We help our clients build upon existing data and reporting capabilities by developing additional functional controls for swift and focused value optimization.
Client Situation
Pharmacies are responsible for overseeing a multitude of tasks to maintain operational excellence and consistent financial execution.
Limitations on data availability paired with inadequate tools were hampering a pharmacy’s ability to identify opportunities for process efficiency and cost reduction. The pharmacy was aiming to remove these hurdles and avoid future delays in detecting and resolving potential concerns.
Opportunities/Actionable Items
Proper took an extensive, multifaceted approach to categorize areas of improvement – from conducting broad system reviews to detailed cataloging of contracts and terms.
Administration of the pharmacy’s supply chain requires timely access to necessary data and appropriate business assets to analyze trends and forecast performance. Assessing the pharmacy’s end-to-end product cycle brought to light several initiatives including improved drug purchasing via manufacturers and wholesalers, robust invoice accounting, strategic inventory planning, and strengthened payer reconciliation activities.
In evaluating the pharmacy’s purchasing contracts, Proper unveiled various strategies for cost savings. The pharmacy could choose to leverage maintaining multiple contracts with manufacturers and/or wholesalers, develop an exclusive relationship, or partner with a GPO to bolster purchasing power. In addition, the team analyzed the pharmacy’s capabilities in applying clinical programs and identified an expansion of patient and prescriber outreach to promote efficient prescription fills.
Under any strategy, the pharmacy had to ensure it was receiving accurate invoices compliant with contractual terms. Proper aided in the consolidation of invoice data joined against product level pricing to isolate discrepancies and quickly resolve any billing issues. In joining inventory data and dispensing data to a central data source within a proprietary reporting portal, Proper created alerts bringing to attention the need to examine products within the pharmacy’s inventory which were out of stock or in need of return to the supplier.
Proper also worked to enhance payer contract mapping and automate reporting to help target claims with non-compliant reimbursement. The pharmacy then had the relevant support at its fingertips to remedy the problem claims and initiate the reconciliation process.
Results
The combination of these initiatives yielded immediate results. In facilitating negotiations with its vendors, the pharmacy was able to select the most economically beneficial sourcing arrangement. Application of the automated inventory reporting uncovered $2M+ of products which had not been dispensed in months and were eligible for return. With greater insight into payer reimbursement trends, the Proper team recouped $5M+ due to a large PBM’s historical under-reimbursement.
