Elevate Provider Network: Using data to simplify pharmacists’ lives

A year after its launch, AmerisourceBergen and Good Neighbor Pharmacy’s Elevate Provider Network is serving as an example of how a pharmacy services administrative organization driven by data can enhance member pharmacies’ ability to improve patient health while excelling on Star ratings measures.



“With Elevate Provider Network and our advanced features, what we're really trying to do is build a platform that would allow us to help our pharmacies manage the life cycle of their claims — from making sure they get access to the patient, which is our primary duty, but also to bill it accurately. Also, they’re able to reconcile it and know they got paid for all the claims they submitted,” Chuck Reed, Group Vice President of Pharmacy Innovation & Solutions at AmerisourceBergen, told Drug Store News.



Helping independent pharmacies manage the life cycle of a claim begins with Elevate Provider Network’s partnership with Change Healthcare. Change Healthcare acts both as a claim switching service, allowing for pre- and post-editing of claims to ensure accuracy, and a unifying platform for 26 participating pharmacy software vendors — a number that has grown from just six participants a year ago, according to Richard Brook, SVP Sales Pharmacy Services at Change Healthcare. Change Healthcare also can make a copy of the claims data and pass it along to AmerisourceBergen, which stores the data in its InSite 2.0 platform.



And while Change Healthcare ensures claim accuracy for Elevate Provider Network, FDS Healthcare Solutions — which has been the provider of central pay services, disbursing funds from payers to individual pharmacies — uses the claim data to provide reconciliation services for both central pay claims and those that don’t go through central pay. Pharmacy owners can choose to handle the reconciliation process themselves, but FDS also offers a concierge reconciliation service for a monthly fee.



“We handle all the payments coming in on the central pay side and then, because of the new relationship with Change Healthcare, we get all the claim information. We're now able to put those two pieces together,” FDS Healthcare Services president Peter Fianu told Drug Store News. “That helps a store understand they've been paid for everything they’ve done. … So they understand the health of their business and understand that that they’re truly recovering all the money they’re supposed to get, because that’s the big risk to the store. … Making sure you’re collecting every dollar that you’re supposed to is very critical.”



Equally critical for pharmacies in an environment that emphasizes providing outcomes is keeping track of whether they’re delivering those outcomes in quantifiable ways. This is where the Elevate Provider Network looks to leverage claim data beyond its life cycle to help its members, as the PrescribeWellness-powered Patient Engagement Center uses InSite 2.0 data to help pharmacists track patient adherence.



And after a year in operation, Reed said members of Elevate Provider Network are seeing results. About 70% of Elevate Provider Network premier-level member pharmacies have a five-star rating in one or more adherence measures monitored by EQuIPP, according to Reed, and of those, 40% have one or more scores that rank in the top 20% of all pharmacies. As of May 2016, Reed said that member pharmacies grew their prescription counts by 3.4%, whereas the rest of the market grew an average of 1.9%, with chains growing 2.9% and independents as a whole staying more or less flat in script count. Reed attributed this to Elevate Provider Network and its offerings that pave the way for pharmacists to grow their businesses while providing a high level of patient care.



“We think part of that is our new tools and the new suite of services that we brought to the customers,” Reed said. “Most fundamentally, everything that we want to do is to help our customers grow their businesses and do it profitably. … It’s a complex world for these pharmacists, and we need to simplify their lives so they can care for their patients.”