Maximize benefits, minimize confusion

Louisville-based company using technology to enhance hospital 340B programs.

By Ben Keeton

A new Louisville-based company recently launched using proprietary technology to help hospitals maximize the benefits of the federal 340B program. PrescriptLink, a new company focused on managing prescription utilization by healthcare organizations, has recently been launched David Laird, Doug Howell and Dan Scott, as an outgrowth of consulting work for a health system client two years ago. The company also includes Kevin Bramer, former president and CEO of MedVenture Technology Corporation and David Anstey.

The company operates as a Health Information Organization (HIO), collecting and mining patient data from multiple sources to improve health system financial performance and patient outcomes. “Innovations come in a number of different forms,” said Bramer, PrescriptLink’s president and CEO.

“PrescriptLink’s innovation began as an attempt to solve a problem for a single client who needed to enhance 340B reimbursement in a way that fully complied with the myriad of rules for this program.”

Simple Solution

The 340B program was originated in 1992. The program is managed under HRSA (Health Resource and Service Administration). The program enables disproportionate share and rural hospitals the ability to receive discounts on drugs for their patients. These discounts are provided by the pharmaceutical companies under 340B. However, the ability for providers to claim theses discounts is complicated, as it requires significant compliance with HRSA regulations to ensure the accuracy of the claims.

According to Bramer, “Since 1992 very few hospitals have taken advantage of the program given the complexity, time and effort to ensure the integrity of the claims. In addition, hospitals must undergo audits by HRSA and in some cases the pharmaceutical companies. The penalties for filing erroneous claims can be significant and negate the value of the program.”

However, in recent years as reimbursement has gone down significantly in other hospital services, hospitals have become more interested in how the program works and how it can help supplement lost revenues in other areas. PrescriptLink provides its customers an algorithm-based technology that ensures patient eligibility within all components of the 340B program matching all necessary data from qualified hospitals and retail pharmacies to ensure compliance. The PrescriptLink technology is built to ensure hospitals will successfully complete the required audits, but also put the hospital in a position to better manage population health.

Broader Use

The outcome of this problem solving is a proprietary, compliant program that uses a data extract from the health system and matches it with contract pharmacy data. The program then analyzes the data for the necessary links in the chain of care with proprietary algorithms developed specifically for this task. While that analysis is initially used to identify 340B opportunities for a health system, its broader use in the management of patients and their prescribed medications may prove even more valuable as population health concepts become reality.

“Any 340B program is subject to complex, shifting rules and guidelines. The expansion of 340B in 2010, which allowed prescriptions written in health system departments, clinics and, in some cases, physician offices to be counted, greatly compounded those rules and the definitions contained within them,” said Bramer. “PrescriptLink was created especially for those rules. Our flexible program design will accommodate these changes and various interpretations of rules and allow for the collection of other data elements in the future. “

The technology isn’t limited to the 340B program alone. According to Bramer, “Our mission is to become the leading company in the market for accumulating, managing, and analyzing data to improve overall population health.” He gives an example of congestive heart failure patients that fail to stay on their medications and end up being readmitted to the hospital four to five times per year. The cost of these readmissions is significant to the healthcare system. Hospitals are becoming more interested in these this type of data because payment is being either eliminated or reduced by government and third party payors. In addition, the overall well-being of the community improves.

According to Bramer, the handling of protected health information requires full compliance with HIPAA regulations. “As an HIO, we exchange data with clients and their pharmacy partners through a system that is secure and verified on both ends. Our database is fully encrypted and obsolete data is either returned to the client or certified as destroyed. At the heart of our product is a firm commitment to the security of patient data.”

Case study: After using PrescriptLink technology, five months of prescription data was reviewed and more than $1M in discounts were found; the hospital was able to file and be reimbursed for under the 340B program. The annual review disclosed $6M.