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Pharmaceutical Technologies, Inc.® and the National Pharmaceutical Network pharmacists have been working together for over a decade to bring you the best and most flexible pharmacy benefits programs available today ! We deliver to fully insured or self funded group health insurance and workers compensation plan operators a dedicated staff trained in providing you with a turn-key solution to your pharmacy benefit management needs. We provide the infrastructure and you choose the cost containment and claims features and protocols that you believe will deliver the best services at the lowest possible claims costs. Of course this means we deliver the finest in Smart Disease State Management™ along with the following Program Components. Please take a few minutes to view some the Reports available as part of our standard administrative package. Member Identification, Risk Assessment, and Stratification A highly developed identification, risk assessment, and disease stratification method is used to identify disease state management candidates. Members have the right to opt-out, decline participation, revoke consent, or disenroll at any time. Evidence Based Clinical Practice Guidelines Decision support tools that utilize evidence based clinical practice guidelines, are utilized to support protocols and therapy guidelines for clinical and medication management of targeted disease states. Patient Education An initial educational packet containing helpful self-monitoring charts, a resource listing, and other disease-specific self-care tips is sent to the home. All members also receive a quarterly disease-specific newsletter, providing up-to-date information on the disease and helpful lifestyle, behavior modification programs, and self-care information. All patient education materials encourage communication with practitioners regarding any healthcare needs or assistance. Provider Communication Ongoing provider communication is an essential component of disease state management programs and helps to ensure physician understanding of the needs of disease state management members. Providers receive an introductory packet with disease-specific guidelines, quarterly communication, and ongoing member reports, which include information on the member’s health status, symptom severity, identified risk factors and compliance issues. The frequency of reporting is based on the member’s severity/compliance levels. Providers are contacted on an as-needed basis dependent upon concerns identified during an assessment and/or follow-up calls and/or educational sessions. Pharmacy Communication On-line drug utilization review edits are blocked from payment at the point of sale pending appropriate interventions from pharmacy providers. This tool protects plans and employers from claims cost associated with inappropriate therapy and or prescribing due to drug/drug interactions, allergy/disease state interactions. Patient Satisfaction Member satisfaction surveys are conducted annually to develop a routine feedback loop for program evaluation and development. Outcomes Reporting Semi-annual outcomes reporting is provided on total cost analysis, utilization, medical and clinical interventions, comprehensive care measures, patient adherence/compliance, patient health status, drug utilization review interventions, clinical and cost measures, as well as health care cost reductions. Compliance Management Patient medication compliance adherence is monitored utilizing medication possession ratios. Over/underutilization issues are identified and communicated to providers depending upon risk stratification levels. Patients are reminded of medication refills through pharmacy refill reminders and renewal reminders via email or mail. Interventions Focused interventions targeting members with the greatest potential for improved outcomes based on a stratified risk assessment measure. Different interventions for each risk level. Proprietary, evidence-based, clinical software that houses protocols that drive the intervention process and stores member data including pharmacy, compliance, clinical values, and clinical stability data. Interventions include, but are not limited to, the following: 1. Preferred Drug Utilization – Supports appropriate drug utilization and patient conversion to preferred medications within plan benefit design specifications. Encouraging the use of appropriate and cost-effective medications in accordance with accepted clinical and medical guidelines. 2. Drug Interaction Management – Identification of serious drug-drug interactions and ensures appropriate intervention by pharmacy providers to correct therapy. 3. Drug-Disease Management – Identifies patients with serious drug-disease interactions or contraindications and ensures appropriate interventions by pharmacy providers to correct therapy. 4. Drug – Age contraindications 5. Drug – Gender contraindications 6. Clinical Guidelines Therapy Management – Encourages evidence-based protocols and therapy guidelines for drug management of specific disease or therapeutic class by on-line edits and clinical consultations. 7. Therapeutic Duplication 8. Multiple Medications 9. Excessive Duration Confidentiality All information obtained and used in disease state management programs shall be used for the sole purpose of maximizing optimal outcomes for the patient through efficient and cost conscious resource utilization. The patient has the right to expect that their personal data and medical information will be kept confidential, and that all information shall be on a need to know basis to ensure privacy and confidentiality. The patient has the right to expect that all services and aspects of the program are designed to be an advocate for the patient. The patient has the right to be supported in their decision-making ability to interact with their healthcare providers to be informed and make decisions about their treatment options, whether covered or not by their plan sponsor.
By implementing these programs, which are designed to improve our clients’ compliance with certain quality initiatives established by the National Committee for Quality Assurance (NCQA), American Accreditation HealthCare Commission (URAC), and Joint Commission Accreditation for Hospital Organizations (JCAHO), our clients are able to utilize healthcare resources more efficiently, manage costs more effectively, and improve the quality of life for their members. The result is standardized high-quality patient care, improved clinical outcomes and reduced healthcare costs.
If you would like more information please send us an email at ORDER The Pharmacy SmartCard NOW!
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