Payers
Take the next step in your
pharmacy evolution
Improve quality performance across multiple HEDIS and Star measures while also driving real reductions in total cost of care
Payer Solutions
Do you or your organization need to:
- Engage providers successfully in your pharmacy outcomes strategy?
- Improve appropriate use of high-risk medication for elderly patients?
- Increase medication adherence rates for patients with diabetes or hypertension?
- Improve completion rates for comprehensive medication reviews (CMRs) while also lowering overall hospitalization and re-admissions rates?
Payers benefits
RxLive services
create value for payers
The RxLive® program addresses quality performance across multiple HEDIS measures. But unlike most pharmacy programs, the pharmacist intervention is executed in collaboration and fully integrated into the provider’s workflow and systems. Doing so transforms pharmacy engagement from a “check-the-box” quality activity to fully integrated clinical care that delivers real and substantial clinical outcomes, improves patient satisfaction, and lowers total cost of care.
70%
Better compliance
Increase in medication compliance from speaking with a pharmacist
28%
Decrease in hospital admissions
Decrease hospital admissions per year after speaking with an RxLive pharmacist
27%
Decrease in readmissions
Decrease 30-day hospital readmissions per year after speaking with an RxLive pharmacist
Payer Implementation
How it works
Although RxLive tailors the workflow to suit the needs of each organization, here is an example standard procedure when working with a payer.
Patient selection
Clinical registry development that incorporates existing payer gaps in care, HEDIS objectives, adherence and star goals.
Scheduling
Patients are then invited to meet with the clinical pharmacist in a way that maximizes provider engagement.
Preparation
RxLive® pharmacists are exposed to all payer quality objectives as part of their pre-work, and can address them holistically during the comprehensive medication management session (CMM).
Documentation
After the CMM, the patient receives a Medicare-approved comprehensive medication review document (CMR) and the results are uploaded directly into the provider’s electronic health record for the patient.
Recommendation implementation
Patient and provider meet face-to-face to review pharmacist recommendations. The provider executes on any drug changes that a) lower financial burdens for payer/patient, b) address behavioral issues related to compliance and c) close any clinical gaps and optimize the regimen.
Follow-up
RxLive then monitors patient pharmacy behavior over time and re-engages per clinical protocol or if medication adherence drops meaningfully.