Productivity Analysis and Reporting for Prescription Claims
Background
In this case study we describe how a leading provider of pharmacy benefit management services achieved improved pricing and design strategy through Systech’s comprehensive, cost effective solution and analytics solution.
The client needed a powerful Business Intelligence system to cut costs to analyze spending patterns across the country. An improvement in physician compliance to utilize and better manage the pharmacy dollar was needed in order to lower healthcare costs and provide better services for customers. They needed to find a cost effective, complete and comprehensive solution which would perform complex analysis quickly and efficiently.
Challenges
The principal challenge was the analysis of claims costs, profits, sales comparisons, product comparisons and overall productivity. The customer wanted a robust system that would be easy for their IT department to maintain after it was implemented and also, one that would be scalable and reliable.
Solution
As a strategic consultant Systech’s first evaluated client’s infrastructure and environment, and recommended a datawarehouse infrastructure for implementing the solution. Systech was responsible for building and maintaining a robust Business Intelligence solution. The data warehouse is used to report on a variety of information for a multitude of clients. This helped to identify the key metrics such as top prescribers, members, and drugs by medical groups among many other functions required for prescription claims analysis and fraudulent claims detection. The data warehouse also enabled accurate forecasts of the industry’s leading trends, utilization trends & patterns. It enhanced the quality and reliability of the information gathered.
Result
The solution helped our client perform accurate forecasts of pharmacy trends leading to improvements in benefit plan design and pricing, resulting in better financial decisions. It helped physicians be better informed and helped provide quality health care for patients. Fraudulent claim detection also helped save revenue leakage for the company.
