A never-ending challenge for healthcare organizations is enhancing provider efficiency, improving patient drug adherence, and reducing drug costs. One of the most useful yet overlooked areas is ensuring better benefit data and more intelligent alternatives are delivered during the prescription workflow.
Unfortunately, organizations encounter a variety of obstacles ranging from outdated systems to pervasive skepticism on various fronts. This includes but is not limited to the perceived utility of Formulary & Benefit (F&B) data, the false perception that updated formulary education will be ignored, and the necessity of engagement relations teams educating providers. In this article, we will break down these misconceptions through our own experiences and data that indicates nothing could be further from the truth.
Benmedica has dispelled misconceptions by delivering a proven solution that has implemented formulary changes successfully alongside its smart drug alternatives.
The impact has been measured across 29 states, multiple lines of business, and over 12.5 million members throughout the US by a major health plan sponsor. By delivering accurate, enhanced F&B information and drug alternatives at the point of prescribing without any provider engagement, inherent adoption and significant savings were successfully demonstrated.
That said, it is important to recognize that active relations and programs with providers will accelerate a healthcare organization's ability to maximize the benefits.
Misconceptions Uncovered Related to the Benefits of F&B Data
This article reviews the voice of the customer uncovered by Point of Care Partners (POCP) as they developed a pivotal whitepaper, “From Ignored to Impactful: Maximizing Payer Value through Formulary Validation, Intelligent Alternatives and Real-Time Benefit Check at Point of Care.”
POCP conducted 12 one-on-one interviews with top leaders of major payers, PBMs, and other healthcare organizations. Benmedica has also acquired feedback from its Pharmacy and Therapeutics (P&T) committee members among other sources.
Misconception 1: There is High Complexity in Updating F&B Information
The process of updating Formulary and Benefit (F&B) data is often viewed as daunting. Many PBM stakeholders perceive it as a significant undertaking, and that is fraught with complexities while placing a substantial burden in terms of user training requirements and technical implementation.
This perception is deeply rooted in the historical context of these systems, where bandaged solutions were created, with most not having seen significant technological investment or upgrades in a decade (or two!). The lack of investment has inevitably led to an ecosystem resistant to change, where the mere idea of updating F&B data can seem overwhelming. The payers have the data to support online members and adjudication, but the systems are disparate so merging them to create usable extracts is a major lift.
By delivering accurate, enhanced F&B information including drug alternatives at the point of prescribing without any provider engagement, inherent adoption and significant savings were successfully demonstrated.
Benmedica aggregates many disparate payer data sources to deliver its Precision F&B™ information, which reduces the complexity of the implementation, generating savings for patients and payers in the native EHR workflows without requiring integration.
Virtually all EHRs support F&B, which can automatically be delivered using existing data streams with no effort on the part of the EHR and little on the part of the payer.
Misconception 2: Adoption of Lower Cost Drug Alternatives Guided by F&B Requires Provider Education and Incentives
Health plans have many priorities that consume their engagement teams beyond communicating and educating F&B improvements with health systems and provider organizations. Quality metrics, including those impacting Medicare Part D Star Ratings, are typically a high incentive priority.
In addition, value-based care or accountable care organizations (ACOs) are also another priority. Many believe that improvements in F&B data would require education or a refresher of their provider community and incentives.
However, this is not our experience. F&B has existed in EHRs for more than two decades with improvements in the information appearing automatically in the physician workflow. And, as a bonus, enhancing F&B data improves the Star Ratings and value-based savings.
Benmedica’s experience is that savings for patients and the plan sponsor appear seamlessly and immediately on implementation without any physician engagement or incentives required for an inherent adoption, significantly lowering drug costs while enhancing efficiency.
Misconception 3: Simply Updating F&B Data Will Not Generate Savings
A prevalent skepticism within the healthcare sector is the belief that updates to Formulary & Benefit (F&B) data will not translate into actual savings. This doubt stems from the assumption that providers will overlook the updated information—whether based on a bad experience with incorrect data, habitual practices, resistance to change, or simply the overwhelming volume of daily information.
Benmedica has proven that significant savings will occur despite many believing providers will overlook the information. Therefore, delivering the enhanced F&B data with accurate and relevant information impacts prescribing, especially over time.
Misconception 4: F&B Data is Often Not Accurate or Relevant
Despite the critical role that Formulary & Benefit (F&B) data plays in the prescribing process, a significant challenge persists regarding the accuracy and relevance of the information delivered to healthcare providers. Many prescribers express concerns that the F&B data they receive is inaccurate and/or not sufficiently tailored to their patient's specific needs.This can be due to the quality of F&B which can vary between payers.
This complicates decision-making processes and potentially affects patient outcomes. This discrepancy between the expectation and reality of data utility can hinder the effective use of F&B information in clinical settings.
One respondent in a recent study on physicians’ views on non-formulary prescribing noted, “..the formulary itself should be up to date. We cannot ask people to provide the best possible care for their patients if your formulary is not up to date.”
In fact, "providers who have access to eligibility and formulary information tend to use it heavily.” This is further illustrated as “90% refer to the patient’s formulary information within the EHR. And nearly all say they value access to group/plan-level prescription benefit information within the e-prescribing workflow." (source)
Benmedica enhances the accuracy and succinctness of F&B data to significantly improve its utility, ensuring that prescribers have access to relevant information that is also directly applicable to the care of their patients. Addressing these issues requires a Benmedica solution to provide reliable information including drug alternatives that will save payers and patients money.
Misconception 5: Real-Time Prescription Benefits (RTPB) is the Ultimate Solution
As the healthcare industry seeks efficient ways to manage rising prescription costs and enhance patient care, Real-Time Prescription Benefits (RTPB) information is increasingly touted as the definitive solution. This approach offers several distinct advantages that reshape how prescription decisions are made at the point of care.
F&B Enhances Use of RTPB
When F&B data is precise and up to date, it enhances the utility of RTPB by supporting the prescribing decision-making so that by the time the RTPB is run, the optimal drug is submitted. It’s important to recognize that RTPB can only occur just after the prescription is completed. This means the prescriber is “done” with the prescription and ready to move on to the next task. Unless RTPB presents a significant warning, the prescriber is ready to submit the prescription.
This leads to minimal surprises, and the cost information provided is relevant to the patient's specific benefits package. This synergy allows healthcare providers to make cost-effective prescribing decisions confidently.
RTPB without F&B Misses Information
If F&B is bypassed, RTPB will miss significant information and prevent providers from seeing a better list of drug alternatives. Given this lack of transparency and the fact that providers will have to rework prescriptions when relying on RTPB capabilities, it’s critical that EHRs provide guiding F&B data at the start of the prescribing workflow.
These insights underscore the foundational role of accurate and timely F&B information in enhancing RTPB systems' functionality while fundamentally improving the prescribing process. F&B informs the drug selection process. RTPB is further insurance against more costly prescriptions displayed to providers when more cost-effective options are available.
The reality is that the provider interviews recognize that the best time to see coverage information is at the time of drug selection, not after the prescription has been completed and is about to be submitted. Informing the initial choice of prescribers can provide more benefits than after the drug has been selected and the prescription has been entered into the system.
Benmedica offers the most Intelligent RTPBTM to complement Precision F&B™ and SmartAlts™ providing a seamless workflow between F&B and RTPB data at the point of prescribing. By having this information in their native EHR workflows, providers inherently adopt the selection of the lowest-cost drug alternatives without engagement or incentives.
Proof of Effectiveness: The Impact of Benmedica on Healthcare Cost Management
The transformative impact of Benmedica on prescribing and healthcare cost management is supported by proven evidence of effectiveness and efficiency. This section explores how Benmedica's innovative solutions have proven to not only enhance the quality of healthcare information but also deliver substantial cost savings with streamlined processes.
Documented Savings: A Case Study
One of the most compelling examples of Benmedica's effectiveness is a documented case study where a health plan saved $90 million after implementing Benmedica's solutions. This translates to over $150 million on an annualized basis. This significant cost reduction was achieved through enhanced prescription drug selection, which reduced unnecessary spending and optimized medication use across the board.
Benmedica’s Precision F&B and SmartAlts delivered the case study results, which automatically appeared in EHR workflows in 29 states across the US. The implementation focused on importing, enhancing, and automating the formulary data process, which allowed for improved data dissemination among prescribers.
This provided enhanced information and enabled more accurate prescribing, directly translating to substantial cost savings.
What’s Next? Taking Action to Increase Savings Today
The healthcare sector faces a complex array of hurdles in addressing Formulary and Benefit (F&B) data management, from the misconceptions of costly physician engagement to the skepticism about the tangible benefits of updates. Despite these legacy viewpoints, the introduction and application of Benmedica's solutions overcome these challenges and leverage innovative technology to revolutionize ePrescribing practices. Benmedica's solutions have proven exceptionally effective, evidenced by substantial cost savings, improved data accuracy, and enhanced usability that integrates seamlessly within healthcare EHR workflows without any integration required.By providing up-to-date, relevant F&B information directly within prescribers' EHR workflows, Benmedica ensures that the data is not only accessible but also actionable, leading to better patient outcomes and more efficient healthcare delivery while minimizing the cost to implement.
Moreover, the opportunity to combine the power of Benmedica’s Intelligent RTPB™ solution adds a layer of immediacy and specificity to the cost information available to prescribers, further enhancing the decision-making process at the point of care. This synergy between updated F&B data and RTPB systems demonstrates what can happen when information is precise, timely, and user-friendly. As a result, the potential for improving healthcare efficiency and effectiveness is profound.
Benmedica's market-leading, holistic approach not only addresses immediate challenges but also sets a new standard for what can be achieved in healthcare technology. For healthcare organizations seeking to reduce costs, enhance operational efficiency, and improve patient care, Benmedica’s comprehensive solutions can offer substantial promise. By adopting Benmedica’s solution, healthcare organizations can ensure they are equipped to meet the market's demands for high-quality, cost-effective care. Explore Benmedica's offerings today to see how your organization can benefit from the next generation Benmedica solution.
Ready to optimize formulary and benefit management to maximize savings with Benmedica? Click here to learn more or request a demo.