Amplicare Match provides opportunity reporting that is beneficial to your patient’s health and cost effective for your Pharmacy.  Engaging with patients this holiday season and during Open Enrollment is front of mind for all healthcare stakeholders. This is why Amplicare provides this insightful reporting for their pharmacies who are key advocates in the improvement of patients’ healthcare and costs.

DIR Mitigation Report

Medication adherence is a key measure evaluated by healthcare entities when evaluating cost drivers for the most chronically ill patients.  Improvement of patients’ adherence measures can prove to be impactful to the patient and cost effective for your pharmacy.  Certain health plans will apply higher DIR fees based on the medication remedy of patients with low medication adherence.  Amplicare’s report will identify these patients, their current health plan and maximum DIR fees that your pharmacy may incur.  The value add of this report  includes recommendations on how to mitigate DIR fees by migrating patients to plans that have the lowest out-of-pocket cost for the patients and have a positive impact on the pharmacy in terms of reducing DIR fees.

PLAN A’s logic for expensing DIR fees to a pharmacy takes into account patients in the categories listed below with adherence scoring of < 80%.  For each pharmacy being evaluated, PLAN A applies a percentile scoring on the groups of patients that improve their adherence measures and key metrics.  If a pharmacy improves these measurements for their patients with these chronic conditions and score in the 80th percentile, PLAN A will provide rebates and return all DIR fees collected.

Patient Adherence Measures:

  • Diabetic Adherence 
  • Hypertension Adherence 
  • Cholesterol Adherence 

How do I mitigate with these opportunities?

Potential migrations of patients on health plans identified in the DIR Mitigation report.  Amplicare Match will provide pharmacies with alternative health plan options, improving low adherence and reducing DIR fees

  1. Migrate Plan A patients with low adherence who are forecasted to choose the most cost-effective plan if presented their options can move to Plan B
  2. Migrate Plan B patients with high adherence who are forecasted to pick Plan A if informed of their options can migrate to Plan A*, as Plan B currently does not reward the pharmacy for the patient having high adherence. 
  3. Identify and prioritize interventions with patients between 50% and 80% medication adherence 
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