The Affordable Care Act (ACA) mandates implementation of a wide range of information and communications technologies (ICT) in healthcare. This includes pharmacies, which are an essential part of the industry. With close to 67,000 pharmacies in the United States made up of chains and independently owned businesses, incremental changes across the value chain using ICT has produced noticeable improvements. Argus Health Systems, provider of pharmacy and health management solutions to key healthcare organizations, announced it has extended its pharmacy administration services contract with Humana through 2020.
Since 2005 Argus has been supporting Humana’s core pharmacy benefit initiatives, including its Medicare Part D drug benefit strategy. This extension will see the pharmacy claims processing, reporting and other administration services Argus has been providing into the next decade.
The nationwide health services Humana provides covers individual consumers as well as many different public and private organizations. Understanding the complexities required to deliver efficient and cost saving pharmaceutical services is vitally important as the company continues to navigate the new healthcare environment.
The Argus network includes all major chains and has more than 63,000 retail pharmacies nationally. This coverage allows the company to offer healthcare organizations value and convenience for their members, including specialty pharmacy networks to address specialized forms of disease management and other health care issues.
Using medical and pharmacy insights with prescriptive analytics, Argus has an infrastructure in place that delivers better clinical outcomes and financial results for organizations such as Humana.
One of the solutions it provides is pharmacy auditing designed to guard against Fraud, Waste and Abuse (FWA). The Argus Detection Awareness and Prevention Team (ADAPT) uses specially designed algorithms to perform an in-depth detailed analysis to help companies meet the health care reform mandates in the ACA and other regulations.
The company’s audit process has cost-effective audit programs for verifying claim accuracy, dispensing and overall performance by managing both pharmacy desktop and on-site audits. The audit findings are then used to improve pharmacy business practices and performance while decreasing potential risk of FWA.
"Our pharmacy management business has made significant investment in its clinical, network, and analytic capabilities. All with an eye toward helping companies like Humana effectively manage their member populations. We've come to know Humana well over the last ten years, and I'm confident in our ability to support their continued growth over the next five." Jonathan Boehm, President and CEO of DST's Healthcare segment, said.
Edited by
Dominick Sorrentino
