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InTech Retiree Drug Subsidy Services
- 1. SubsidyLink: A Retiree Drug Subsidy Solution John Hoyt Partner 1
- 2. InTech Health Ventures New company – founded in October 2006 Vision - Healthcare technology services company focused on transforming, connecting and exchanging healthcare through innovative use of technology. Mission Providing technology solutions for specific niches that require complex data sharing or management Providing technology services to organizations needing technical resources or expertise with government initiatives Providing customer oriented solutions enabling them to improve operational and financial performance Solutions SubsidyLink – Retiree Drug Subsidy Program Technology Services – hospitals, rural clinics, regional data exchange Accomplishments 350% revenue growth in twelve months Now facilitating over $20,000,000 in subsidy reimbursement Actuarial and Benefit Consulting Partners
- 3. Retiree Drug Program Challenges Data verification, aggregation, and exchange is complex Lots of different data sources with different formats Need experience with complex data management Must comply with data security and HIPAA requirements RDS regulatory requirements are complicated, confusing, and frequently change Initial MMA guidelines were confusing in regard to the subsidy process and compliance requirements Application process CMS/RDS website Rebate process Eligible and non eligible drugs Inconsistent vendor capabilities to do RDS Significant vendor/PBM difficulty with RDS administrative processes and compliance requirements
- 4. SubsidyLink Solution Overview Administrative process: Data connectivity, aggregation, Monthly Enrollment File Submissions matching, and management Timely and accurate submissions Add/Changes/Deletions Feedback on CMS eligibility status Other RDS customer issues to updates consider: Claims identification and aggregation Liability for accuracy of Calculation of subsidy amounts subsidy amounts Monthly/Quarterly/Annual HIPAA compliance submissions Accurate calculations of subsidy Program changes amounts Formulary monitoring Annual reconciliation Retain claims data for six Support services for appeals years Enrollment appeals Subsidy appeals SubsidyLink is an outsourcing service that handles the RDS administrative process
- 5. Who Uses InTech Health Ventures? Direct Service Customer Model Employers Unions “Virtual Services” PBMs TPAs Referral to InTech BX BS Employee benefit consultants InTech adapts and supports different RDS customer’s needs
- 6. SubsidyLink Capabilities Eligibility Updates Managing retiree list Handling response errors Reporting/Data Gathering Claims/cost reporting Retiree eligibility and rejection report Claims Analysis Part D vs. Part B Drugs Limit aggregation Annual Reconciliation Multiple claims data sources
- 7. SubsidyLink Value For RDS participating organizations: InTech average annual subsidy reimbursement - $575/yr Reduces internal resources and effort to support RDS process Insures RDS participant is fully compliant with RDS requirements On-going customer service specific to: Identifying and helping customers correct ineligible (rejected) retirees Check list and scheduled interaction time to complete reconciliation Technical leadership and resources to initiate and maintain data exchange between CMS, PBM, TPA, and InTech Subsidy amount example: 100 CMS eligible retirees Reimbursement: 100 x $546 PEPY = $54,600 Cost: 100 x $60 PEPY (using $5/PEPM) = $6,000 Net RDS revenue: $48,600 Reduces effort, maximizes subsidy amount, low cost
- 8. SubsidyLink Pricing Pricing approaches: PEPM Percentage of RDS Subsidy Actuarial Services not part of InTech SubsidyLink solution Comprehensive Service to Manage Subsidy Process
- 9. Account Management- Customer Support Account Management responsibilities: InTech commitment: Consistent on-going RDS information exchange communications Conference calls Responsible for RDS relationship Webinars Facilitates InTech Quarterly Updates technical/implementation On-site visits if needed resources Ability to private label InTech Customer Support – Technical sales and marketing materials Services responsibilities: Ability to private label RDS File/data transfer processes reports Data management Sales and marketing assistance Issue resolution Customer Satisfaction Is Our Top Priority
- 10. SubsidyLink Testimonials Transit Employees’ Health and Welfare Fund: “There is no way that we could have done what InTech HV has done for us, as thoroughly and as promptly, as they were able to do. They not only got us money we likely would have never found, they were a pleasure to deal with in the process.” Bricklayers and Stone Masons Union Local 20 Fund: “It has been a tremendous benefit in working with InTech. They have done the entire RDS process correctly, answered many, many, many questions and guided us every step of the way.” Black Hills Corporation: “InTech Health Ventures has provided exceptional service throughout the RDS process.” American Health Care: “InTech Health Ventures is a great company work with. Their teams of highly trained professionals are very knowledgeable, caring, understanding, and always there to help with anything you need. InTech Health Ventures provides me with the best Customer Service I could ask for, and is always there to answer any of my questions on a level I can understand. The employees provide me with the information that I request in a timely matter and it is always accurate.”
- 11. RDS/SubsidyLink Summary RDS program can be a lucrative reimbursement to employers! RDS administrative process is a challenge for employers (and some vendors). InTech greatly simplifies the administrative process as well as helps maximize reimbursement InTech provides comprehensive administrative and technical services resulting in a full service solution for challenging RDS environments InTech focuses on customer service to help customers be successful with the RDS program InTech has strong knowledge and background in the RDS program as well as valuable expertise in complex data management InTech offers a robust solution at a fair price InTech has fully operational customers receiving over $20,000,000 in RDS subsidy today
- 12. Discussion – Questions - Recap Questions? Review of any parts of presentation? Thank You!!