For a few years now, the healthcare industry has been hearing about real-time benefit (RTB) services as an option that holds a lot of potential for plans, needs further development, and may “someday” offer an improvement over services such as e-Prescribing. At SS&C Health, we know that “someday” is right now. There are many reasons why health plans should be considering implementing an RTB solution; just make sure your RTB partner has experience with the solution.
First, the capabilities included with today’s RTB services deliver members and providers new levels of transparency around the cost of treatment—available at the point of care. Today’s RTB services allow providers to view reliable, complete medication options integrated with patient-specific benefit, cost, and channel information. This supports adherence and cost savings for all stakeholders along the healthcare continuum, which is particularly important in today’s value-based world.
If that were the only reason to consider RTB, we think it would suffice. However, there are additional compelling reasons to give the service a new look.
RTB promotes member satisfaction by giving the member and provider more control over treatment costs. Evolving benefit designs, such as high-deductible plans, are forcing consumers to pay more out of pocket, and when it comes to reliably eliminating sticker shock, a comprehensive integrated RTB solution outshines formulary and benefit validation capabilities of the past. So, if member satisfaction is important to your plan, then RTB can help.
RTB aligns well with value-based care, which is about improved outcomes for all stakeholders, and adherence drives improved outcomes both clinically and financially. RTB was created to drive adherence by lowering first fill abandonment, as well as to add value at key points during a patient’s healthcare journey: at the point of care and at the pharmacy. Further, mature RTB solutions provide sophisticated provider adoption data that can help plans manage value-based contracts more effectively.
RTB solves many utilization management problems, helping providers avoid step therapy or prior authorization (PA) requirements. These can delay time to therapy, cause patients to abandon prescriptions, and force caregivers to spend too much time on administrative tasks such as PAs or writing a new prescription.
RTB plays an important role in streamlining a patient’s journey from illness or injury to better health, reducing the negative impact of common access-to-care issues. It’s so effective that the Centers for Medicare and Medicaid Services (CMS) will likely be making it a requirement for Part D plans, effective January, 2020.
Most RTB solutions available today are new to the marketplace, so you should research your options carefully, looking for a solution that allows you to measure results and prove ROI through clear associations across the RTB request, response, prescription and the paid claim. At SS&C Health, we launched the industry’s first RTB pilot project in 2012, and we have been working to deliver transparency and value ever since.
To learn more about how RTB can help your plan bring price transparency at the point of care, support value-based care, and mitigate common access-to-care issues, download our white paper: Real-Time Benefit: Validating Outcomes and Savings for Health Plans, Providers, and Patients.
Written by Jonathan Bollinger