Your new and improved Dual Eligible report now identifies needle-in-the-haystack opportunities for your dual eligible patients, who can change their Medicare plan once each quarter of the year. Opportunities are generated if, based on our analysis, a dual eligible patient has an alternative plan option that could be more beneficial for them in one of two different ways:

  1. cheaper total out-of-pocket (OOP) cost compared to their current plan

  2. the same OOP cost with a higher CMS star rating (higher star rating = plan will provide higher quality service to the patient)

Note: Only patients that have current plans entered or detected in their Amplicare profile can be analyzed since this information is required in order to accurately compare to alternative plan options.

Win-Win Opportunities

Recommended Filters in the report now allow you to further pinpoint your highest priority patients to engage with. Top Opportunities (“WIN-WINs”) will identify patients that have an alternative plan option that has a higher projected revenue for the pharmacy, taking into account estimated DIR fees.

To access these opportunities:

  1. Click your Opportunities tab on the left

  2. Select Dual Eligible from the worklist dropdown

  3. Select the Recommended Filter dropdown and choose Top Opportunities (WIN-WINS)

Recommended Plan Alternative

For every opportunity we now run an analysis and recommend an alternative plan for the patient based on several factors including out-of-pocket cost, estimated revenue, DIR fees, CMS star rating, and drug restrictions. Basically, we do the work for you!

When you click an opportunity you'll see an overview of these factors for the patient's Current Plan and Recommended Plan, so you can do a quick comparison and decide whether you want to continue pursuing the opportunity.

Note: if there is an alternative plan option that doesn’t have DIR fees at all, we will always prioritize recommending that plan over others!

What's Next?

Click here to learn best practices for taking action on these new opportunities!

Did this answer your question?