Discussion Week 2 PBM Model In Health Care Discussion

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Health Medical

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Please provide a response to the attached peer discussion post as well as answering the below discussion post for week 2. Please continue to use Texas Health Resources in Texas. I have attached the response provided in Week 1. Please provide references for each.

Week 2 Post:

Funding Your Winning Move and ROI

What is the most important financial data you intend to evaluate and interpret to support your winning move?

  • What is the winning move going to cost?
  • How much profit will this winning move generate?
  • What are the potential financial risks of your winning move?

You must answer the discussion questions by speaking in the first person as the CEO of your organization and respond to your peers as a Board member of their organization. See Course Guide for additional details.

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1 Texas Health Resource Student’s Name Professor’s Name Course Title Date 2 Texas Health Resource The Texas Health Resource's competitive approach is embracing automated dispensing cabinets (ADC) to minimize medication errors in healthcare. Medication errors are a significant challenge throughout the healthcare industry. What does the playing field look like? What are the current trends in your industry? The Healthcare industry is a significant beneficiary of technological advances. Such developments have forced organizations to advance their operations to meet the needs of service users. As such, the playing field is competitive due to the ever-changing dimensions of illnesses. ADC is a current computerized system with greater efficiency than the traditional medical administration system. What has the competition been up to? How does your winning move address competitive challenges in your sector? Competition in healthcare service delivery rests on practitioner competence to minimize medication errors and set a standardized program for analyzing medication errors. ADC would address competitive issues by helping healthcare practitioners in my organization pinpoint medication errors correctly and report for prompt actions. How will your winning move improve your company's current performance? ADC would increase my organization’s current performance by helping staff execute successful medication administration. In doing so, affective staff commitment to Texas Health Resource would improve due to excellent job satisfaction. Furthermore, the competitive strategy would guide my facility to form a multidisciplinary committee that would evaluate possible discrepancies and solve medication practices' challenges. The 3 multidisciplinary team would classify, prioritize and regularize the medication error reporting system to ensure the medication error evaluation system remains operational. What actions are you recommending for improving your company's performance in the short term (1 year) and long term (3 years)? Actions that would increase my company’s performance are staff training and continuous learning to stay updated on healthcare trends. Staff training every quarter for one year on analyzing medication errors and using automated dispensing cabinets would help tech-savvy individuals and learners read from the same page. Secondly, personal initiative is also critical for the success of my organization. Therefore, my staff would enjoy virtual learning services to improve teamwork and advance individual skills for handling patients with the utmost compassion. Cherilyn Post Week 1 Discussion Attachment - Your Winning Move Based on your analysis in JWI 581, as a CEO seeking to increase the competitive strength of your organization, restate the winning move you want to pursue and why. In considering your winning move think about Jack's 5 Slides and address the following: What does the playing field look like? The current PBM playing field is an important role but still tricky at best. PBM’s are creating huge networks to ensure better buying and bargaining power. By PBM’s acting as the middlemen and processing pharmacy claims we can facilitate and negotiate pharmaceutical costs between manufacturers and retailers. This gives us the opportunity to negotiate better contracts and rebates. What are the current trends in your industry? Currently some of the biggest trends in the industry and a significant amount of vertical integration with health plans and other health provider types to increase those networks. A lot of these current trends have been facilitated due to the implementation of the ACA to move volume-based care and services to value-based care and services. Consolidation of specialty pharmacies has been another trend which we have done ourselves. What has the competition been up to? Our competitors have been doing much of the same in moving towards outcomesbased contracting for seeking value. Additionally, there have been a ton of acquisitions from the big 3 being CVS, Express Scripts, and OptumRx leading them to account for nearly 70% of all pharmacy claims processing volume. CVS has been one of the big contenders acquiring specialty pharmacies. This enables them huge bargaining power in contract negotiations with manufacturers. These top 3 typically exclude several brand drugs from their more robust formularies giving them optimal savings opportunities. RxParadigm has vowed to disrupt the PBM market by instituting a transparent view of how prescription drugs are priced and opening up new channels to increase competition. How does your winning move address competitive challenges in your sector? Some of the more pressing challenges as of late have been pricing transparency, slowing growth based on generic drugs, regulatory changes, and insufficient PBM analytics and reporting tools. Our proposed winning move of incorporating COVID-19 vaccine information into our newly created COVID-19 drug trends dashboard will provide tools that are not currently provided. We acted quickly to build the COVID-19 dashboard which is utilized by all our clinicians as well as our Chief Medical Officer, around media requests and responses. This application has been beneficial early on by providing week over week drug utilization and trend, so we could prepare for shortages in COVID therapy. Adding Covid Vaccine information will help us recover lost funds from improperly billed claims as well as review population adherence for both vaccine doses. How will your winning move improve your company's current performance? Adding Covid Vaccine information will help us recover lost funds from improperly billed claims, by allowing account managers to target providers with the training necessary to submit claims correctly. This will also allow us to track adherence and non-adherence for patients of both vaccine dosages. What actions are you recommending for improving your company's performance in the short term (1 year) and long term (3 years)? Over the short term, let's continue to collect COVID-19 vaccine data and measure performance by recovered monies on improperly submitted claims as well as sending target notifications to those members who have not received their second vaccination dosage. This will help us identify our group adherence measures and then determine the effects of our targeted messaging. Long term we should keep collecting this data and start to build more analytics around the effects of patients diagnosed with COVID19 that received the vaccinations and that did not against certain clinical population groups. This could really step our ability to provide more forecasting capabilities within our clinical insight’s programs and gauge population outcomes in the future. References: Content, A. (2021, February 9). Disrupting pharmacy benefit management: RxParadigm launches to restore drug industry competitiveness and reduce the costs of prescription drugs for Americans. WFMJ.Com. https://www.wfmj.com/story/43319967/disrupting-pharmacy-benefit-management-rxparadigm-launches-torestore-drug-industry-competitiveness-and-reduce-the-costs-of-prescription-drugs-for Decision Resources Group. (2020, January 14). Top 10 PBM Industry Macrotrends in 2019 & What to Expect in 2020. DRG. https://decisionresourcesgroup.com/blog/top-10-pbm-industry-macrotrends-2019-expect-2020/ HIRC. (n.d.). Pharmacy benefit managers: Market landscape and strategic imperatives | health industries research companies (HIRC). Hirc.Com. Retrieved February 17, 2021, from https://www.hirc.com/pharmacy-benefitmanagers-market-landscape-and-strategic-imperatives-1 PBM watch. (n.d.). Pbmwatch.Com. Retrieved February 17, 2021, from http://www.pbmwatch.com/problems-inthe-market.html Karen’s Post Good morning everyone, • What does the playing field look like? The characteristics of the environment- Technology-driven deliver system focusing on acute care. The high in cost, unequal in access, and average • • • • • in outcome. Delivery of health care under imperfect market conditions. The most important customers- Customers external to healthcare organizations include patients, patients' families, and visitors. Internal customers include nurses, staff physicians and other professionals, students, trainees, employees, departments, and committees. Your competition- Northside Hospital System, Northeast Georgia Health System, Novant Health and Centra Care. Competition in health care markets benefits consumers because it helps contain costs, improve quality, and encourage innovation. • What are the current trends in your industry? • Telehealth • Staffing shortages • Cybersecurity • Optimization & Ancillary Technology What has the competition been up to? How does your winning move address competitive challenges in your sector? Northside Hospital System is one of the biggest competitors to WellStar Health System. I did not realize until doing research, that the blood and marrow transplant (BMT) program at Northside Hospital Cancer Institute (NHCI) is one of the largest and most comprehensive programs of its kind in the Southeast and has among the best survival rates in the nation for bone marrow transplants How will your winning move improve your company's current performance? In the current state telehealth has a huge role in the future of medicine. Patients get both convenience and improved health outcomes. As a health system physician gain flexibility, there is a new revenue source, and the satisfaction of helping their patients feel better. Telemedicine represents a net positive for the health system. • What actions are you recommending for improving your company's performance in the short term (1 year) and long term (3 years)? Some areas that our health system should look at improving on are: • • • • • • • Improves patient engagement. Expands access to healthcare. Decreases hospital admissions. Providing new revenue streams. Improves quality metrics. Improves patient satisfaction. Reference Welch, J. & Welch, S. (2005). Winning. New York, NY: Harper https://www.northside.com/about/news-center/articles/2021/02/08/bmtsurvival-outcomes
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Explanation & Answer

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Discussion Responses
Response to Cherilyn
Hello Cherilyn,
The statement that the contemporary PBM playing field is essential resonates with me. PBMs are
in a lucrative and fast-growing industry courtesy of the relationship with retail pharmacies,
pharmaceutical manufacturers, and health plans. PBMs indeed enjoys an excellent chance for
negotiating better rebates and contracts for customers. I agree with the several trends in this
industry, including consolidating specialty pharmacies and vertical integration with different
health providers. Nonetheless, PBM's capacity to negotiate correctly with manufacturers is
criticized in the contemporary world (Garrett & Garis, 2007). Critics hold that PBMs cannot
succeed during drug-by-drug negotiations since manufacturers bundle drugs and offer aggregate
prices. The winning move proposed in this case is unique and well-calculated during this period
of the COVID-19 pandemic. Incorporating information about the COVID-19 vaccine...


Anonymous
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