Pharmaceutical Care Solutions 8 March 2010 © Copyright ESH 2010 Submission to Greek Ministry

Pharmaceutical Pharmaceutical Care SolutionsCare Solutions

8 March 20108 March 2010

© Copyright ESH 2010© Copyright ESH 2010

Submission to Greek Ministry Submission to Greek Ministry

Company Profile – EuroSwiss Mediscor

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• Specialized health care company offering comprehensive pharmaceutical and medical management solutions

• Established in 1989 with over 20 years experience

• Processes > 800,000 real-time pharmacy and > 50,000 doctor transactions daily

• Broad client base, managing millions of livesMarkets• Europe

• Africa• Asia• Middle East

Markets• Europe

• Africa• Asia• Middle East

Services• Pharmaceutical Management • Managed Care • Consulting – Systems & Policy• Provider Networks & Financing • Specialized solutions

Services• Pharmaceutical Management • Managed Care • Consulting – Systems & Policy• Provider Networks & Financing • Specialized solutions


Greece: Key Objectives

Accessible Health Care at the :RIGHT timeRIGHT quantityRIGHT qualityRIGHT formatRIGHT placeRIGHT price


How Is This Going To Be Done?


Beyond Prescription Control

Pharmacy Benefit Management

(PBM)


What is a PBM?

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A PBM is a company

that manages the medicine claims for

a medical funder/insurer


Benefits of a PBM

Benefits are produced for • the funder / insurer• the pharmacy• the patient and• the state

resulting in a positive member, service provider and healthcare insurer experience

7© Copyright ESH 2010© Copyright ESH 2010

Benefits for the Insurer• Eliminates paper claims• Speeds up administrative processes• Processing is in real-time online (similar to credit

card systems)

Diverse list of management rules• Down to patient or product level• Pricing management• Utilization management• Clinical management• Comprehensive information

• Derive a 20-30% saving on medicine spend• Eliminate addiction & abuse• Substantially reduce fraud


Benefits for the Pharmacy

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• Appropriateness of medicines prescribed• Prevents ingredient duplication• Empower provider to consult with patient• Overdose prevention• Drug interactions

• Electronic – no more paper claims• Faster payment• Improved practice management • Claims submitted in real-time (similar to credit card

systems)• Better credit control• Real-time payment confirmation• Reduced claims administration

Improved quality of care


Benefits for the Patient

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• Appropriateness of medicines prescribed• Prevents ingredient duplication• Empower provider to consult with patient• Overdose prevention• Drug interactions

Improved quality of

care

• Eliminates upfront payment at pharmacy• Eliminates need to submit paper claims• Timely claims administration• Timely follow-up and query resolution• Faster re-imbursement cycles

Efficient Claims Administration


Benefits for the State

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• Disease profiles• Patient profiles• Demographics of medicine usage• Pharmacy profiles• Prescriber profiles• Manufacturers/product usage

Build an information

base


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Claims Process

Providers

SWITCH Mediscor PBM

SWITCH Mediscor PBM

Funder/Insurer

Entire real-time transaction takes less than 9 seconds

E-prescribingE-prescribing

Third partyAdministration (TPA)

Third partyAdministration (TPA)


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Claims Process

Providers

SWITCH Mediscor PBM

SWITCH Mediscor PBM

Funder/Insurer

Provider Coverage• 100% of pharmacies should use real-time• 100% of hospital and clinic pharmacies should use real-time• All pharmacy vendors accredited for real-time• All postal/courier pharmacies


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Claims process

Providers

SWITCH Mediscor PBM

SWITCH Mediscor PBM

Funder/Insurer

Claims Delivery

• Provided by switch company

•Triangulated redundancy for intelligent business continuity


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Claims process

Providers

SWITCH Mediscor PBM

SWITCH Mediscor PBM

Funder/Insurer

Claims processing software on IBM Hardware• Data integrity validation• Eligibility determination• Medicine utilization management• Clinical management (Drug database)• Price management• Benefit validation


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Integrated UtilisationManagement &

Pharmaceutical Care

Pharmacy Claims

Patient Claims

Clinic/DoctorClaims

HospitalClaims

Central Patient Medicine Claims Record

at Active Ingredient Level

Centralized Management


Our Technology

• Claims processing system used currently manages over 70 million lives worldwide

• Country-specific software customization• Clinical product database • Business Intelligence Application• Interface – multitude of insurance and provider platforms • Connectivity – with pharmacy software systems and

doctor e-prescribing systems supporting the following technologies:

- Health smart cards - Barcode - Digital pens - OCR


Our Service Offering

• Real-time electronic medicine claims processing• Client support services - for e.g. Call centre with

extended working hours• Information services - through our web-based reporting

tool, the Mediscor Analyzer• Consulting services - to aid with benefit design &

formulary management • Chronic medicine pre-authorizations • Other supplementary services: for product and price file

maintenance


Analyzer Dashboard


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Trend Analysis - Expenditure


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Trend Analysis - Cost


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Trend Analysis - Utilization


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Our ResultsSource: Council for Medical Schemes Annual Report 2006-2007

Introduction of PBM services


Our Results

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Savings measured and reported as a percentage of the submitted claim value

Service Category

2006%

2007%

2008%

Claims Processing:

20.4 18.4 16.8

Utilization management

9.2 11.2 9.9

Clinical management

2.4 2.4 2.3

Pricing management

8.8 4.8 4.6

Authorization interventions:

13.6 9.3 6.2


Why Euroswiss Mediscor?

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• SAVINGS – in a highly specialized field!!• Quality of Service• Local customization - experience in converting a

country to electronic claims• System integration abilities• Comprehensive quality assurance capabilities• Clinical abilities• Benefit design specialists• Product coding expertise• Experienced staff• 20 year history


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- Unique Specialized Expertise - Understanding of Greek situation

- World-Class technology

- World-Class Partnerships

Why EuroSwiss Mediscor ?


Contact Persons• PresidentDr. Delon HUMANM.B.Ch.B., M Prax Med, MFGP, DCH, MBAE-mail: [email protected]: + 41 79 200 4424

• Greek OperationsMr. Panos PAPADAKOSE-mail: [email protected]: +30 6945757555


Documents

Pharmaceutical Care Solutions 8 March 2010 © Copyright ESH 2010 Submission to Greek Ministry