Pharmacy Benefit Managers

Pharmacy Benefit Managers are faced with increasing client demands as well as competitive pressure which increases the need to be more client retention focused. NationsHealth provides the PBM industry with proven solutions designed to enhance your offering and differentiate you in the marketplace. At NationsHealth we are particularly well positioned to meet your needs.

Our solutions provide a robust menu of operational and technical management tools. These solutions can be purchased as an entire package or a la carte, and most components are customizable to meet your specific business needs. They include:

Medical Product Services

Fulfillment Services

• Medicare Part B fulfillment and distribution services (i.e. diabetes, respiratory, ostomy and urological)
• Mail order delivery program - with deep Medicare Part B experience
• Formulary development assistance
• Physician outreach
• Part B retail to mail conversion

Over-the-counter (OTC)

• Over-the-counter (OTC) product distribution and benefit administration
• Development of CMS compliant catalogs and literature
• Custom and special products

Part B Conversion

• Conversion of self-funded employer retirees to part B for diabetic and respiratory supplies

Distribution Engagement Services

• Proactive patient outreach to educate and encourage compliance with physician orders
  • Average telephonic patient outreach frequency of four times per year
  • Hassle Free Healthy Living program educational literature and tools delivered to patients / members as part of our mail order supply program
• We do not compete in the prescription drug space
• Medical billing and compliance infrastructure to mitigate risk

Medicare Part D BPO Services

Licensed Insurance Agents

• Year-round enrollment activities
• AEP enrollment
• Insurance broker outreach
• Retention

Unlicensed Representatives

• Year-round member service
• Outbound education and verification
• Customer satisfaction surveys
• Plan change services

Flexible Technology

• Innovative healthcare IT platform
• Robust reporting and analytics capabilities
• Eligibility management
• Enrollment / disenrollment management
• Premium billing and collections
• Member mail management
• Fulfillment services
• Document reconciliation and management
• Three-way reconciliation (CMS, fiduciary, PBM)
• PBM integration
• EGWP functionality to administer group enrollment and eligibility

Healthcare BPO Services

Member Engagement Center Services

• Clinical and non-clinical staffing
• Clinical and non-clinical rollover capacity
• Inbound / outbound engagement services
• Physician and insurance broker outreach
• On-shore and off-shore agent options
• Survey capabilities for satisfaction measurement as well as clinical data gathering (Five-Star and HEDIS support)
• Inbound / outbound provider engagement
• Compliance and audit services
• Health education, reminders and reporting
• Flexible thin client IT environment with robust reporting capabilities
• Automated call processing (IVR)
• Print and email campaigns
• Internet landing pages for information capture and educational content delivery

We deliver these strategic advantages:

• Outstanding reliability, scalability, and flexibility of healthcare contact services
• Multiple locations to mitigate service disruptions caused by weather or other unforeseen circumstances
• Capacity scaling expertise to allow for fast response to unexpectedly large call volume
• Multi-lingual services
• Blended on- and off-shore solutions