Health Plan Charts Path for Groundbreaking Pharmacy Benefit Improvements
A major regional health plan seeks to improve pharmacy benefits for its members by lowering drug pricing and improving their member experience. The health plan engaged Freed Associates to discern and chart a productive, multi-year course for enhancing its pharmacy services.
Healthcare Plans Have a Pharmacy Quality Problem to Solve
Undeniably pricey prescription drugs have prompted a range of players – from big-box retailers to famous serial entrepreneurs – to try to find ways to lower drug prices for patients. An estimated 18 million Americans, 7% of the population, reported being unable to pay for at least one prescription drug for a member of their household.
Yet prices are just one issue plaguing the prescription drug “ecosystem.” Health plans are starting pharmacy quality improvement projects to improve pharmacy services and overall member satisfaction. One major regional health plan is seeking to create a transformative member experience focused on convenience, education, and clinical quality. This means finding new ways to not only lower drug pricing, but also to improve patient care and compliance.
Achieving this new healthcare ecosystem, however, will take substantial coordination and organization, which is why this health plan engaged Freed Associates (Freed) to discern and chart a productive, multi-year course for enhancing its pharmacy services. What began as an effort to prepare for and implement a pilot rollout to improve pharmacy services quickly evolved into a much more comprehensive implementation initiative that took a year to establish.
Strategies to Improve Pharmacy Services
Initially, the health plan sought to pilot a “virtual” pharmacy program, focused on implementing a series of digital improvements to pharmacy benefits. Freed completed an initial, comprehensive assessment of this pilot initiative to understand its historical underpinnings, the client’s future goals, and the potential support offered by the client’s third-party pharmacy services vendors. Based on this initial assessment, Freed was able to make recommendations on the scope and schedule of the pilot program plans and identified the need for a revised implementation plan, based on changes to the client’s needs and budget.
Through the assessment, it quickly became apparent that the insurer’s opportunities for pharmacy care enhancements extended beyond just digital enhancements. The client and Freed embarked on a broader initiative to enhance the client’s pharmacy care services to focus on clinical value and quality for members. This included delineating the project’s charter and plans, its scope, risks, needed roles, and corresponding project requirements, including a budget.
Implementing the Quality Improvement Plan
Freed began by aligning on the scope and charter of the pharmacy quality improvement initiative, including establishing a baseline, identifying potential quality improvements and setting functional requirements. Freed also outlined key roles and primary responsibilities for execution within the insurer, including developing relevant governance materials. This ultimately included coordinating key enterprise support teams to complete all necessary technology and capability assessments for execution.
Freed and the client then developed an implementation plan and timeline, and coordinated with the client’s stakeholders and internal executive sponsor to ensure the right level of overall program leadership, management and execution.
Ensuring Long-Term Success
As it became apparent that the client’s fiscal year budget limitations would impinge on immediate execution plans for the pharmacy services initiative, Freed and the client partnered to develop a new, strategic investment framework, to ensure the initiative’s long-term viability. To ensure that the client’s internal team members, tasked with executing the pharmacy initiative, would be able to hit the ground running once plans were re-initiated, Freed assisted with team member skillset development and established program management best practices and efficiencies.
A Sustainable Plan for Continuous Pharmacy Quality Improvements
Freed’s fundamental groundwork and preparations for the pharmacy initiative ensured the health plan will be ready to execute on the plan once it is ready to move forward. Freed’s efforts helped the client’s internal virtual pharmacy team transition from solely a pilot project plan to a comprehensive transformative quality improvement initiative. Once implemented, the initiative should improve health outcomes, especially for members with chronic conditions or those with complex medication management requirements. It should also help increase member retention and satisfaction with the client’s pharmacy services.
Now equipped with a broad, robust plan for implementing a series of pharmacy services improvements, the insurer is prepared to go to market with its enhanced pharmacy care initiative, ready to benefit the plan and its members.
