Success Stories

Outsourcing: A Game-Changer for Long-Term Care Pharmacies

Prior Authorization Outsourcing: Transforming Medication Management for Long-Term Care

The healthcare sector was hit hard by staffing shortages and increased administrative demands during the COVID-19 pandemic. Long-Term Care (LTC) pharmacies, serving thousands of patients, found themselves grappling with a surge in prior authorization requests, particularly for telemedicine appointments. To manage this influx effectively, a large LTC pharmacy partnered with Staffingly, Inc., an outsourcing expert in healthcare services. This strategic move allowed the pharmacy to streamline its authorization process, enabling quicker patient care and reducing administrative strain.

This partnership extended beyond prior authorization, with Staffingly now managing a range of services such as medical coding, data entry, and insurance verifications. As a result, the pharmacy outsourced nearly 90% of its administrative tasks, achieving up to 70% in cost savings. Below are real-life case studies demonstrating how Staffingly’s support has made a significant impact on the pharmacy’s daily operations.

Case Study 1: Efficient Prescription Management

Background:
On average, the pharmacy handles around 1,000 prescriptions daily from various Assisted Living Facility (ALF) centers. Staffingly’s team plays a crucial role in processing these prescriptions promptly to ensure timely delivery of medications to patients.

Challenge:
Of these 1,000 prescriptions, approximately 800 are covered by insurance, while around 200 are not. Managing these uncovered prescriptions posed a challenge, as the pharmacy needed to ensure patients were informed about costs without disrupting workflow efficiency.

Solution:

• Utilization of Tools: Staffingly used tools like FRAMEWORK LTC, ECM, and COVER-MYMEDS to streamline prescription verification and identify non-covered prescriptions quickly.
• Clear Communication: The team promptly communicated with the ALF centers about the 200 non-covered prescriptions, advising on alternative payment options and ensuring patients understood their financial obligations.
• Comprehensive Documentation: All interactions were recorded in ECM, creating a transparent record of communications and decisions regarding each prescription.

Outcome:
By efficiently managing covered and non-covered prescriptions, the pharmacy achieved a 95% satisfaction rate among ALF centers, maintaining a steady workflow with minimal delays. This proactive approach strengthened the pharmacy’s relationship with ALF partners and upheld its commitment to timely patient care.

Case Study 2: Specialty Medications Management

Background:
The pharmacy frequently receives requests for specialty medications that require special handling or are not part of their regular inventory. Staffingly’s team managed one such scenario involving a specialty medication request for an ALF patient.

Challenge:
An ALF nurse requested a specialty medication that the pharmacy couldn’t dispense, creating potential delays in treatment for the patient.

Solution:

• Immediate Notification: Staffingly’s team quickly informed the nurse that the medication was not available through the pharmacy’s regular supply.
• Offering Alternatives: Staff suggested that the ALF nurse check if the patient had an existing supply or helped them connect with a specialty pharmacy that could fulfill the request.
• Detailed Documentation: The interaction was documented, ensuring clear communication across all parties and providing a record of the steps taken.

Outcome:
The proactive response and guidance allowed the ALF nurse to obtain the medication from a specialty pharmacy, minimizing disruption to patient care. The ALF staff appreciated the pharmacy’s transparency and support, which reinforced their trust in the service.

Case Study 3: Navigating Complex Insurance Claims

Background:
As part of daily operations, the pharmacy frequently processes insurance claims, some of which require additional documentation to support coverage. This case study demonstrates Staffingly’s role in efficiently managing a complex insurance claim.

Challenge:
An insurance provider denied coverage for a medication, stating a lack of medical necessity documentation. The pharmacy needed to act swiftly to avoid delays in the patient’s treatment.

Solution:

• Coordination with Healthcare Providers: Staffingly’s team reached out to the prescribing physician to obtain necessary documentation supporting the claim.
• Efficient Use of Technology: Utilizing COVER-MYMEDS and ECM, the team compiled and submitted all required information, ensuring a quick response to the insurance company.
• Persistent Follow-Up: Regular follow-ups were conducted with the insurance provider to ensure the claim’s progress, minimizing delays.

Outcome:
The claim was ultimately approved, allowing the patient to receive the medication without out-of-pocket expenses. The pharmacy’s ability to manage complex insurance claims effectively enhanced its reputation among ALF centers and ensured continuity of care for patients.

Frequently Asked Questions (FAQs) on Outsourcing Prior Authorization and Support Services

Q: How does outsourcing prior authorization help improve efficiency?
A: Outsourcing allows pharmacies to offload time-consuming tasks like prior authorizations to specialized teams, reducing administrative burden and ensuring patients receive medications promptly.

Q: What tools does Staffingly use to manage prior authorizations and prescriptions?
A: Staffingly uses advanced tools like FRAMEWORK LTC, ECM, and COVER-MYMEDS to streamline the verification, authorization, and documentation processes.

Q: Can Staffingly handle insurance claims and denials?
A: Yes, Staffingly’s team is skilled in managing insurance claims, including follow-ups and handling denials. They work closely with healthcare providers to secure necessary documentation and ensure claims are processed smoothly.

Q: What are the cost savings of outsourcing administrative tasks?
A: By outsourcing with Staffingly, pharmacies can achieve cost savings of up to 70%, allowing them to focus resources on patient care rather than administrative expenses.