ACS Heritage, Inc. – SmartPA

ACS Heritage, Inc., a division of Affiliated Computer Services, Inc. (“ACS”) has developed a revolutionary solution to prospectively screen pharmacy claims - SmartPA.

Situation

In an effort to reign the rising costs of administering a quality healthcare program, many payors have turned to prior authorization programs that limit access to high-cost drugs. These programs require the provider to answer a litany of questions via phone or written application about the patient, so that the payor can determine if the provider is appropriately prescribing therapies. While these programs have controlled expenditures in some cases, the administrative costs to payors and providers have limited their applicability and effectiveness.

Solution

ACS Heritage, Inc., a division of Affiliated Computer Services, Inc. (“ACS”) has developed a revolutionary solution to prospectively screen pharmacy claims - SmartPA. SmartPA represents a revolutionary platform to instill preferred prescribing patterns for the providers.

SmartPA uses a highly sophisticated clinical rules system to determine if evidence-based criteria for appropriate drug use are met. The application executes real time prior authorization (“PA”) decisions within the pharmacy POS process by leveraging high performance, table driven clinical rules fueled by up to 36 months of client-specific drug and medical claims data.

SmartPA rewards physicians who adhere to proper prescribing patterns by streamlining the PA process. Those providers who prescribe outside the recommended guidelines are directed to contact the Clinical Call Center for a clinical discussion which is supported by the SmartPA web based call center application. With SmartPA, providers are rewarded for adhering to preferred prescribing habits. The reward comes in the form on no administrative hassle – i.e. no call to the call center.

Better Health and Lower Costs

The evidence-based approach rewards physicians for prescribing appropriately. This leads to a change in prescribing behavior, which leads to appropriate utilization, and therefore lower costs. For example, Missouri Medicaid was able to curb the cost of the prescription drug program by 9% - approximately $83 million per year.