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RX Analytics Used to Reform Plan and Save Thousands: A Case Study
Problem
An Oswald client faced the challenge of identifying the source of their skyrocketing medical costs. At the same time, they experienced extremely high medical benefit drug charges due to the network paying a percentage of charges that the outpatient facility determines.
Solution
Our analytics advisors and service team worked with the client to obtain medical claims data. We conducted an in-depth analysis of paid medical claims data and identified several claims administered in a high-cost outpatient facility. The findings included overcharges of approximately $500,000 for one member who received infusion therapy.
Result
Using the data, we developed and recommended the appropriate strategy for site-of-service solutions resulting in real cost savings. Using a new pharmacy has produced savings of $199,000 for each two-day infusion.
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NOTE: This content is for informational purposes only and is not intended as a representation of likely outcomes. Each scenario is different. Speak to an Oswald insurance advisor to discuss your particular situation.
