Program Objective
Not all high-risk and high-cost patients have
costly procedures that would alert us to the need for case
management. The Pharmacy Review program was designed as an
alternate method of detecting patients with chronic conditions
that would benefit from our Case Management and Disease State
Management programs. Additionally, the program provides a method
of:
- Enhancing physician coordination
- Identifying possible drug
interactions
- Detecting patients who may be misusing drugs
- Detecting patients
who may be overusing of drugs
- Coordinating benefits
- Coordinating patient care
- Identifying less costly drug alternatives
Cost Savings
Our ability to detect patients with chronic
conditions at an early period allows us to encourage the patient
in caring for their condition properly, with the end result
being fewer hospitalizations and high cost remedies. Our approach
is to ensure that preventative measures are being taken, rather
than far more expensive reactive measures.
Additionally, our ability to detect misuse of certain drugs
and coordinate physician interaction allows us to catch these
cases and control the problems they cause. For instance, if
a patient is receiving multiple prescriptions from a variety
of physicians that may overlap or even conflict with each other,
we are able to contact the prescribing physicians, and ensure
that the patient receives the necessary medications from one
prescribing physician, so that all medication is being monitored
properly. Or as another example, if a patient has a high usage
of narcotics, we have the ability to do a tablet count, and
determine if a better alternative exists for the patient, at
the same time reducing the number of prescriptions the patient
is receiving.
Program Description
Every month, we receive a report from the
Pharmacy Benefit Manager (PBM), and from the data, we identify
the patients based on a variety of parameters. Based on this
data, we sort which patients are potentially high risk patients,
and get claims data from the TPA, and a complete list of
prescription information from the PBM. From this data, we
are able to determine which patients would benefit from Case
Management or Disease Management, and are also able to determine
any red flags regarding drug usage, eligibility, or incorrect
billing.
Implementation of this program requires extensive collaboration
with the employer's pharmacy benefit manager (PBM). Currently,
ICM has established relationships with multiple PBMs where
we can easily retrieve data from existing report databases
at no extra cost. We are also able to work with new PBMs
to establish a similar relationship. The fee for this program
covers the compilation and analysis of reports from the
vendor. Patients identified through this mechanism are
referred to the Case Management or Disease Management programs
to facilitate the appropriate treatment plan and manage
costs.
Contact Us
Call Innovative Care Management to ask our sales department
about the Pharmacy Review Program or our other programs.
We're here to help you start saving while maintaining the
highest quality care.
General Contact Information:
Innovative Care Management, Inc.
10117 SE Sunnyside Rd., Box F409
Clackamas, OR 97015
Toll Free: 800-862-3338
Portland Area: 503-654-9447
Fax: 503-654-8570
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