Pharmaceutical Company: Hub Services Cloud Implementation

The Challenge

It is an on-going challenge in the industry to make sure to get patients their prescribed drugs on time – and to collect payments (frequently in significant amounts) in a timely manner.

Hub services providers offer a variety of services to their clients to address these challenges, including:

• Revenue Cycle Management (RCM) front-end tasks – e.g., benefits investigation and verification, prior authorizations (PAs), and Appeals.
• Copay support.
• Financial assistance.
• Patient Assistance Programs (PAP).
• Adherence.
• Prescription renewals.
• Patient Health Management.
• RCM back-end tasks (Claims management, drug dispensing, and refills).

Hubs obtain and route prescriptions to ensure quick and appropriate delivery. The client was providing hub services to 40 drug manufacturers with over 100 drugs in multiple disparate systems. For example, intake and triage was done in one system; benefit verification happened in another; and claims management, claims adjudication and Adherence/compliance occurred in a third different system.

Our client’s strategic objectives were to create a one-stop platform that accelerated the process for patients to get their prescribed drugs – and to be able to extend the platform to support future drugs and vendors with minimal changes.

The Solution

Wilco Source conducted operational and evidence-based assessments that identified workflow inefficiencies. We then implemented an adaptive hub services platform that automated and streamlined the process from patient intake to patient obtaining drug – greatly reducing the cycle time.

The platform also automated and streamlined claim management for multiple drugs across multiple manufacturers – with minimal configuration changes. In addition, the platform integrated with external systems including billing and web portals.

Analytics was another major component of the system that provided real-time visibility on the patient journey, workforce management, and billing activities. Using robust data warehouse mechanisms to pull data, the platform was able to support the business intelligence tools used to generate reports and dashboards.

The Results

Our team implemented a system that allowed agents to work on one platform. This did not necessarily remove and replace all of their existing systems but helped with setting up a platform that could interact with external and internal systems to manage the processes.