Custom, Automated 340B Solution for PBM

The Client

The client is a leader in providing automated PBM solutions for managing drug discount programs such as the 340B. In 2007, they partnered with leading community health administrators, health centers, hospitals, doctors, pharmacies, and covered entities to develop their flagship 340B solution from the ground up. Since then, the client has provided simple, cost-effective, and easy-to-manage 340B services and other discount drugs programs to safety net organizations across the nation.

The Challenge

The client was dependent on an antiquated order processing system that was time-consuming and unreliable. Also, their legacy systems needed automation to deliver customized services for healthcare centers, contract pharmacies, and wholesalers. Some of the other challenges included: 

• Unable to coordinate billing with other entities 
• Unable to create enough orders for 340B NDCs to meet the threshold 
• Expired inventory and high carrying costs 
• Lack of formulary automation and sliding fee scale 
• Unable to provide low-cost drugs to its patients

The Solution

After a thorough understanding of the client’s business challenges, Excellarate offered a multi-pronged approach to help drive transformation and operational efficiency by improving the core components of the client’s PBM platform.

• Built an inventory system to process all incoming claims and purchase orders, update order statuses, and replenish inventory in real-time
• Automated claims and billing processes to ensure that each transaction happens in real-time
• Developed an integration engine to process real-time incoming messages from various entities such as Health Centers, Wholesalers (Cardinal), PBM (Med Impact), and Switches
• Created dashboard reporting through data warehousing and business intelligence implementation
• Provide ongoing technical support and enhancements to stay up-to-date with regulatory compliance

The Outcome

The system now supports more than 1500 Pharmacies, 366 Covered Entities/Health Centers,8 Wholesalers, captures more than 8000 claims, and processes millions of them. The client’s 340B platform manages inventory and financial transactions between health centers, contract pharmacies, and wholesalers to maintain compliance with the program requirements. 

• Captures all prescription claim transactions at the switch, across multiple entities
• Accurately determines patient eligibility by syncing claims to patient encounters and other criteria
• Manages inventory and places wholesaler orders
• Reports popular metrics for tracking results
• Receives automated payments to ensure seamless functioning
• Patient Assistance Program (PAP) was made easier
• Automated formulary to ensure patients pay the lowest price

In addition to significant cost savings and enhanced patient care, the client improved healthcare outcomes by providing better access, mitigating risk, and adhering to compliance standards.

• On-time delivery of the inventory (340B) System
• Robust and scalable architecture that supports a suite of web applications for all the entities in the healthcare system
• Enabled cross-platform integration to improve third party coordination for billing, claims, eligibility processing, and formulary management
• Implemented a document repository for internal use
• Reduced patient data lags and issues like identification of junk data from actual data
• Reduced time to execute data specific integrations to new customers from 1 month to 2 days
• Role-based access to the applications that are easy to configure
• Meets all HIPAA requirements for security