Ryan Jackson’s Post

80% of any risk adjustment or data analytics project is acquiring, cleaning, labeling, and preparing data. If you don't have clean data to start with, your output will be trash. It will not matter how much you spent on your software, or how "advanced" your analytics software is. Garbage in, garbage out. If you need an expert in processing Medicare Advantage and Prescription Drug (MAPD) Plan data with almost 20 years experience doing just that, then give me a call. #riskadjustment #medicareadvantage #datanalytics #edps #claims #mmr #pde

The 340B Drug Pricing Program has always been a lifeline for underserved communities, but managing it? That’s been a challenge—until now. No more hours lost in spreadsheets, no more time-taking audits, and no more sleepless nights over compliance risks. With automation, the 340B program has stepped into the future - Effortless Compliance - Automated tracking ensures every transaction is audit-ready, eliminating headaches before they happen. Smart Data Insights - Imagine having all your data synced, analyzed, and actionable—at your fingertips. Consultants and TPAs now have the power to optimize performance like never before. More Time, Less Hassle - Forget tedious manual tasks. Automation lets you focus on strategy and impact while the system handles the grunt work. Scaling Made Easy - Whether managing hundreds or thousands of transactions, automation ensures accuracy and efficiency every step of the way. At Histroke, we’ve built solutions that do more than just streamline operations—they transform how consultants and TPAs unlock the full potential of the 340B program. What’s the biggest difference automation has made in your work? Let’s hear your stories and to know ours mail us at - [email protected] #AutomationRevolution #340BProgram #InnovationInHealthcare #TechForGood #histroke #histrokellc

The progress towards precision medicine continues to show promise as more states approve universal coverage or pharmacogenomics (PGx) testing! As of July 1, California joins 13 other states aligning with Medicare coverage in place since 2020. Along with dosing mistakes that cause toxicity and fatalities, this will help curb the annual loss of 33,000 lives and 62 billion dollar spend due to non-optimized medications in the state. DoseMe shares the mission to help patients access personalized care, but the work is not over until similar efforts move forward in every state and nationally. Please see where your state stands in moving biomarker legislation forward and join the efforts if needed - https://lnkd.in/gwgcHA8Q. And support national efforts to reduce adverse drug events by asking your Congressional representatives to support the Right Drug Dose Now Act of 2024 - https://lnkd.in/dAf--N7p. #pharmacogenomics #PGX #medicare #insurance #precisiondosing

This week's Medicare Market Insights deep dive looked at the shift in Stars, Premiums, Drug Deductibles and MOOPs. For plans that are renewing in 2025, how are these components changing? Here's a summary. -Star Rating Down -Premiums Level/Down -Drug Deductibles Up -MOOP Mixed, though largely up Go here for the full deep dive -> https://lnkd.in/gs_wURZG __ P.S.- don't forget to subscribe!

This is very simple. ✔ 15% markup on actual cost ✔ $3 "handling fee" ✔ $5 shipping cost 💯% Transparency 💥💥💥 The only reason complexity has crept in, is to secretly drive costs for the Payers/PBMs. #pharmacy #pbm

This legislation is a critical step toward ending the PBM exploitative practices. It’s time to put patients first. PBM ownership of specialty pharmacies is a disaster for patients and providers. Here’s what’s happening: Patients are steered toward PBM-owned pharmacies PBMs prioritize profits by pushing higher-priced medications than lower cost alternatives Independent pharmacies lose out because PBMs reimburse their own pharmacies at higher rates (as confirmed by the FTC).

This!! “Don’t combine the medical with the money under one corporate roof.” As I said before, this matter is not about #pharmacy practice alone. These unfair practices have been going on for years in #healthcare industry and many of us have been fighting for our patients’ access to care. Everyone has been affected by this in one way or another without even realizing it. I have been in practice for over 20 years, and I have seen firsthand the negative impact of pharmacy benefit managers (PBMs) on PATIENTS. Many pharmacies have closed already, and in the next few months we are going to see the number of closures go up. Private/independent pharmacies will not survive as fair reimbursement, fair access to networks and contracts are all being denied by these PBMs. PBMs profit exorbitantly while driving up Americans' prescription drug costs, while reducing Americans' access to medications and pharmacies, and while forcing pharmacies to close. Every day care is being delayed or denied because PBMs are not regulated.

📍Coverage from Trade & Channel Strategies Conference 2024 📹 In this video interview, EVERSANA's VP of Patient Services, Kevin O'Meara discusses the Patient-Cetric 3.0 breakout session and the challenges of drug manufactures implementing Direct-to-Patient models.

High pharmacy spend is very good indicator for claims that require further intervention. Independent Med Management are working with insurers nation-wide to review their top claims every month or quarter. Ask your IMA or Team Leaders to provide you with a list of your top pharmacy spend claims to investigate these further.

Staying informed on the latest treatment options is crucial for supporting patients with MS. In our recent webinar, our expert Can Do Coaches delve into generics and biosimilars, providing a comprehensive overview of their development, FDA approval process, and comparative effectiveness. They also tackle key considerations, including transitioning from existing DMTs and navigating insurance coverage for these therapies. Watch the full webinar and equip yourself with the knowledge to better guide your patients. Watch the entire webinar here: https://lnkd.in/eT-V6UUg