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Navigating Healthcare and Improving Outcomes
Achieving Outstanding Results with Tailored Network Strategies
A medium-sized city in Michigan with 1,350 members was seeking ways to lower its pharmacy benefit costs, which were growing under its existing traditional pharmacy benefit manager (PBM). With its member covered by a two-tier, open formulary including…
Breaking Through Barriers with Value-Based Plan Design
Facing increased pharmacy benefit expenses, Blain’s Farm and Fleet, a Midwestern employer group, desired to improve plan performance. Specifically it was interested in educating eligible members about the benefits available to them, promoting cost-effective…
Finding a Solution to Lower Prescription Drug Costs
The Rural Arizona Group Health Trust (RAGHT) wanted to gain better control of its escalating drug trend with its large, traditional pharmacy benefit manager (PBM). Having only worked with traditional PBMs in the past, RAGHT was interested in exploring…
Empowered by Strategic Opportunities and Service Excellence
Putnam | Northern Westchester Health Benefits Consortium (PNW HBC) was the first municipal cooperative health plan in the state of New York to become certified by the Department of Insurance. They are dedicated to meeting — and exceeding — the standards…
QUALYiQ Program Delivers Significant Savings for Both Members and Health Plans
As part of their treatment plan for hypophosphatasia (HPP), a rare genetic disorder affecting bone and teeth development, one of our members required Strensiq, a medication designed to manage HPP. However, Strensiq’s annual treatment costs ranged from…
RISE: Reporting and Intervention for Stars Excellence
RISE is a comprehensive Star Ratings Improvement program that focuses on positive outcomes for Medicare Part D (Part D) clinical measures, including: medication adherence for diabetes medications, medication adherence for hypertension, medication adherence…
Medication Therapy Management: Improving Health Outcomes and Reducing Cost
Patients with chronic diseases can face greater risks for medication-related challenges such as non-adherence. This can lead to poor health outcomes and higher plan costs. That’s why we developed an MTM program, offered through our Clinical Engagement…
Personalized Member Transitions: Creating a Smoother Benefit Transition
Navigating benefit transitions is no easy task. Our personalized member transition (PMT) program makes it smoother for both plan sponsors and members. Through our high-touch outreach to members, we eliminate gaps in care, minimize member disruption, improve…
Pharmacy and Practitioner Exclusions and How to Resolve Them
Prescribers and Pharmacies can be deemed ineligible for providing services to government programs like Medicare, Medicaid or even to payers who are participating in government programs. Being ineligible to provide those services is commonly referred to…
