{"id":7029,"date":"2014-12-12T11:24:16","date_gmt":"2014-12-12T16:24:16","guid":{"rendered":"http:\/\/www.rxedo.com\/?page_id=7029"},"modified":"2015-03-25T16:49:57","modified_gmt":"2015-03-25T20:49:57","slug":"implementation","status":"publish","type":"page","link":"https:\/\/www.rxedo.com\/?page_id=7029","title":{"rendered":"Health Plan Case Studies"},"content":{"rendered":"[vc_row][vc_column width=”1\/1″]

Successful Mid-Year PBM Conversion<\/span><\/h1>
R<\/span>x<\/sub><\/span>EDO<\/span>, the country\u2019s first Prescription Benefit Partner, teams up\u00a0with a major health plan to successfully convert their prescription drug benefit administration on July 1, 2014.<\/h5>\n

Objective<\/h3>\n

Security Health Plan has been named one of the nation\u2019s best health insurance plans for ten consecutive years. One reason Security Health Plan is consistently at the top is the ongoing pursuit to always be above and beyond status quo. During the last quarter of 2013, Security Health Plan began to analyze its pharmacy benefits operation. The Health Plan determined that it was not satisfied with service levels and costs with its PBM. That\u2019s when Security Health Plan andR<\/span>x<\/sub><\/span>EDO<\/span>\u00a0began discussing the possibility of a partner relationship. The two companies devised a plan to accommodate Security Health Plan\u2019s goals.<\/p>\n

Partnership<\/h3>\n

R<\/span>x<\/sub><\/span>EDO<\/span>, an eleven-year veteran in the prescription drug administration industry, has always put the interests of its clients first.\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0works to understand the unique issues and challenges that face each of its clients and prospects. When\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0studied the health plan industry, and began talking with\u00a0Security Health Plan, it became evident that a 1\/1 conversion of prescription drug administration services was probably not the best way to approach changing the Health Plan’s claims processing system. Twila Johnson,\u00a0Director of Pharmacy Services at Security Health Plan, stated, \u201cThe trend for health plans was and still is to try to convert plans at the start of a plan year, reducing the complexity involved with matching accumulators. There is also risk inherent in a mid-year conversion from potential issues that would cause exposure with CMS regarding member balances being incorrect.\u00a0R<\/span>x<\/sub><\/span>EDO\u00a0<\/span>helped us prove a mid-year conversion could be successful.\u201d<\/em> <\/span><\/strong>Leadership at Security Health Plan\u00a0decided that as long as the focus was on thorough planning and testing, the added flexibility and avoidance of other year-end obligations outweighed the risk.<\/p>\n

Results<\/h3>\n

On July 1, 2014, all of Security Health Plan\u2019s prescription drug claims were converted to\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>. Had the transition to\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0been a standard year-end conversion, the success markers would still have been excellent. However considering the fact that Security Health Plan\u00a0converted to\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0mid-year, the accomplishment was remarkable indeed.<\/p>\n

R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0and Security Health Plan\u00a0had adequately prepared for the conversion and for the additional challenges arising from Security Health Plan\u00a0moving its prescription drug program mid-year. For example\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0had already successfully analyzed members\u2019 historical accumulators and\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0correctly loaded the members\u2019 data, so that the claims history was accurate and the members remained in their appropriate phase (bucket) when the conversion occurred. The preparation proved invaluable.<\/p>\n

The\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\/Security Health Plan\u00a0implementation teams working as partners with a mutual goal, successfully completed the conversion.<\/p>\n

Benefits<\/h3>\n

Dr. Mark LePage, Security Health Plan’s\u00a0Chief Medical Officer, said, \u201cWe are very pleased with\u00a0R<\/span>x<\/sub><\/span>EDO.<\/span>\u00a0The conversion was great and\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u2019s service is exceptional. Our members are happy. The administration of the prescription drug program is operating smoothly, and\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0is very responsive to our every need. It is wonderful to have a Prescription Benefit Partner that understood our needs, and then built a program specifically for us. I highly recommend\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>, and I am happy to visit with anyone about this experience.\u201d<\/span><\/em><\/strong><\/p>\n

R<\/span>x<\/sub><\/span>EDO<\/span>\u2019s pricing model is unique, and cutting edge.\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u2019s pricing model is transparent, in all respects.\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0charges a modest administration fee on each claim processed. There are\u00a0no mark-ups on prescription drug charges and no hidden drug spend spread. In the end\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u2019s pricing model creates lower net drug costs for its clients!<\/p>\n

R<\/span>x<\/sub><\/span>EDO<\/span>\u2019s Future in the Health Plan Industry<\/h3>\n

R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0is excited about the impact it is having at Security Health Plan.\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u2019s first mid-year conversion was a huge success, and Security Health Plan\u00a0is reaping the benefits, through great service and significant savings.\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u2019s deliberate focus on the precise needs of Security Health Plan\u00a0was well worth the investment. As partners\u00a0R<\/span>x<\/sub><\/span>EDO<\/span>\u00a0and Security Health Plan\u00a0have opened the door to a brand new way of converting prescription drug administration programs\u2026 any time during the year!<\/strong><\/span>\u00a0R<\/span>x<\/sub><\/span>EDO<\/span> is committed to further development of new and innovative ways to service their clients.<\/p>\n[\/vc_column][\/vc_row]\n","protected":false},"excerpt":{"rendered":"

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