How Automation Helps LTC Operators Achieve Their Lowest Net Drug Cost

An Exclusive Look into the Technology Helping Operators in Skilled Nursing and Post-Acute Care Save on Rising Drug Costs and Improve Practices

Technological innovations are transforming health care at a rapid pace. From remote patient monitoring providing acute insights into patient health to telehealth services expanding the reach of providers into rural areas, access to better care is expanding across the nation thanks to these advances in technology.

For the long-term care industry, one particular issue has seen an ongoing need for a technological solution: rising drug costs. SRX’s technology has been built from the ground up to address this exact issue, specifically for long-term care operators. By creating software systems that utilize automation to streamline many complex, repetitive tasks and integrate complicated data from pricing databases and EHRs, SRX’s technology helps operators lower their drug costs to the tune of hundreds of thousands of dollars per year.

This article dissects the various ways we implement automation to help operators lower costs, improve transparency, and reduce staff hours allocated to prohibitively time-consuming tasks. Together, these solutions provide an unrivaled solution that enables operators to achieve lowest net cost and channel those savings into providing exceptional care.

Building a System to Automate Drug Manufacturer Rebates

In order to provide the best possible solution for long-term care operators to automate rebate submission, we first had to build a platform that could intake claim and invoice data in an unlimited number of formats. We then analyzed different drug formularies to identify all drugs that can be invoiced for manufacturer rebates and, finally, created a custom long-term care formulary that optimizes rebate opportunities for our market.

Using this information, we import claim and invoice data daily and invoice drug manufacturers once per month for eligible drug rebates. Here’s how it works:

1. Invoice and claim data are imported into the SRX platform daily.
2. Line items are cross-referenced against our proprietary database to identify rebate-eligible drugs.
3. Our software automatically collates all available information required for each rebate submission and handles returns, partial returns, and reversals in one place.
4. Rebate submission data is analyzed by our Pharmacy Operations team prior to invoicing to ensure all exceptions are reviewed and all data are accurate.
5. SRX guarantees rebate payments, reducing any risk to operators.
6. Facilities and operators are delivered a rebate check of the guaranteed amount quarterly.

We’ve built the most convenient solution for long-term care operators to automate drug rebate submissions. We work with our customers’ LTC pharmacies to adjudicate claims data in real-time, and also provide a platform for customers to upload their pharmacy invoices. Our software and experts do the rest, identifying which medications are eligible and how much facilities can expect in the mail.

Before SRX, operators weren’t certain how to navigate the complex process to qualify for these valuable rebates. SRX has made the process as simple as possible and our program ensures maximum rebates are obtained for our customers.

—Austin Montgomery, VP of Pharmacy Operations, SRX

Managed Care Exclusions Meet SRX’s Automation

Using SRX’s managed care software, operators are able to identify 90% more exclusions, on average, and submit many more claims for reimbursement than has been possible when auditing payer contracts manually.

Our managed care solution consists of dashboards for billing officers, case managers, and dedicated operator-level dashboards. At each stage, automation assists all parties involved in seeing real-time data and be fed the right information to take action on exclusions as they become available.

For billing staff, the SRX managed care solution provides the following:

1. Automatically programs in each managed care contract’s exclusions
2. Creates real-time alerts around claims status
3. Flags medications requiring prior authorization and conveniently collates the information required to submit the prior authorization

A combination of automation and expert advisors helps billing officers submit claims quickly and easily with fewer errors. The manual alternative is prohibitively time-consuming and opens the door to errors being made when submitting the information required for prior authorization. Reimbursement claims require equally specific information be submitted in the correct format. Our system makes sure all information is included and correctly formatted before a prior authorization or reimbursement claim is submitted.

For operators, Plan Performance and Exclusion Tracking dashboards provide high-level oversight for VPs and C-level officers. Again, our software leverages smart automation to feed decision-makers the information they need to assess the performance of managed care plans at their facilities.

Our Plan Performance Dashboard tracks:

1. Length of stay data
2. Daily number of exclusions being captured
3. Highest cost drugs per plan

Our Exclusion Tracking Dashboard features:

1. Real-time tracking of managed care exclusions
2. Cumulative reimbursement figures

As the use of managed care payer contracts increases, it is vital operators take the opportunities afforded by exclusions to make an impact on their net pharmacy management costs. Utilizing SRX’s managed care solutions, operators are positioning themselves to be financially successful despite the level of complexity these contracts and exclusions carry.

Identifying Rule Violations through Adjudication

SRX’s adjudication solution creates a pipeline of transparency between operators and pharmacy partners. Using intelligent automation, every pharmacy transaction is observed and vetted against agreed-upon terms.

For long-term care operators, improving transparency with pharmacy partners through adjudication provides an opportunity to save time and money. This is how automation powers adjudication that helps operators:

1. Contract rules are enforced. Preferred and excluded drugs are listed, dispense timings set, and contractually fixed rates are adhered to.
2. Waste is reduced. Quantity, maximum day supply, and refills can be automated depending on need and care schedules.
3. Greater control. SRX’s technology allows operators to set maximum cost thresholds, improve billing accuracy for compounds, and require signed therapeutic interchange letters.

By implementing checks and balances for every submitted claim, SRX’s adjudication technology saves operators time and money. Far fewer credits need to be chased, invoices reviewed for proper pricing, or waste produced by incorrect dispensing. Instead, operators receive alerts in real-time when rules are violated, enabling them to communicate and correct issues before a billing cycle creates extra work.

Beyond our technology, SRX’s pharmacy experts help operators negotiate fair, beneficial contracts and establish positive relationships with their pharmacy partners. Due to the volume and value involved in this particular relationship in the long-term care industry, it’s imperative operators have trust in their pharmacy and clearly communicate their expectations.

The Human Factor

While our intelligent solutions do a tremendous amount of work for operators, no process can be fully optimized without the human factor. At SRX, our pharmacy experts and advisors add an additional layer of support that helps the entire pharmacy management process at long-term care facilities.

From creating relationships with drug manufacturers to liaising between operators and pharmacy partners, our experts are a vital part of SRX’s solutions. Similarly, they provide all the technical and industrial support our customers could need to best manage their facilities’ drug costs and pharmacy relationships.

To learn more about how our automation and expert advisors can help lower your drug costs and improve practices, schedule a demo with one of our experts.

Speak to an Expert

Related Articles:

3 Places Where Excess LTC Drug Costs Are Hiding in Plain Sight

See How SRX is Tackling the Problem of Rising Drug Costs

Top 3 Things to Look for in a Pharmacy Partner

Follow us on LinkedIn

SRX is a unified drug cost management solution for long-term care operators. We achieve unrivaled drug cost savings by combining our proprietary technology with expert advisors. SRX’s solutions automate drug rebates, optimize pharmacy management practices, increase managed care exclusion reimbursements, and provide cost-effective employee prescription benefits. SRX guarantees quarterly rebates are paid on time, every time, with no out-of-pocket cost.

Learn more about SRX’s cost-saving solutions