Take control of your pharmacy profitability through analytics.
Maintaining profitability is increasingly challenging for pharmacies.
The shift in healthcare from the fee-for-service business model to value-based reimbursement can be overwhelming, and there is still more change to come. There are different contracting models for Medicare, HIX/Marketplace plans, Medicaid. CMS is adding new measures and adjusting thresholds on others. Plans are responding by aligning formularies, clinical strategies, network contracts, and promotions with Star Ratings measures; and by moving towards pay for performance and narrowing their preferred networks based on quality and value criteria. Meanwhile, the average retail pharmacy has $50,000 to $100,000 in reimbursements at risk in 2016 for quality, and this will continue to grow.
Without the proper tools or the required visibility into overall business activity, pharmacies cannot make informed decisions how to be more successful and better protect margins in today’s marketplace. Inmar’s Pharmacy Performance Analytics web application provides the data and leverage needed to work with carriers for better reimbursement rates, and positions you for success in value-based reimbursement through measuring quality at the contract level, forecasting DIR fees, modeling financial upsides and downsides of different scenarios, and pinpointing which patients need what services.
Our patented contract rate reconciliation program automates the highly complex process of matching pharmacy claims to the reimbursement contracts for those transactions. It allows Inmar clients to review only claims where the reimbursement rate is not compliant with the contract.
With contract profitability and performance management, clients can quickly view carrier and contract profitability and benchmark carriers and drugs on key metrics. Comprehensive modeling tools measure the financial impact of contract and industry changes.
Pharmacy Performance Analytics identifies unacceptable reimbursement rates, enables informed decisions regarding preferred drug recommendations, U&C price optimization and improved acquisition costs; helps you negotiate to improve reimbursement rates and profitability, increase dispensing fees and reduce transaction / service fees. It also helps you evaluate and manage the impact of DIR fees, and improves procurement analysis and helps you manage generic volume fluctuation.
Clients can also document the actions they take to improve and measure the results. Our web-based workflow tracks revenue improvement resulting from reimbursement and cost adjustments right on the screen.
Ultimately, Pharmacy Performance Analytics provides clients with a method to ensure they are paid the correct amount for each receivable; shows the true value, or lack thereof, in each contract; improves contract negotiations to increase profitability and enables a successful transition to value-based reimbursement.
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Ready to learn more about Pharmacy Performance Analytics or another Inmar product or service? Contact us using one of the methods below and we’ll be happy to help.