Health System

Assessment of Specialty Generics Contract with PBM

IndustryHealth System
ProblemA health system made a change in their PBM contract to separate specialty products into brand and generics. The client reached out to PHSL to ensure this was a financially beneficial decision and to aid in planning for future negotiations.
PHSL SolutionPHSL reviewed specialty generic rates using prescription claims data, reimbursement rates, and acquisition cost trends to provide insights on the resulting change for the health plan.
ResultsPHSL’s data analysis indicated specialty generics follow a trend similar to non-specialty generics. This validated that a separate contract rate for specialty generics was a favorable decision the client, based on their specific book of business, and gave them the guidance to shape future decisions.

Health Systems Seeks Insight on Increasing Biosimilar Adoption Rate

IndustryHealth System
ProblemA client was seeking data analysis to evaluate and forecast whether increasing their use of biosimilars would lower their cost of providing services across different lines of business. The client needed a financial model estimating if the switch to biosimilars would be beneficial across their health system.
PHSL SolutionPHSL used multiple processes to analyze and compare biosimilar data with innovator products. PHSL reviewed quarterly pricing changes, reimbursement models, and ASP value trends to provide an estimated model for the client to measure the impact of biosimilar adoption, which also considered the impact of rebates.
ResultsPHSL’s projected model indicated that increasing biosimilar usage can be beneficial to the health system. The model gave the client insight by line of business where biosimilars could generate savings and assisted management to determine the future strategic direction.

Ambulatory Pharmacy Operations – Strategic Assessment

IndustryHealth System
ProblemA health system pharmacy was planning an accelerated expansion of their ambulatory pharmacies and wanted a review of their operational controls and management system. The health system desired the assessment to ensure the strategies and processes for their ambulatory pharmacy program were scalable and sustainable.
PHSL SolutionPHSI conducted on-site interviews to understand the current ambulatory pharmacy operations and the strategic intent of the pharmacies within the health system. PHSI collected information to analyze the organizational structure, evaluate operational controls, benchmark financial performance, and conduct claims margin optimization analysis. PHSI used this information to provide actionable recommendations that were prioritized for realizing the financial benefits identified.
ResultsThe health system pharmacy used the assessment to refine their strategies and tactics, while focusing on improving customer service and financial results. The assessment provided specific recommendations that enabled senior health system management to better understand the business drivers of their ambulatory pharmacies. Tactical recommendations have been implemented by operations management.

340B Compliance Review

IndustryHealth System
ProblemThe client requested a gap analysis to identify any issues that needed to be addressed in the management controls, processes, and procedures to make sure that the health system was in compliance with 340B Drug Pricing Program regulations.
PHSL SolutionA compliance audit was conducted including onsite interviews, review of policies and procedures, and management controls. This review enabled PHSI to recommend operational changes to their policies and procedures along with implementing feedback mechanisms for better management controls of the end-to-end process.
ResultsPHSI provided recommendations that reduced the audit risk to the health system when HRSA conducts an audit analyzing the health systems compliance with 340B regulations.

Integrated Delivery System Retail Pharmacy Assessment

IndustryHealth System
ProblemA health system pharmacy was experiencing a decline in profits over several years due to various reasons. The health system needed an unbiased assessment of their management system and pharmacy program to analyze why current strategies were not working and how to improve them.
PHSL SolutionPHSI gathered information about the current operations of the health system, including its management structure, patient base, and the technology utilized. Pharmacists, management, and administrators were interviewed to help PHSI completely understand the health system’s operations and possible flaws. PHSI used this information to prepare alternative pharmacy strategic plans and management policies. These recommendations were prioritized by the potential return on investment and level of difficulty to implement the new system.
ResultsThe health system pharmacy can now make informed decisions that will help them better manage their company. They are also armed with the knowledge to implement the plan they choose.