340B Referral Capture Program

SpendMend Team

By: Riley Protz

 

Client Background

  • Large non-profit hospital Disproportionate Share Hospital (DSH) with eligible child sites in Primary Care, Neurology, and
  • An expansive contract pharmacy network of over 95 contracts

Problem

In line with the experiences of many covered entities around the nation, this hospital has experienced a drastic decline in its 340B program savings, particularly in the contract pharmacy arena. Hospital Leadership became increasingly concerned with the reduction in savings, subsequent decline in the viability of clinical services supported by these savings, and overall financial stability of the hospital. The hospital engaged SpendMend Pharmacy to identify an opportunity to mitigate its contract pharmacy losses in an efficient and compliant manner.

Solution

Leveraging the organization’s primary care child sites and contract pharmacy network, SpendMend Pharmacy was able to identify an untapped opportunity for capturing prescriptions written by referred Specialist Providers. By providing SpendMend Pharmacy experts with access to their contract pharmacy TPAs and EMR system, the hospital’s operational workload remained minimal. A SpendMend 340B Specialist reviewed non-qualified contract pharmacy claims each month to identify prescriptions written by referred Specialists for which the covered entity maintained responsibility of care. These prescriptions were then manually qualified as 340B-eligible within the TPA and auditable records supporting this classification were retained for the hospital.

Result

Within the first 6 months of implementation of a referral capture program with SpendMend Pharmacy, the hospital achieved a net savings increase of over $240,000. This takes into account all SpendMend and TPA fees as well as 340B drug cost for inventory replenished. With the confidence that SpendMend Pharmacy prioritizes compliance, hospital leadership remains engaged and satisfied with the program.

+$240K Net Savings in First 6 Months

340B Program Excellence: A Year in Review

SpendMend Team

Written By: Rob Nahoopii

This week marks exactly one year since Turnkey Pharmacy Solutions became a member of the SpendMend team.  If I think back to that hectic time surrounding our transition, I remember sharing the news with several colleagues.  Everyone was supportive but they all asked a similar question, “why make this move in the middle of a pandemic?”

The answer is simple… joining SpendMend enables us to grow faster, to reach more broadly, and to do much more for Covered Entities.

For nearly a decade, Turnkey has been recognized as the industry’s premier supplier of 340B compliance and optimization services.  But I always knew we could do more, and I knew that with a large client base and a great reputation, SpendMend was the right group to facilitate our growth and increase our impact on the market.

It’s been a year now, and despite the difficult circumstances facing hospitals and clinics we have been able to expand our world-class team and serve many more Covered Entities.  We’re extremely proud of the work we do to ensure 340B compliance and to drive a material decrease in annual drug spend for our clients.

The decision to join SpendMend has also come with other critical benefits relating to our product roadmap.  In the last quarter alone, we’ve been able to expedite the development and release of two new solutions to deliver even more value to our clients.

  • 340B Referral Capture ensures that all referral captures will meet compliance testing during a HRSA audit.  We help covered entities identify all existing opportunities, while capturing new opportunities as well.
  • 340B Staff Augmentation helps covered entities manage 340B compliance when staff members are on extended leave, when key positions are vacant or hard to fill, and when new positions are filled but no one is available to train.

If you have any questions about Turnkey Pharmacy Solutions,  SpendMend, or our solutions please reach out to me or any member of the team.  We know how difficult it can be, as a Covered Entity, to manage your 340B Program and we are here to answer your questions and to help whenever possible.

Is 340B Referral Capture Right For Your Organization?

SpendMend Team

Written By: Jake Thompson, jthompson@spendmend.com

Earlier this month we announced that the 340B Referral Capture program has been made available to all current and new clients moving forward.  Since this announcement, we have been receiving calls daily about this service, so we wanted to highlight a few points of interest which arise frequently in these conversations.

How can I learn more?   

Check out our website (https://www.spendmend.com/solutions/pharmacy-solutions/) for more details about the offering.

How do I know if my organization can benefit? 

We can help you assess that. To start, there are a few key items that may help you quickly understand if the service can assist your needs.

1. Clinic Setup: Do you have primary care clinics as part of your 340B Covered Entity (CE)?

  • Having primary care clinics helps you, as the CE, establish patient responsibility of care for any potential referral to a specialist. If you are unsure, we can quickly help you assess this by evaluating your most-recently filed Medicare Cost Report or the services consistent with your scope of grant.

2. Specialists: Are your patients routinely being referred to non-CE specialty clinics?

  • These documented referrals are what we can help track down in order to evaluate potential 340B eligible prescriptions. If you are unsure how to assess, we can help you get the right data out of your EMR to evaluate.

3.  Contract Pharmacy Network: Does your CE have relationships with the pharmacies that fill specialty prescriptions for your patients?

  • Having a contract pharmacy network in place can facilitate 340B Referral Capture savings.  If you do not, we can help evaluate which pharmacies would benefit you to be in contract with and help you with implementation.

4. Documentation: Does your CE receive clinical information back from the prescribing specialist after a patient has been seen?

  • This documentation helps close the loop for a 340B referral prescription.  If you are unsure or lacking in this area, we can help your CE get the necessary clinical information to qualify the prescriptions.

Our team is already overworked, won’t this require a lot of time? 

Our team will do all the work to set up the program and administer it and each month you will get a report of all the prescriptions found!

It may be difficult for us to budget this type of service. How can you help? 

Our model is based on the shared savings of the realized 340B value of each 340B referral prescription qualified.  Therefore, there is no up-front cost, and you only pay us a small portion of the savings when we find 340B savings for your CE.

 

As always, do not hesitate to reach out to us if you are interested and we can discuss all the details and answer any questions.  We would love to help your CE regain any 340B savings that have been eroded during these uncertain times.