Transcript Slide 1

Pharmaceutical
Care Solutions
Submission to Greek Ministry
8 March 2010
© Copyright ESH 2010
Company Profile – EuroSwiss
Mediscor
•
Specialized health care company offering
comprehensive pharmaceutical and medical
management solutions
•
•
Established in 1989 with over 20 years experience
Processes > 800,000 real-time pharmacy and
> 50,000 doctor transactions daily
Broad client base, managing millions of lives
•
Markets
• Europe
• Africa
• Asia
• Middle East
Services
• Pharmaceutical Management
• Managed Care
• Consulting – Systems & Policy
• Provider Networks & Financing
• Specialized solutions
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2
Greece: Key Objectives
Accessible Health Care at the :
RIGHT time
RIGHT quantity
RIGHT quality
RIGHT format
RIGHT place
RIGHT price
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How Is This Going To Be Done?
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Beyond Prescription
Control
Pharmacy Benefit
Management
(PBM)
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What is a PBM?
• Flexible management tool
A PBM
is a company
that manages the
medicine claims for
a medical funder/insurer
• Electronic claims processing
• Financial rules
• Drug utilization and clinical
management
• Claims payment
• Provide management reports
and information
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6
Benefits of a PBM
Benefits
• the
• the
• the
• the
are produced for
funder / insurer
pharmacy
patient and
state
resulting in a positive member, service provider
and healthcare insurer experience
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Benefits for the Insurer
Effective claim
submission system
Sophisticated
medicine
management
system
Achieve real
savings
• Eliminates paper claims
• Speeds up administrative processes
• Processing is in real-time online (similar to credit
card systems)
Diverse list of management rules
• Down to patient or product level
• Pricing management
• Utilization management
• Clinical management
• Comprehensive information
• Derive a 20-30% saving on medicine spend
• Eliminate addiction & abuse
• Substantially reduce fraud
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Benefits for the Pharmacy
Effective claim
submission
system
Improved
quality of care
• Electronic – no more paper claims
• Faster payment
• Improved practice management
• Claims submitted in real-time (similar to credit card
systems)
• Better credit control
• Real-time payment confirmation
• Reduced claims administration
• Appropriateness of medicines prescribed
• Prevents ingredient duplication
• Empower provider to consult with patient
• Overdose prevention
• Drug interactions
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Benefits for the Patient
Efficient Claims
Administration
Improved
quality of
care
• Eliminates upfront payment at pharmacy
• Eliminates need to submit paper claims
• Timely claims administration
• Timely follow-up and query resolution
• Faster re-imbursement cycles
• Appropriateness of medicines prescribed
• Prevents ingredient duplication
• Empower provider to consult with patient
• Overdose prevention
• Drug interactions
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Benefits for the State
Build an
information
base
• Disease profiles
• Patient profiles
• Demographics of medicine usage
• Pharmacy profiles
• Prescriber profiles
• Manufacturers/product usage
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11
Claims Process
E-prescribing
SWITCH
Mediscor PBM
Funder/
Insurer
Providers
SWITCH
Mediscor PBM
Third party
Administration
(TPA)
Entire real-time transaction takes less than 9 seconds
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12
Claims Process
SWITCH
Mediscor PBM
Funder/
Insurer
Providers
SWITCH
Mediscor PBM
Provider Coverage
• 100% of pharmacies should use real-time
• 100% of hospital and clinic pharmacies should
use real-time
• All pharmacy vendors accredited for real-time
• All postal/courier pharmacies
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Claims process
SWITCH
Mediscor PBM
Funder/
Insurer
Providers
SWITCH
Mediscor PBM
Claims Delivery
• Provided by switch company
•Triangulated redundancy for intelligent
business continuity
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14
Claims process
SWITCH
Mediscor PBM
Funder/
Insurer
Providers
SWITCH
Mediscor PBM
Claims processing software on IBM Hardware
• Data integrity validation
• Eligibility determination
• Medicine utilization management
• Clinical management (Drug database)
• Price management
• Benefit validation
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Centralized Management
Pharmacy
Claims
Clinic/Doctor
Claims
Patient
Claims
Hospital
Claims
Central
Patient Medicine Claims Record
at Active Ingredient Level
Integrated Utilisation
Management &
Pharmaceutical Care
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Our Technology
• Claims processing system used currently manages over 70
million lives worldwide
• Country-specific software customization
• Clinical product database
• Business Intelligence Application
• Interface – multitude of insurance and provider platforms
• Connectivity – with pharmacy software systems and doctor
e-prescribing systems supporting the following technologies:
- Health smart cards
- Barcode
- Digital pens
- OCR
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Our Service Offering
• Real-time electronic medicine claims processing
• Client support services - for e.g. Call centre with extended
working hours
• Information services - through our web-based reporting tool,
the Mediscor Analyzer
• Consulting services - to aid with benefit design & formulary
management
• Chronic medicine pre-authorizations
• Other supplementary services: for product and price file
maintenance
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Analyzer Dashboard
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Trend Analysis - Expenditure
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Trend Analysis - Cost
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Trend Analysis - Utilization
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Our Results
Source: Council for Medical Schemes Annual Report 2006-2007
Introduction of
PBM services
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Our Results
Savings measured and reported as a percentage
of the submitted claim value
Service
Category
Claims
Processing:
Utilization
management
Clinical
management
Pricing
management
Authorization
interventions:
2006
%
2007
%
2008
%
20.4
18.4
16.8
9.2
11.2
9.9
2.4
2.4
2.3
8.8
4.8
4.6
13.6
9.3
6.2
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Why Euroswiss Mediscor?
• SAVINGS – in a highly specialized field!!
• Quality of Service
• Local customization - experience in converting a country
to electronic claims
• System integration abilities
• Comprehensive quality assurance capabilities
• Clinical abilities
• Benefit design specialists
• Product coding expertise
• Experienced staff
• 20 year history
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Why EuroSwiss
Mediscor ?
- Unique Specialized Expertise
- Understanding of Greek situation
- World-Class technology
- World-Class Partnerships
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Contact Persons
• President
Dr. Delon HUMAN
M.B.Ch.B., M Prax Med, MFGP, DCH, MBA
E-mail: [email protected]
Mobile: + 41 79 200 4424
• Greek Operations
Mr. Panos PAPADAKOS
E-mail: [email protected]
Mobile: +30 6945757555
© Copyright ESH 2010