At the Intersection of Exhausted and Impossible
Today, most employees and employers in all organizations struggle to do more with less…not just health plans.
Information flow and the necessity to respond quickly to change have totally transformed existing jobs in the last ten years. There is little opportunity to spend days considering the implications of data and information received. The necessity of implementing new programs to meet the Centers for Medicare & Medicaid Services (CMS) requirements strains the resources of health plan organizations and departments even further and may contribute to lapses in compliance and, therefore, regulatory risk. A daily to-do list for the Part D team routinely includes:
- Rejected claims review
- Formulary maintenance
- Adjudication issues resolution
- Intra-departmental calls to assist with resolution of grievances and Complaints Tracking Module cases (CTMs)
- Transition fill and notice monitoring
- B versus D medication resolutions
- Intra-departmental and other organization meetings
- Compliance communications and directives
- Personnel issue resolution
- Clinical pharmacy activities
- Part D Star Ratings monitoring and report reviews
- Case management activities
- CMS-required reporting
- Enrollment and eligibility issue resolution
- Prescription drug event (PDE) reconciliation
- AND the never diminishing email inbox
The list goes on and on. A thorough review of all department functions either utilizing internal human resource assistance or external experts can provide recommendations for the right size staffing, resource delineation, and recommendations for new products or tools for the Pharmacy/Part D Department. The review should include the following questions: What is the right mix of pharmacists, pharmacy technicians, and business analysts? How many hours or full-time employee (FTE) segments should be dedicated to the various tasks? Will additional training and refining of work processes help to alleviate some of the burden? Is there a software solution that will streamline some of the manual processes currently in place?
With the insufficient amount of true subject matter experts in the industry, we know recruiting is difficult and time consuming. If interim staffing is what you need, Gorman Health Group (GHG) can enhance your team with our own, providing knowledgeable, effective assistance and an eye for detail from processors and analysts with decades of experience. Our pharmacy consultants come fully trained and prepared to provide short-term or long-term support and create a business case for additional resources, training, and tools. We offer strategic and operational leadership experts when, and where you need it.
Interested in more information? Contact us today.
Resources
Our Part D services are designed with your staff in mind, ensuring that with a mix of counsel and DIY tools your staff will have access to actionable information — faster. Don’t chase data points. Spend your time on the things that will impact your audit results when a CMS audit comes — and it always does. Visit our website to learn more >>
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