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NACDS Cover Story

MedImpact leverages advanced technology and network solutions to improve member experience and reduce costs for our pharmacy partners

Dave Halter Cover Story
BY: DAVE HALTER

The U.S. spends more per capita on healthcare than any other country in the world, but it has a high prevalence of diabetes, worse cardiovascular outcomes and lower life expectancy compared to other high-income countries.1 U.S. healthcare costs reached $3.6 trillion in 2018 and spending is anticipated to soar to nearly $6 trillion by 2027.2 However, the U.S. ranks poorly in health system performance.3

Our nation’s unsustainable healthcare costs are forcing the industry to recognize — from a cost and outcomes perspective — that it’s more efficent to move toward a healthcare delivery model based on performance, value and outcomes.

As the industry migrates away from fee-for-service reimbursement and moves toward pay-for-performance models, pharmacies will no longer get paid simply for providing services like dispensing drugs.

Pharmacies are the most frequent touchpoint in all of healthcare that a member experiences.

PBMs can help improve outcomes and reduce costs by offering high-performing pharmacy solutions that drive quality care by influencing behavior change, increasing clinical value, and improving adherence, safety and member service.

Research also reveals that every $1 invested in pharmacist clinical services results in nearly $4 in benefit.

Industry-Leading, Transparent Technology Saves Time & Money

MedImpact partnered with NCPDP to develop the first industry Pharmacy Portal that accesses NCPDP's resQ data in real-time.

By leveraging industry efforts like NCPDP's resQ, MedImpact helps eliminate significant ongoing operational and technology costs and reduces overhead associated with managing network member pharmacies. 

Our Pharmacy Portal is designed to make network enrollment and credentialing easy and transparent. Pharmacy users can use the same user login credentials to access the MedImpact Pharmacy Portal as they do to update their NCPDP pharmacy profile.

This innovative technology also enables MedImpact to use all the data and documents uploaded to NCPDP's resQ as part of our enrollment and credentialing processes, eliminating the need for pharmacies to respond to redundant “asks” for information.

By working closely with our pharmacy partners, MedImpact helps streamline the onboarding process, identify potential issues and save PSAOs time and money.

Clinical Indication & Efficacy

MedNetwork® Performance is a transparent, high-performance pharmacy solution that leverages advanced analytics and reporting that scores pharmacy performance to help guide pharmacies to reduce costs and improve member adherence and outcomes across all channels:

  • Pharmacies can maximize outcomes and differentiate with enhanced clinical consultative services to improve adherence and member experience. Transparent, data-driven performance metrics in comparison with non-participating or low-performing networks can increase sales and volume
  • Members can improve adherence, outcomes and their overall experience with deeper pharmacist engagement
  • Health Plans can improve outcomes — quality, financial and member— with transparent pharmacy performance reporting

Similar to CMS Star Ratings, MedNetwork scores and ranks pharmacy performance for pharmacies and plan sponsors. We apply cluster analysis to categorize and distinguish network performance, allowing them to maximize quality care while reducing costs.

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1 Instituter of Medicine. 2013. U.S. health in international perspective: Shorter lives, poorer health. Available: https://www.ncbi.nlm.nih.gov/books/NBK154469

2 CMS, 2019: National health expenditure projections 2018-2027. Available: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ForecastSummary.pdf

3 Commonwealth Fund. 2017. Mirror, Mirror 2017: International comparison reflects flaws and opportunities for better U.S. health care: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and Reports/ National Health Expend Data/ Downloads/ ForecastSummary.pdf

4  Manolakis PG, Skelton JB. 2010. Pharmacists’ contributions to primary care in the United States collaborating to address unmet patient care needs: The emerging role for pharmacists to address the shortage of primary care providers. Am J Pharm Educ 74(10):S7: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058447

 

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