What a Health Plan Wants, a Health Plan Gets (PBM)
Recently, polling and speaking with government programs service directors of PBMs, revealed mindsets that their existing workflows are adequate to maintain Health Plan loyalty. That’s not surprising. How do you feel about those workflows? Health plan surveys, show they do not always agree. Research indicates that this process potentially opens the door to risk, reputation loss, wastes time, and resources.
The average CMS fine to the health plan in 2015 was $750k. Now think about Section 1557, real-time versioning of government recently released templates and what happens “when” not “if” the health plan asks for posting to portals for boosting their wellness campaigns and brand. Think about every time the health plan asks for audit support and the time requirement for finding valid records? How much resources are being wasted due these perceived adequate processes?