We assist our clients by simplifying their network management methods and intricate data structures through centralizing contract attributes and creating versatile data sets.
Client Situation
PBMs experience constant change throughout the year, including sizable network performance fluctuations impacting client guarantees and financial planning.
In this instance, a PBM’s current retail network contract did not represent a viable long-term response to its needs for pricing competitiveness, flexible management, and predictable outcomes. The PBM sought improved results from within the industry, aligning available solutions to its specific size and scale.
Opportunities/Actionable Items
Proper partners with the PBM to identify inadequacies within their network and pricing management. After conducting a diagnostic, Proper can determine and offer the following solutions depending on the client’s specific situation:
- – Develop a complete repository of all network pharmacy and client contracts
- – Build a centralized data warehouse as a single-source of truth with daily claims updates
- – Create automated dataset and dashboards to reconcile client and pharmacy contracts in near-real time
- – Collaborate with the client’s Plan Build configuration team to reconfigure the adjudication system in a manner to efficiently manage client and pharmacy side pricing
- – Implement network pharmacy and client specific pricing changes
Results
Proper’s network management engagement with just one of their PBM clients resulted in both quantifiable and qualitative improvements including:
- – $10M+ in annual margin improvement
- – Accurate client pricing
- – Minimal member impact
- – Funded investment in new client wins
- – Automated near real-time reporting
