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Pharmaceutical Care Solutions 8 March 2010 © Copyright ESH 2010 Submission to Greek Ministry
Company Profile – EuroSwiss Mediscor 2 Specialized health care company offering comprehensive pharmaceutical and medical management solutions Established in 1989 with over 20 years experience Processes > 800,000 real-time pharmacy and > 50,000 doctor transactions daily Broad client base, managing millions of lives Markets Europe Africa Asia Middle East Services Pharmaceutical Management Managed Care Consulting – Systems & Policy Provider Networks & Financing Specialized solutions © Copyright ESH 2010
Greece: Key Objectives Accessible Health Care at the : RIGHT time RIGHT quantity RIGHT quality RIGHT format RIGHT place RIGHT price © Copyright ESH 2010
How Is This Going To Be Done? © Copyright ESH 2010
Beyond Prescription Control Pharmacy Benefit Management (PBM) © Copyright ESH 2010
What is a PBM? 6 Flexible management tool Electronic claims processing Financial rules Drug utilization and clinical management Claims payment Provide management reports and information A PBM is a company that manages the medicine claims for a medical funder/insurer © Copyright ESH 2010
Benefits of a PBM Benefits are produced for the funder / insurer the pharmacy the patient and the state resulting in a positive member, service provider and healthcare insurer experience 7 © Copyright ESH 2010
Benefits for the Insurer Eliminates paper claims Speeds up administrative processes Processing is in real-time online (similar to credit card systems) Diverse list of management rules Down to patient or product level Pricing management Utilization management Clinical management Comprehensive information Derive a 20-30% saving on medicine spend Eliminate addiction & abuse Substantially reduce fraud Effective claim submission system Sophisticated medicine management system Achieve real savings © Copyright ESH 2010
Benefits for the Pharmacy 9 Appropriateness of medicines prescribed Prevents ingredient duplication Empower provider to consult with patient Overdose prevention Drug interactions Electronic – no more paper claims Faster payment Improved practice management Claims submitted in real-time (similar to credit card systems) Better credit control Real-time payment confirmation Reduced claims administration Improved quality of care Effective claim submission system © Copyright ESH 2010
Benefits for the Patient 10 Appropriateness of medicines prescribed Prevents ingredient duplication Empower provider to consult with patient Overdose prevention Drug interactions Improved quality of care Eliminates upfront payment at pharmacy Eliminates need to submit paper claims Timely claims administration Timely follow-up and query resolution Faster re-imbursement cycles Efficient Claims Administration © Copyright ESH 2010
Benefits for the State 11 Disease profiles Patient profiles Demographics of medicine usage Pharmacy profiles Prescriber profiles Manufacturers/product usage Build an information base © Copyright ESH 2010
12 Claims Process Providers SWITCH Mediscor PBM SWITCH Mediscor PBM Funder/ Insurer Funder/ Insurer Entire real-time transaction takes less than 9 seconds E-prescribing Third party Administration (TPA) © Copyright ESH 2010
13 Claims Process Providers SWITCH Mediscor PBM SWITCH Mediscor PBM Funder/ Insurer Funder/ Insurer Provider Coverage 100% of pharmacies should use real-time 100% of hospital and clinic pharmacies should use real-time All pharmacy vendors accredited for real-time All postal/courier pharmacies © Copyright ESH 2010
14 Claims process Providers SWITCH Mediscor PBM SWITCH Mediscor PBM Funder/ Insurer Funder/ Insurer Claims Delivery Provided by switch company Triangulated redundancy for intelligent business continuity © Copyright ESH 2010
15 Claims process Providers SWITCH Mediscor PBM SWITCH Mediscor PBM Funder/ Insurer Funder/ Insurer Claims processing software on IBM Hardware Data integrity validation Eligibility determination Medicine utilization management Clinical management (Drug database) Price management Benefit validation © Copyright ESH 2010
16 Integrated Utilisation Management & Pharmaceutical Care Integrated Utilisation Management & Pharmaceutical Care Pharmacy Claims Pharmacy Claims Patient Claims Patient Claims Clinic/Doctor Claims Clinic/Doctor Claims Hospital Claims Hospital Claims Central Patient Medicine Claims Record at Active Ingredient Level Central Patient Medicine Claims Record at Active Ingredient Level Centralized Management © Copyright ESH 2010
Our Technology Claims processing system used currently manages over 70 million lives worldwide Country-specific software customization Clinical product database Business Intelligence Application Interface – multitude of insurance and provider platforms Connectivity – with pharmacy software systems and doctor e-prescribing systems supporting the following technologies: -Health smart cards -Barcode -Digital pens -OCR 17 © Copyright ESH 2010
Our Service Offering Real-time electronic medicine claims processing Client support services - for e.g. Call centre with extended working hours Information services - through our web-based reporting tool, the Mediscor Analyzer Consulting services - to aid with benefit design & formulary management Chronic medicine pre-authorizations Other supplementary services: for product and price file maintenance 18 © Copyright ESH 2010
Analyzer Dashboard 19 © Copyright ESH 2010
20 Trend Analysis - Expenditure © Copyright ESH 2010
21 Trend Analysis - Cost © Copyright ESH 2010
22 Trend Analysis - Utilization © Copyright ESH 2010
23 Our Results Source: Council for Medical Schemes Annual Report Introduction of PBM services © Copyright ESH 2010
Our Results 24 Savings measured and reported as a percentage of the submitted claim value Service Category 2006 % 2007 % 2008 % Claims Processing: Utilization management Clinical management Pricing management Authorization interventions: © Copyright ESH 2010
Why Euroswiss Mediscor? 25 SAVINGS – in a highly specialized field!! Quality of Service Local customization - experience in converting a country to electronic claims System integration abilities Comprehensive quality assurance capabilities Clinical abilities Benefit design specialists Product coding expertise Experienced staff 20 year history © Copyright ESH 2010
26 - Unique Specialized Expertise - Understanding of Greek situation - World-Class technology - World-Class Partnerships Why EuroSwiss Mediscor ? © Copyright ESH 2010
Contact Persons President Dr. Delon HUMAN M.B.Ch.B., M Prax Med, MFGP, DCH, MBA Mobile: Greek Operations Mr. Panos PAPADAKOS Mobile: © Copyright ESH 2010
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