PE Digital and Technology

There are a lot of challenging factors when it comes to prescription review. While the process may seem straightforward, there are many pitfalls along the way that can waste time and money. Moreover, poor execution risks damaging the customer experience, which leads to a decrease in satisfaction, confidence, and retention. To prevent fraud, waste, and abuse, pharmacy claims containing similar prescriptions must be reviewed in an automated, streamlined, accurate, and efficient manner.

Doing Things the Old Fashioned Way
A client in the healthcare field noticed a unique problem when it came to their prescription process. Doing things the old way was proving inefficient. The inefficiencies were leading to fraudulent claims, wasted resources, and overall abuse of the system. The goal was to find a way to streamline the review process and automate it in order to achieve organizational and financial goals. The company could no longer sit idly by and watch as their system for prescription review negatively impacted its bottom line.
PE Solutions Utilized
Intelligent Automation and Artificial Intelligence

Automation Becomes Second Nature

In order to assist the client, Productive Edge first automated the detailed review of duplicate prescriptions. The reason for this was to leverage business rules and historical data. Next, the client needed to automate the classification of prescriptions for fulfillment or cancellation. Doing this would lead to a more streamlined process and reduce redundancies. From there, human-in-the-loop review for specialty drugs was implemented. After that, Productive Edge leveraged Machine Learning based information extraction of data from provider correspondence. Lastly, the client needed to automate process bridges across multiple systems which were managing prescriptions patient data, and provider correspondence. Automating the process is a critical part of the prescription review process. But it needs to be done in the right way to reap the rewards of digital transformation.

Reaping the Rewards of Successful Implementation

This level of attention to automation proved a successful way for the client to realize their goals and digitally transform the way the did business. The projected year-one cost savings of the project came in at $1.1 million. But that’s not all that automation brought to the table. The client also realized an increase in the processing time of flagged prescriptions. This helped lead to a reduction in fraud and waste. There was also an improved patient experience by reducing the time to fulfill prescriptions. When the customer experience is good, the patients will smile. Lastly, the company saw an increase in the accuracy and consistency of duplicate resolution.

Intelligent Automation Success Story: Combined Rx Review