One of the major and overwhelming changes that has occurred within a real life case of the Genzyme Sanofi Renassist Program is the marked increase in applications for this program. In May, we received 87 applications for patients that were in their 90D Waiting Period. That is a 32% increase over the number of applications received in May 2012. In May of 2012 only a total of 66 applications were received (66 applications). Helping patients is nothing new to Renassist. According to their official website, "the Renassist® team has been helping patients with and without prescription drug coverage identify the Renvela® (sevelamer carbonate) reimbursement solution that is right for them…" (renassist.com, 2013). To be clear, the Renal Patient Assistance Program (RPAP) was designed specifically for patients who had significant financial needs but were not covered for Renvela under and specific prescription drug plan or cmmerical insurance, including government plan (renassist.com, 2013). In this particular case study, we're examining all the factors and changes which are attached to the Part D assistance Program (PDAP). "PDAP provides a free supply of Renvela® (sevelamer carbonate) to eligible patients with Medicare Part D who cannot afford their copayments or co-insurance for their prescriptions: The 2013 Renvela® Medicare Part D Assistance Program opens on March 1, 2013. Refills must be requested by the healthcare professional. If less than 3 months remain in the year, the patient will receive enough medication to last until December 31, 2013" (renassist.com/partd, 2013). These are part of the eligibility requirements that need to examined and assessed closely, when processing all applications for eligibility.
For instance, starting in 2013, there's been almost a 50% jump in the 90D applications received; this means if the current rate of applications continues, in 2013 there will be just under 1,000 applications that will need to be processed. Currently, the team workload timeframes operates under the following schedule:
Pre-entry of Dailies: same day
Pre-entry of Apps: 1 day out
Pre-entry of TPGs: 2 in-queue for pre-entry
Dailies: 3 day turn-around
TPGs: 4-week total turn-around
RPAP applications in-house: 2-week turn-around
RPAP applications with AKF/Diplomat/delivery: 1 week turn-around
As these notes reflect, in order to meet the higher demand for the drug within this set reimbursal program, several things need to happen. First there needs to be an overall increase in efficient. The turn around time for RPAP applications in house is 14 days on average. This is far too long. If anything this number demonstrates a severe lack of efficiency. However, in order to improve it all of the factors connected to it must be adequately improved. For instance, staff members need to be better trained in processing applications and there also need to be more staff members hired to do this process. In order to hire more staff members and in order to train the current staff members more efficiently, there needs to be money carved out of the budget to accomplish such endeavors. For instance, as organizations like healthit.gov have found, with health care organizations working through better compliance and business models, cutting costs becomes a must. "Increased cost savings through effective infrastructure planning. Cost savings can be realized by correctly predicting resource utilization, appropriate use of site of service and improved care delivery team communication" (healthit.gov, 2010). Improving team communication is truly essential to ensure that the team is not only strong and that there's a high level of visibility, but to ensure that applications get processed as quickly as possible. Furthermore, even if money is carved out of the budget to streamline the entire application processing routine, this advancement of the general process will all be for nothing unless there's strong communication to take advantage of those changes.
For example, with certain health care organization, the advancement of the processing methods includes, "Provision of higher specificity of coded clinical data in payor contracting to obtain appropriate reimbursement, improved outcome management and monitoring of key revenue cycle effectiveness indicators (re-admission rates, medical necessity screenings, etc.)" (healthit.gov, 2013). The most important aspect to keep in mind with this particular change is how a "higher specificity of coded clinical data" was able to create a playing field of necessary changes and additions. One of the current problems that the organization is dealing with is the fact that there's never been an effective method of dealing with certain problematic prescriptions. As the case study notes on Renassist reflect, incomplete and/or High Dosage Rxs will take longer to ship -- depends on length of time it takes for prescriber to send in the complete Rx and/or the High Dosage Confirmation Form.
Total RPAP turn-around: 3 weeks (timeframe to give customers)
RPAP refills: 1-2-week total turn-around
PDAP applications in-house: 2-week turn-around
PDAP applications with Diplomat/delivery: 1 week turn-around
*Please note: Incomplete and/or High Dosage Rxs will take longer to ship -- depends on length of time it takes for prescriber to send in the complete Rx and/or the High Dosage Confirmation Form.*
Total PDAP turn-around: 3 weeks (timeframe to give customers)
RPAP refills: 1-2-week total turn-around
Processing Applications/Prescriptions within the Healthcare System in General
The issues and obstacles that Renassist has been facing are symptomatic of the struggles of the healthcare system in general.
"Absolute simplicity is impossible, but relative simplicity -- reducing the number of prices to negotiate -- is imaginable"(Oregon.gov). This quote reminds all parties in involved that its absolutely vital to keep their expectations realistic. The healthcare system in America -- including this exact niche system of Renassist, is never going to be so streamlined that it's as simple as returning a sweater to a department store. However, with concerted effort, focusing on specific problems such as some of the ones presented in this case study, can help illuminate more modern solutions. For instance, revamping the entire reimbursement system is also something to be considered. "Encourage providers to deliver care in a high-quality, efficient manner; Ensure the accurate valuation of provider services including care coordination and management work that is conducted outside of face-to-face patient visits; support and encourage investment in health information technologies that will lead to improvements in efficiency and quality; support coordination of care among multiple providers; provide accountability and transparency; not encourage or reward over-treatment or medically unnecessary procedures; not encourage or reward under-treatment or exclusion of high-risk patients; not reward provider errors or adverse events; not encourage cost-shifting" (Oregon.gov). If anything all of these endeavors for change and transformation demonstrate a range of things: that healthcare organization and programs, even ones as a small as Renassist, need to have a far more comprehensive philosophy and method to their work. There needs to be not only a far more comprehensive method of flagging problematic applications and other hazard-centered content, but there also needs to be a way of communicating with patients so that they know that errors or adverse events will not be rewarded or perhaps even given attention to. There needs to be s strong example set in the vision, mission and philosophy of the company regarding the importance of communication, values and integrity, and that patients are expected to showcase those values as well.
Thus, with this type of engagement, the company needs to be the one to set the overall example. Setting the example starts by meeting the client halfway. In this case, meeting the client halfway means making a commitment to drastic changes within the actual application that the client must complete. Such a change is strategic for several reasons: first, it will demonstrate that Renassist genuinely wants to work with the client in an efficient and effective manner. Furthermore, by drastically simplifying the application process there will be less leeway for clients to present inaccurate information or adverse information. Finally, a dramatic simplification of the application process means that…