The Meritain Pharmacy Solutions team discusses:
The Meritain Pharmacy Solutions team discusses:
BC Welcome to another edition of In the Booth. My name is Bridgette Cassety and I work in the broker engagement department at Meritain Health. Today I have two colleagues that have joined me for our conversation. Jeremy Wisniewski and Kristen Wudyka. So I'm happy to have both of them with me today. Jeremy, I thought I'd start our conversation out with you and maybe talk a little bit with our listeners about all the work that you and your team have been doing and our Meritain pharmacy solutions department and just give us some updates of some of the things that you've been focused on and are working towards in in this plan year. JW Absolutely. So, you know, one of the most important things when it comes to your pharmacy benefit or when people are looking at, at pharmacy in general is that price point, right? People want to know what are, what am I paying for in terms of drugs. So that was kind of where we, we knew that we had to start and you know, through our, our partnership now with CVS we've been able to create a very compelling, very competitive price point or our clients. And again, that's kind of the baseline, so to speak for where we need to start the overall offering is, is offering a competitive price to our clients. Because at the end of the day, you know, one of the main things that we're, we're trying to push towards is helping our clients lower their total cost of care. And again, the, the starting point for doing so is making sure that you have the, the best price point that you're paying the least amount possible, so to speak, for your prescription benefit. So again, that was kind of our, our starting point, to address price. BC And I think you're right, Jeremy. I think when, when certainly when pharmacy comes up and we talk about prescriptions, the first thing that comes to everyone's find is price. And you're right, we have to be competitively priced in the market. But I think also people are interested, but you know what else, what's the value of integration and how do we manage the overall cost of care when we talk about bringing medical and pharmacy together. And do you want to talk a little bit about what your, what you and your team has been doing as far as delivering value around total cost of care when we integrate pharmacy with medical? JW Absolutely. You hit on it too. I think that that's really the key, right? So the price that we talked about a moment ago, that's just a starting point because the next place, there's kind of the next part that you want to evolve to is where you really start to be able to differentiate yourself from the competition. And that's showing real value, right? But effective results. And one of the best ways that we as Meritain can do that is through the integration, right? We have the, we have the medical and when you have the pharmacy integrated in one kind of offering, you're able to take a holistic approach where you're looking at how your medical is going to impact your pharmacy spend. And also vice versa, how your pharmacy spend is going to be impacting your medical spend. It is just so much easier when both of those things are being handled by the same team of folks. As opposed to, you know, kind of two separate vendors who might try to kind of cross collaborate or whatnot. For us it's all under, it's all under one roof that it's one team and it gives us the ability to, to again draw those correlations and to see how we can, we can kind of plug and play for lack of a better term with what's happening on the medical side with what's happening on the pharmacy and vice versa. There's a third component to that though that is again, it really enhances our overall a kind of integrated offering and that's when we bring American health holdings into the picture, right? It's through the med management. They have their high construct management program, which is looking at high cost drugs on the medical side. And now on the pharmacy side, we're looking at high cost drugs, you know, on the pharmacy side as well. And we begin to collaborate kind of across the medical, the med management and pharmacy. And you get a team of folks who are focused on that, that kind of overall healthcare journey for our members. And again, looking for the right way, the most cost effective way to either source a medication, where to purchase medication, how to purchase that medication or even where to have that medication administered. And when you have all those folks kind of working together and talking to one another, it opens up a whole kind of realm of amazing possibilities for us to, to help drive that total cost of care down. And that to me is that where, you know, Kristen and the CARE program come into play because that is our value, a huge part of our value prop where we're trying to specifically you know, interact with and drive down costs on behalf of our clients. BC So Jeremy, when I, when I listened to you talk, it sort of sounds like that the value proposition of having, you know, the medical management and the clinical expertise along with all the data reporting, I think you're right. What that allows us to do is sort of identify opportunities where we can deliver even more value. It had the innovation to create a program like CARE and Kristen, I think this would be a great opportunity for you to sort of share with our listeners what is the value proposition behind CARE and what that delivers is part of as part of our overall offerings. KW Sure. Yeah. So the CARE program through Meritain Health pharmacy solutions is truly a proactive, collaborative effort of care specialists and clinicians that are guiding our clients and members through this crazy ever changing healthcare world to try to decrease total cost of care. I mean costs are totally on the rise when it comes to specialty spend and we are truly looking at claims with a magnifying glass. We have eight different strategies that we're actually targeting. When we look at spend, we're looking at the drug, we're looking at the dose, we're looking at the individual to make sure it's the correct drug for that individual. And then we're also looking at the time as well as the length that they're actually getting that medication. We're actually looking at the cost as well because sometimes the cost is incorrect. And then where is that member getting that medication? Because sometimes that can drive down costs as well. And then also looking at the diagnosis of that member, are they getting that medication for the correct reason? Truly looking at each and every claim through a magnifying glass to make sure that these claims are there and correct. To see if we can try to decrease spend. So CARE is truly dedicated to strategically aim and decreasing overall spend through different channels and different areas of focus that we are actually looking at for CARE is like decreasing drug waste. There's actually drug waste happening out there with specialty spend. So we're focusing on, we're trying to shift site of care just like Jeremy was just talking about is data integration is so important right now. We have a data powerhouse between us here at Meritain pharmacy solutions as well as AHH as well as medical management with Meritain that we need to make sure that all that data, it's really integrated so that we can do this through CARE. So we've had tremendous savings with it that manufacturer savings. We're trying to target that to try to decrease client spend as well as number spend because there's so much money through the manufacturers that make these medications. So we're trying to save money through that route. And then also just optimizing dosages of medications and researching options that are clinically effective but also cost alternatives. And these are just some examples of small changes that can truly make a tremendous cost difference, not only for clients but for members as well. BC Kristen, I think you said this, but just to, I just want to make sure that our, it's clear for our listeners, this is a program that they have to opt it to. Is there a cost to the program or is this built in proactive program? That's part of the value add for Meritain pharmacy solutions. I just want to make sure that we make that clear for our listeners, right? KW Yeah So you get CARE through MPS, if you have MPS you have CARE and this is being done in the background for you proactively without you knowing it. But the value add that we Meritain health pharmacy solutions want you to have to show that we are truly protecting your spend and protecting client and member spend equally to make sure that we can drive down any cost that we truly can and so many different ways and so many different focus. BC Great. Thanks so much. I mean, when I sort of listened to our conversation and the work that, that you and Jeremy and the rest of our folks at the Meritain pharmacy solutions team are working on, it sounds to be like really we're bringing together that pricing strength that we could deliver as being part of CVS. That we have the integration that brings a real powerhouse of data that we can leverage, that allow us to innovate and create programs like CARE that will minimize total cost of care and allow us to fulfill our mission as Advocates for Healthier Living. So I want to thank you both for joining me today, which this addition of In the Booth and for our listeners, we look forward to having you join us for the next time.