Pharmacy Benefit Management Optimization for SNFs
Skilled nursing facilities (SNFs) often face inefficiencies and high costs in pharmacy benefit management. Langate's new e-prescription system, with features like a prescription analysis engine and real-time alerts, streamlined management, leading to significant cost savings and improved care quality.
Langate's e-prescription system cut costs and improved care in skilled nursing facilities
Work
- Developing a completely new e-prescription system with an advanced analysis engine
- Ensuring continuous monitoring and support services
- Enabling significant cost reductions and operational efficiencies
Summary
Langate created a comprehensive e-prescription optimization system for SNFs. Features include an advanced analysis engine, real-time alerts, and pharmacist validation, which have resulted in significant cost reductions and operational efficiencies.
Project Scope
3
Years2
Developers1
QA1
Project ManagerTech Stack
.Net
C#
Power Platform
Power BI
Discover how Langate developed a robust and efficient system that significantly reduced medication costs.
Langate developed a robust, streamlined system that dramatically cut medication costs, optimized prescribing practices, and improved revenue cycle management (RCM) for skilled nursing facilities (SNFs). This solution boosted financial efficiency and ensured better care outcomes for residents.
The Client
Our client is a revenue cycle management (RCM) company that specializes in streamlining financial processes for skilled nursing facilities. They offer comprehensive solutions to optimize revenue generation, billing, and reimbursement. With their deep understanding of the SNF industry, the company implements tailored strategies to ensure compliance with regulations and maximize revenue capture. The client’s expertise lies in bridging the gap between healthcare providers and payers, facilitating smooth transactions and timely reimbursements.
The Problem
When doctors affiliated with the SNFs our client serves prescribed medications, they often weren’t optimal choices. They also needed to be processed. However, they didn’t have a system to monitor these prescriptions effectively. As a result, several issues arose:
OverprescriptionDoctors were frequently prescribing more medications than necessary, leading to wastage and increased costs.
Brand Preference Expensive brands were being prescribed despite the availability of cheaper alternatives with the same active ingredients. This practice significantly impacted costs and underscored the need for a monitoring system.
Lack of Oversight No system existed to track and analyze the prescribing patterns, leading to inefficient drug use and higher expenses.
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Primary Challenges
Our client needed to create a system to process and optimize prescriptions effectively. The challenge involved developing several vital elements:
Database Integration
Developing a comprehensive database containing all relevant medication nomenclature and pricing information to support the optimization process.
Real-time Monitoring
Implementing a system that could automatically respond to prescription patterns and send alerts for potential optimizations, ensuring timely interventions.
Human Oversight
Supplementing the automated system with a team of hired pharmacists to oversee and validate the optimization suggestions, ensuring accuracy and compliance with medical guidelines.
User Adoption
Ensuring that doctors and other stakeholders within the SNFs adopted the new system and followed the optimization suggestions. This required practical training and change management.
The Process
First, we gathered requirements and set clear objectives to reduce medication costs and improve prescription accuracy. We then designed the system architecture, created a comprehensive medication database, and planned integration with existing EHR systems. An advanced prescription analysis engine was developed to identify cheaper alternatives and monitor prescription quantities. Our team also created an intuitive user interface and real-time monitoring features with alerts for doctors and pharmacists.
The Solution
Achievements and Future Plans
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Increased Efficiency
The streamlined prescription process improved operational efficiency, allowing healthcare providers to focus more on patient care than administrative tasks. The real-time alerts and pharmacist validation ensured accurate and compliant prescriptions. -
Financial Success
The project was a resounding success, delivering significant financial benefits to the client. The cost reductions and improved efficiency directly translated into enhanced RCM, bolstering SNFs’ financial health and demonstrating the project’s financial success. -
Profitable Sale
Our client was able to sell the solution profitably due to the project’s success and tangible benefits. The optimized processes and cost-saving measures made the solution highly attractive to potential buyers, resulting in a lucrative sale.
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