This article is sponsored by SRX. In this Voices interview, Skilled Nursing News sits down with SRX Senior Analyst Dhaval Thakkar to get his take on how SRX is changing the long-term care pharmacy environment, where technology can revolutionize providers’ drug utilization cost review, and how they recoup significant costs for operators through this process.
Skilled Nursing News: You’ve been with SRX since 2018. Give us some background on your role there.
Dhaval Thakkar: I joined SRX after working 10 years in the long-term care pharmacy space. I was involved in procurement channeling, as well as operational flow. That experience gave me unique insight into the long-term care pharmacy environment and medication cost.
My responsibilities with SRX primarily revolve around medication spend analysis. I currently work with our clients to review their monthly pharmacy utilization and the many analytical reports that SRX generates to help reduce medication cost. I also work with our clients to create customized reports based on selected metrics to provide further guidance in how they can mitigate their spend.
One area of medication spend that is very important to SRX is drug utilization cost review, or DUR. What is that?
Every prescription claim needs to be checked and validated to ensure that the facility is receiving the most cost-effective drugs. There need to be rules in place in order to reduce waste and control costs. These rules capture formulary-preferred medication, quantity limits, and step therapy. The DUR that SRX has authored helps maintain this oversight so that prescriptions are consistently being reviewed using technology for optimization, which also enables for sustainable change.
Why is DUR important to long-term care facilities, other than to be cost effective and reduce waste?
Using a tech-centric structure, the SRX Drug Utilization Program allows a facility owner/operator to sustain dispense behavioral changes regardless of workforce turnover. The intrinsic benefit of automating the DUR allows any client to reap the financial benefits and control costs regardless of the personnel at a facility. Anecdotally, I can say that employee turnover is often a concern for most facilities. Knowing that the DUR process flow revolves around automated technology and not a user is an invaluable sustainable benefit.
A DUR is one of the best ways to improve efficiencies and control costs. What kind of outcomes do we see in terms of financial and health outcomes? Are there ripple effects?
Yes, the drug utilization review program designed with SRX has SNFs (skilled nursing facilities) already seeing significant upfront savings as well as recoupment of dollars back to our clients. The ripple effect or byproduct from this review is a greater sense of awareness by each operator as they now have greater insight into their monthly pharmacy utilization. Our client operators are now able to simplify a workflow that used to be very complex, labor intensive, and time consuming by leveraging SRX technology.
This process has already seen credits come into play, where we can leverage this report to say, “These prescription claims do not adhere to the dispense rules we have put into place.” In turn, clients now have the tools and guidance to know how to engage their pharmacies regarding a drug review.
At SRX, we’re a very tech-forward company. We leverage data and technology wherever we can to drive positive change. For the DUR in particular, we took historical dispense data for specific facilities and then parsed through the various drug criteria to implement our edits and rules to help providers curtail behavior.
How does the technology work?
When I came to SRX, one of the things that I was most excited about was SRX’s integration with two national publications: Medi-Span and First Databank. These two publications are the warehouses of all medication pricing and product identifiers.
With this access, we have a direct, real-time line-of-sight. Combined with the SRX programming capabilities, we can parse out specific claims and therapeutic classes. These datasets allow us to have a conversation with our clients that is a lot more intelligible than what they’ve previously experienced.
Automation plays a big role in this. Adjudication of claims at the point-of-sale is the preferred way to impact dispense behavioral changes. SRX has the ability to adjudicate claims in real time and enforce DUR at the time of dispense. SRX technology also allows a DUR check of the end-of-month pharmacy invoice.
To help streamline and automate this process, SRX makes sure that all claims reports are sent to the facility and pharmacy on a monthly basis to reconcile all flags/edits that were violated in the prior month. Therefore, if adjudication is not feasible, there is still an automated way for operators to capture all dispenses. These reports are auto-generated based on all billed transactions.
What about working with the pharmacy partner?
With regards to the LTC (long-term care) pharmacies, adjudication would allow us to implement some of these rules and flag claims on a real-time basis, which is ideal. When that is not the case, we have developed a good rapport with our clients’ partner pharmacies. They understand that if behaviors are not being met or are not in accordance with what has been laid out by the decision-makers or detailed in contracts, then they’re willing to capitulate and apply the credits. With the support of the mutual client, the pharmacies have been amenable to these reports as they understand that this is their responsibility as the dispensing pharmacy.
What is the main challenge to implementing an effective DUR?
I would say the primary challenge we faced was figuring out how to implement flags and certain rule behavioral changes when adjudication of claims is not possible. As we explored solutions, we eventually created the DUR reporting feature as a backstop and contingency plan. Once we identified the problem and listened to the voices of our clients who presented us with this problem statement, we effectively developed a solution to meet the challenge.
What is the most impressive outcome that long-term care facilities are seeing from their DUR?
Ironically enough, one of our biggest DUR success stories has been with our pilot client. When we implemented the DUR program, we saw an immediate recoupment of dollars back to the facility. This early success illuminated a hidden value-add that was available to be rolled out to other operators. We’ve seen similar success throughout our client base with the implementation of the DUR as it has proved to be an effective cost management tool.
Editor’s note: This interview has been edited for length and clarity.
SRX is a data-driven technology platform for skilled nursing and long-term care facilities. Their technology automates all areas related to pharmacy spend, including rebates, prescription costs, and reconciliation and reporting. Learn more at SRX-Tech.com.
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