The automated approach to optimizing 340B savings & patient care while overcoming manufacturer restrictions


NOTE:
The purpose of this article is to highlight features and functionality any 340B platform needs to optimize a health system’s 340B savings and revenue. That said, we determined that the easiest way to report those features was to describe the platform used by our own 340B support team — and by the health systems we serve.

– – – – – – – – – – – –

As we reported in a previous post, ProxsysRx’s 340B Team has generated more than $500 million in savings for the hospitals and health systems we serve. And yet, if there is one thing that every member on our team can agree-on, it’s this: There is no such thing as a 340B Expert; for the simple reason that, given the ever-expanding scope and severity of manufacturer restrictions, 340B is a constantly-moving target.

“I’ve lost count of how many times this has happened,” says ProxsysRx 340B Optimization Manager Chance Spivey: “I come into work and find an email in my Inbox that changes all of the data analytics I’d been using to submit a sizable percentage of my clients’ prescriptions for 340B discounts.” And that is why the foundation of every virtually update we’ve implemented in our 340B Analytics platform has been the automation of processes that team members formerly conducted manually.

“Ultimately,” says ProxsysRx’s 340B Analytics project manager Clay Cooper, “my job is helping ProxsysRx’s team make better decisions faster. The problem with healthcare in general, and 340B in particular, is that we collect mountains and mountains of data, but that doesn’t mean we use it well. Or at all, for that matter.”

The fundamental problem with 340B healthcare data

Healthcare data, in general, tends to be extremely siloed. A 340B hospital’s patient information is likely to be in one place, while its insurance information is in another place, and its 340B pharmacy data is in still another place — and none of those data sets (or the people who manage them) are set-up to communicate easily and seamlessly with one another.

The over-arching goal of ProxsysRx’s 340B Analytics platform, from Day One, has been to safely and securely take hospital data from all the locations it currently resides, and assemble it all in a meaningful way that enables our 340B team — and the 340B program-managers in the health systems we serve — to quickly and easily make good decisions.

Documenting a 340B prescription’s journey

ProxsysRx’s 340B Analytics enables us to document the entire journey of every prescription written within a 340B health system — no matter how many clinics, providers and pharmacies participate in the system’s 340B program. That journey proceeds from a provider writing a 340B prescription, to the 340B contract pharmacy (retail or specialty) filling that prescription, to Billing for the prescription, to the stage where that prescription is determined worthwhile to be Claimed And Qualified for 340B savings.

Tracking and following each prescription through that journey enables our team members to constantly improve their understanding of a hospital 340B program’s Big Picture. They quickly begin to see patterns emerging in a health system’s 340B program. And with 340B Analytics’ reporting capabilities, they can help health systems take steps to close the gaps in their 340B programs.

Helping hospitals close 340B gaps

“Here’s a typical gap-scenario that we often see in hospitals’ 340B programs,” Clay notes: “We identify clinics within a health system that have potential to generate 340B income, but they’re not taking advantage of the opportunities. When we see those opportunities not being leveraged, we have to ask ourselves ‘Why?’ At the same time, we can quickly produce data demonstrating unmet 340B-savings potential — and supplement that data with insights we can take to hospitals in explaining where they can make changes to become more effective in generating 340B savings.

“That said, here’s something we’ve understood from the day we launched our 340B Analytics platform: Our recommendations have to be actions that 340B hospitals can implement with a minimum of disruption to their providers’ and contract pharmacies’ work-flows. So we’ve made it our job to make those goals easily achievable, by doing most of the hard work for them.”

Analyzing hospitals’ prescription histories for 340B savings opportunities

Once our data team has secure access to a 340B hospital’s data system, we look at their 340B histories — and identify 340B savings opportunities — as far back two years. We can see the 340B prescriptions they’ve written, the providers who wrote those 340B prescriptions (and the patients for whom they were written), the pharmacies who filled them (as well as their 340B match rates), and the TPAs that qualified them — or didn’t qualify them.

Again, we can break-down everything connected to a health system’s 340B program. We can see our clients’ entire quantifiable 340B markets, and every 340B prescription that’s worth claiming for savings.

Reporting 340B prescriptions by drug. And by provider.

Consider the prescription medication Eliquis, which is a significant income-generator for a number of the 340B hospitals we serve. We can drill-down our analytics and reporting for every 340B-eligible prescription for Eliquis — or for any 340B eligible prescription. We can do the same thing for individual prescribers. We can see which physicians and contract pharmacies are qualifying eligible prescriptions for 340B reimbursement, and which are not.

Helping providers better serve 340B patients.

Hospitals can then share this information with their prescribers to help them better serve their 340B patients, and they can use it to determine which pharmacies best serve those 340B patients’ needs — and their 340B program as a whole.

As a reminder, the 340B program was created to help eligible non-profit health systems fill-in the often-significant revenue gaps inherent to their business models. For many of the health systems we serve, 340B revenue is nothing short of a lifeline — enabling them to serve their communities’ neediest patients; patients who generally lack the financial resources to pay for the care they need.

In an earlier post, we published a conversation between Directors Of Pharmacy for two hospitals we serve — Southwest Mississippi Regional Medical Center’s Tiffany Poole and Conway Medical Center’s Andrew Wright. Here’s a brief excerpt from that conversation —

Tiffany: “Congress started 340B to increase access to healthcare for everyone, and spread scarce resources in our most underserved communities. Our relationship with ProxsysRx lets us spread those scarce resources further than we ever could on our own.”
Andrew: “It’s allowed us to expand into areas of medicine we never thought we could offer. We’ve added a cancer center, a pain clinic as part of our orthopedic practice, a dermatology clinic, and a women’s center. We’re expanding our footprint, and we’re treating so many more patients than we used-to. Without ProxsysRx and 340B, that wouldn’t have been possible.”

Automation’s ultimate advantage: Better 340B program decisions faster.

“The efficiencies we’ve built-into our system,” says ProxsysRx VP and 340B Team Leader Heather Brooks, “enable each of our team members to accomplish as much as any three of us could in our program’s early days. At the same time, the analytics have been invaluable in helping us optimize each health system’s 340B program savings and revenue.”

The primary advantage of automating so many of the team’s processes comes in reacting to external changes to the ways 340B prescription claims are made; which happens almost daily. “Before we automated so many of our processes,” Clay explains, “when external changes were made, our team had to manually research how to deal with them. Now that we’ve logged, into our database, all the historical 340B program changes we’ve adapted-to over the years, when new changes are made, we don’t have to start-over from scratch.”

When new changes are imposed on the 340B program, we can produce actionable data to make decisions on most of those changes within minutes. We can then produce reports, with recommendations, to the hospitals we serve — who then test our recommendations, and provide validating data back to us. “It’s a process that used to take months to implement,” Clay continues, “and now takes days.”

Ensuring 340B program compliance at all times

How do we keep clients compliant? Again, by knowing every prescription drug that’s 340B eligible — and by maintaining a constantly-updated database that keeps us, and the 340B hospitals we serve, compliant. At the same time, by keeping detailed electronic records on every prescription those health systems’ 340B contract pharmacies fill, we can instantly produce all the evidence they would ever need to address an unfounded non-compliance citation.

Providing instant access to NDC numbers

The 340B program runs off of NDC (National Drug Code) numbers. Restrictions, pricing, everything is centered around those NDC numbers. The problem for 340B hospitals is, some EMRs either don’t provide NDC numbers, or provide only the NDCs used for years at the original implementation — which makes them very hard to maintain in the EMRs. Since very few hospitals have the in-house manpower to dig into their systems and determine NDC numbers (separate and apart from the drugs’ names), our data department has assigned NDC numbers to all the drugs by name. “That’s a huge step forward,” Clay says, “because now we don’t have to wait on healthcare entities for those numbers.”

Positively impacting 340B charity support. And hospitals’ self-insured plans.

ProxsysRx’s Analytics database can be used to help financially-struggling patients with prescription-payment assistance programs.

“We can also positively impact the self-insured plans of health systems we serve, by reporting which drugs are most costly to them, and which of those drugs are 340B eligible. If a hospital has an employee-funded plan, we can point their employees to qualified providers and pharmacies they can use to optimize their prescription savings. When we help hospitals lower their costs, they can pass-along those savings to employees in the form of lower co-pays. The opportunities are endless.”

ProxsysRx’s 340B Analytics Platform: Background

Our 340B Analytics platform started with the same basic question that drives virtually every technology innovation: “What if we could…?” Its development began while we were preparing the 2019 launch of our 340B support services, when it became clear to our team leaders just how critical automation would be to the success of our services — and to our client-hospitals’ 340B programs.

Advantage ProxsysRx: Our 340B Analytics’ Project Manager

Before making a career pivot into data analytics, Clay Cooper was a licensed pharmacist for 10 years. That background, he notes, gives him a particular advantage as the 340B Analytics project manager. “I understand the nuts and bolts of pharmacy, and where 340B fits within the spectrum of healthcare, clinical, prescriptions, refills and disease states. I also understand our platform’s technical nuts and bolts. Which means that when someone from the 340B team has a new-feature request, they don’t have to waste a lot of time explaining it to me.

“I can then take each request back to my technical team, and explain it to them in terms they understand. And when they’ve developed a solution, I can offer them quick feedback on whether or not it looks right — and whether or not it will work in the real world.”

Clay estimates that, on average, he receives a new-feature request at least once a week. “Whenever we have a large goal to achieve, we break it down into small steps, and achieve the larger goal in increments. We test each new step and look at its impact on the entire platform’s performance, and on the user experience for our 340B team members — as well as for the people using the platform in the health systems we serve.

“That last component, user experience, is absolutely critical,” Clay concludes. “At some point, anyone who’s ever used technology has been forced to accept product updates that ultimately made a familiar app harder to use — and that’s something we never want to do with our 340B platform.”

ProxsysRx is here to help, if you have questions.

There are so many ways to optimize 340B drug programs’ savings and benefits, while minimizing the likelihood of noncompliance — using the optimal combination of 340B software solutions and experienced, expert support. For more information, contact Howard Hall. C: 205.588.0946 | howard.hall@proxsysrx.com

Recommended For Further Reading:

Specialized Software Can Only Do So Much For 340B Programs

 

 

Leave a Reply