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Big Data Analytics Available to Everyone
The majority of healthcare organizations identify that analytics is a global industry weakness. Pro Pharma’s Analytical Team (29 years of experience) provides analytical expertise and solutions for managing Healthcare Medical & Pharmacy Benefit
Pro Pharma’s Suite of Management Tools™ and Team of Analytical Experts are world-class in assisting clients with establishing a 360° view of benefits and costs integrating pharmacy, medical, and Worker's Comp to identify the drivers and “drain” in the entire program. This, in turn, creates prescriptions for productivity and change, and implements cost-efficient quality improvement measures to ensure an increased Return-On-Investment (ROI) to meet organizational goals and expectations. Dr. Stern goes on to state that “solutions exist to solve problems and provide measureable results. Pro Pharma has been working with payers to solve these issues utilizing data analytics with tremendous success.”
“At a minimum effective Data Analytics saves time, resources and expands the in-house capabilities of an organization”
In summary Big Data Analytics does not have to be in the domain of analysts, but conversely can be available to anyone in an organization.
More specifically, Pro Pharma’s Team of Analysts has been supporting Clients who need:
- Assistance building their own Analytics internally
- A bridge for Analytics until their internal systems are in operation
- Back Office Support (hosting) for those Clients who require more comprehensive “just in time” support
In addition, Clients have asked for specific one-time Analyses that can be addressed quickly, and with a minimum of resources at an affordable cost.
All Analyses are based on Client-specific Pharmacy and/or Medical Claims data and can be in any format that Clients have available, for example.
- Market Share Cost Accounting of Pharmacy Spend
- Custom MAC™ benchmark pricing using a checklist for choosing custom parameters
- Pharmacy Network Provider Discount Analyses
- Analyses of Top Pharmacy Providers for Claims paid below cost leading to potential abuse
- a bridge for Therapeutic Categories GPI-to-GCN, or GCN-to-GPI bridge file
- a Medicare Federal Requirements Bridge File
Mapping of Enrollment and/or Networks
- Geo-access Maps
- Network accessibility Maps
- Population Maps
- Disease Maps of the population
Age/Gender Banding of the population AND
- By Top Drugs used in each band
- By Patient Severity
Fraud Waste Abuse (FWA) Analyses (predicated on profiling and trending of Claims experience over time)
- By Provider
- By Pharmacy
- By Patient
If you have an immediate need, we would appreciate the opportunity to demonstrate the power of these tools and the time-saving ability to answer your management issues and questions.
If you are interested, please contact us via email at carol.stern@
About Pro Pharma Pharmaceutical Consultants, Inc.
PRO PHARMAis a multi-service, woman owned, privately held consulting firm offering a vast portfolio of services to public and private entities including self-insured employers, Taft Hartley Trusts and unions, public employers, for-profit hospitals and integrated health networks, health care insurance companies, worker's compensation insurers, small-to-medium sized HMO's, and physician groups.
As a primary service to plan sponsors for achieving below trend results, PRO PHARMA provides an integrated program of administrative process improvements, clinical quality oversight, and provider/member education.
Pro Pharma’s Consulting services are grounded in the use of data and the communication of that information to define benefit trends, drivers and other analytical indicators. PRO PHARMA markets Comprehensive Specialty Analyses™, JCode Calculator™, Invoice Screening ™, Pro Pharma Suite of Tools™, Rx MAC List™, Quality Management Program™, Treatment Calendar™, and Biotech Modeling™. The Pro Pharma directly markets its products in the U.S. and collaborates with partners to reach international markets.
About Comprehensive Specialty Analyses™
Comprehensive Specialty Analyses™ utilizes a multi-pronged approach to analyze pharmacy and medical encounter claims through problem flagging, feedback on performance, peer to peer comparison, and others parameters. Comprehensive Specialty Analyses™ specifically identify pricing differences, usage, trends, and actionable opportunities in the medical data that were not apparent in the past. In order to achieve these goals it is necessary to view the Medical Data from multiple perspectives, i.e., a 360 degree view that allows for seeing beyond the obvious of top drugs spend and top providers as well as compare and contrast it with the Pharmacy Claims Data.
About JCode Calculator™
Pro Pharma has developed a Standardized Injectable Fee Schedule to assist with the management of claims payment. The advantage to this product is that it bases all Injectable reimbursement on AWP, WAC and ASP cost, and can be customized for drug category discounts or multiple discounts based on drug type or specialty. It includes at least one AWP for every HCPS Code and CPT code description;
About Invoice Screening™
About 10% of drugs spend is being paid from PBM Invoices, and should have been rejected by clients prior to payment. Pro Pharma’s Invoice Screening™ analyzes invoices against: formulary compliance, compliance with MAC pricing, eligibility, claims pricing, invalid claims, and excluded benefits, pre-payment as an Accounts Payable function. This ensures that clients only pay for valid claims, which saves time and dollars in the long run.
Please visit the Pro Pharma Pharmaceutical Consultants, Inc. Website for more complete information at http:www.propharmaconsultants.com
Carol Stern, CEO