best-buy generics. You will learn how to use payer machine-readable files and Medicare benchmarking for payment optimization. And you will develop a practical understanding of AI deployment within health plans, including predictive analytics, cost forecasting, and risk stratification.
Learning Objectives
- Identify the four primary categories of formulary inefficiency and quantify their financial impact.
- Develop a formulary optimization strategy aligned with fiduciary responsibilities.
- Explain how payer machine-readable files enable market-by-market price benchmarking.
- Apply Medicare benchmarking and reference-based pricing strategies.
- Design an AI strategy for an employer-sponsored health plan using the 90-day blueprint.
- Evaluate predictive analytics platforms and clinical groupers for risk stratification.
Estimated Completion Time: 20 hours
