PBM – Health Plan Insights

What a Health Plan Wants, A Health Plan Gets

Recently, polling and speaking with government programs service directors of PBMs, revealed mindsets that their existing workflows are adequate to maintain Health Plan loyalty. That’s not surprising. How do you feel about those workflows? Health plan surveys, show they do not always agree. Research indicates that this process potentially opens the door to risk, reputation loss, wastes time, and resources.

What Health Plans Want

Of course controlling drug spend is the main focus of PBMs, however, health plan loyalty demands more services that assist the health plan manage their spend, government regulations and, branding promotion.

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Industry Challenge – PBM

Just the other day we were speaking to a rather large PBM at CAHP and they were astonished to find out that the internet use demographics for Boomers on up was surprisingly higher than they thought, and that by 2018, most would be on the internet. Think about it, grandma and grandpa are retired, and their link to their families are social media sites such as Instagram and Facebook, where they share pictures and stories.

social media elders

How To Fix It

how to fix it - pbm

how_to_fix_it_lettersThe most successful directors solve this by using processes that embody streamlined tools that very simply empower them to:

  • Request, View, Approve and centrally file a “library” of components available for use in their EOB, TL, IDN and/or other kit fulfillments
  • Define Campaigns when, how frequently and by what compliance dates materials need to be delivered
  • Define the Contents of their kits – specifying particular versions (including foreign language support) and sequences of content
  • Associate designed kits with campaigns
  • Make a Secure Way to upload and validate fulfillment lists and create fulfillment jobs
  • Define when lists are ready, review online proof, and approve fulfillments scheduled to run
  • Make Fulfillment run through a HIPAA compliant e-Presentment or print production facility (local printers are not typically HIPAA compliant)
  • Produce in a manner that avoids “death by email and attachments”
  • Report Posts Back to APIs with search functionality archival ready for CMS audit and other reporting functions

Solutions – Differentiate From The World

ABG Communication’s BridgeSuite™ is the only HIPAA compliant Healthcare Technology Enabled Services Platform that innovatively streamlines workflows managing FTE and compliance costs:

Offers Threshold Language Execution, Automated test scripts, Versioning Templates, Centralized Workflow, Reporting mechanism for Star Measures, Programmatically checks followed by Service QA checks, e-Presentment/Mail Engineering Optimization Consulting & Double Checks, Real-time templating for Instant Proofs, CMS Domain knowledge of Templating all while Boosting to the Health Plan’s portal. Remember, when your car is broken you call a mechanic not a doctor. Health plans take care of members. Fulfillment engineers take care of the communications for those valuable members.

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  • Member Outreach Campaigns
  • Self-Administered Test Kit Fulfillment
  • Member Satisfaction Surveys
  • Medication Therapy Management Communications
  • Clinical Letters
  • Pharmacy Adherence, Drug Recall
  • Medicare Part B, C and D Member Communications
  • EOB’s, IDN’s, Transition Letters, DMR’s, etc.
  • ID Cards
  • Commercial Plan Communications
  • Data-driven Directories, Formulates
  • Member Plan Information Kits
  • Annual Notice of Change (ANOC/EOC)

globe 2017PBM – Pharmacy Benefit Management

  • Clinical Letters
  • Denial Notices
  • Direct Member Reimbursements
  • Drug Recalls
  • Explanation of Benefits
  • ID Cards
  • Medicare part C & D
  • Prior Authorizations
  • Transition Letters

ABG White Paper

$700,000+ in fines saved

Whether you’re a plan administrator, a clinical communicator or a healthcare marketer, developing… Download the Member Communications guide:

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