Case Study: MORE THAN A VENDOR, A TRUE PARTNERSHIP — HMRx and Innovatix Grow their Business with Scriptmax

MORE THAN A VENDOR, A TRUE PARTNERSHIP

HMRx and Innovatix Grow their Business with Scriptmax

BACKGROUND

On-site pharmacy teams allow for more responsive care and reduced medication errors. This sentence represents the value proposition of HMRx Pharmacy services (HMRx), a service line of HMR Veterans Services, Inc. (HMRVSI). In 2012, HMRVSI expanded its offerings to state veterans’ homes because they could bring a high-level of expertise in pharmacy operations. They also understood the significance and unique needs of serving those who served.

HMRx has the privilege of serving nine veterans’ homes across four states where they take on the risk and liabilities, manage medications, and navigate VA formularies and payment sources.

“We are proud that many states choose HMRx to provide cost-effective services for a continuum of care for our veterans,” stated Michael McBride II, director of operations, HMRx, LLC. “Supporting these homes means establishing a gold standard in pharmacy services.”

GOALS

To deliver on every level of pharmacy operations, HMRx assesses areas of improvement. One of the most pressing items is eliminating any roadblocks to receiving the maximum reimbursements on pharmacy prescription claims.

“Along with our growth goal came the imperative to identify revenue opportunities and ensure that 100% of claims are reviewed, adjudicated, processed, and paid at the maximum reimbursement levels,” said McBride.

HMRx knew it needed to streamline its Medicare Part D plans electronic funds processes, and that meant achieving three objectives:

1. Improve efficiencies. Specifically, move from a 15-page report and paper check reconciliations and transition all 835 files to reconcile and transfer funds electronically.

2. Maximize cash flow by minimizing errors with a reconciliation process.

3. Support the team by simplifying claims reviews and making reporting faster and easier.

The aim of HMRx is for a continuous deficiency-free approach, ensuring every pharmacy contract meets all state and federal requirements.

CHALLENGES

HMRx dealt with antiquated tools and processes, causing delays and lost revenue. The existing pharmacy software didn’t have the full reporting to sift through the information and expedite the Medicare Part D claims. And the amount of information required for each claim created dozens of barriers to receiving maximum reimbursement.

“It was like flying blind and navigating without a compass,” said McBride. “We didn’t have the latest technology, and we were dealing with a large volume of prescription claims each month."

It takes time away from patient care if pharmacy directors have to review each claim for inaccuracies, find missing data, or make corrections within the post-adjudication deadline.”

INNOVATIX

HMRx turned to their long-standing partner, Innovatix, a wholly-owned subsidiary of Premier, Inc., to meet goals and address obstacles. They had developed a new web-based tool, Scriptmax, to provide the needed pharmacy data analytics and adjudication services. This solution offered comprehensive pre-edit, post-edit, and reconciliation services.

The partnership with Innovatix started when HMRx chose them as their Medicare Part D network services agency because they excelled at favorable AWP discounts, competitive contracts for DMEs, PDPs, and PBMs, and strong support for their fraud, waste, and abuse program.

“When I came on board in 2014, Innovatix was already a mainstay vendor of HMRx,” said McBride. “The team had spoken highly of their work, but as part of my charge, I assessed all the current contracts by conducting a thorough review of all vendors. Innovatix came out on top.”

McBride’s due diligence involved comparing vendors who could help grow pharmacy offerings and improve operations.

“It was the personal touch from the team at Innovatix that was always present. Their team was always responsive and always quick to follow up on questions. Those are things you can’t always put a dollar figure on, but they matter,” said McBride. “We were growing, and we wanted Innovatix to grow with us. We had and still remain that type of partnership.”

HMRx had such a good experience with the Innovatix’s Preferred Provider Network, the company’s Medicare Part D reimbursement solution, that they decided to roll all nine pharmacies under  

the program.

“Innovatix ensured Part D contracts were loaded and billed accurately or not billed at all,” McBride said. “Bottom line, we’ve never had any issues. So turning to Innovatix for our reimbursement claims was a no-brainer, especially when we looked at the financials. It didn’t make sense to go somewhere else.”

When it came to finding a solution for improved adjudication and analytics, management assessed options and demoed systems but again chose Innovatix to add another layer of value with Scriptmax.

“Scriptmax is now our engine in all of our locations,” said McBride. “And the feature that has made a huge difference is the real-time resolution.”

SCRIPTMAX

Both Innovatix and HMRx take pride in their relationship because they want great things for each other. Their philosophy is to surround each other with good people and do good work for the veterans’ homes.

HMRx has had Scriptmax for five years, and the following details the features of why McBride and team are satisfied with the system.

TURNKEY

“Our existing methods were antiquated, so to transition to an effortless system that installed easily and required minimal training made a huge difference,” said McBride. “Innovatix did all the heavy lifting to get us going. We immediately reaped the benefits of all its features.”

The technology is turnkey and operating system agnostic, allowing simple, straightforward integration with any pharmacy software system and switch. No complex system integration is required.

REAL TIME

Pharmacy operations at the state veterans’ homes now experience real-time claim validation, reducing incomplete and inaccurate claims and minimizing rejected claims. Scriptmax updates the average wholesale price (AWP), verifies national drug code numbers (NDC), and reviews brand name drugs for appropriate dispensing.

“Mistakes happen, and now we catch them earlier,” said McBride. “Correcting data saves money.”

ANALYTICS

Before Scriptmax’s analytics, it took HMRx double the time to do all the necessary reporting. Now all nine pharmacies and corporate get real-time data daily and weekly to make the best decisions.

“The first day we stated our reporting needs, and Innovatix built it. They customized reports during the install that still work well for us now,” said McBride. “The labor-intensive reporting is a thing of the past.”

Key features of the report package include: 

• Actionable reports to reduce future claim errors.

• Margin analyses.

• Contract rate verification.

RECONCILIATION

All the features come together to make Scriptmax’s reconciliation process cost-effective.  

The third-party payment review and contract rate compliance provides reassurance to the management team. The reconciliation feature flags unpaid or underpaid claims, reduces write-offs, and tracks reimbursements and rate discrepancies.

“Pharmacies have the option of uploading 835 files or having Scriptmax obtain them on their behalf,” said McBride.

RESULTS

“Our pharmacy directors do everything, so if there is any way or anything we can do to lessen their workload, we’re going to do it,” said McBride. “And we can do it because the Innovatix team are partners in solving some of the pharmacy billing concerns that have come to light over the years.”

Innovatix has delivered with Scriptmax as it ensures that the pharmacy is being paid according to the contracts. The state benefits from improved operations, and the veterans get the service they deserve.

As HMRx expanded to nine pharmacies, Innovatix grew with them, allowing HMRx to achieve long-term success. The pharmacies have realized a better cash flow, more accurate claims submission, and increased efficiencies.

CONCLUSION

All HMRx’s pharmacies receive the intelligence and tools they need to realize their revenue potential.

“I’ve worked with Innovatix since I started at HMRx and when you have a great rapport with people, and they exceed expectations for seven years, you don’t fix, what is not broken,” said McBride.  

“When we look at the financials, it wouldn’t make sense to go with any other vendor.”

This partnership works because of the big themes of trust and transparency. It also works because little things matter, such as picking up the phone and talking, brainstorming ideas, and putting the needs of the veterans first.