A giant step today in timely access to medical care -- Today's Centers for Medicare & Medicaid Services interoperability and prior authorization rule finalization represents a pivotal moment in the quest for a more efficient and patient-centric healthcare system. The projected $15B in cost savings, coupled with the commitment to digital transformation and streamlined processes, emphasize the pressing need for continued investments in modern prior authorization technologies. Modernizing technologies and adopting streamlined digital solutions are becoming imperative to enhance efficiency, reduce administrative complexities, and ensure that patients receive timely access to essential medical care. This rule comes at a time when leading managed care organizations are already taking steps to alleviate the burden of prior authorizations. UnitedHealthcare, a major player in the industry, declared its commitment to eliminating nearly 20% of prior authorizations starting in Q3 2023. Subsequently, Cigna Healthcare followed suit with a substantial ~25% reduction in prior authorization requests. https://lnkd.in/gEnn2R_X
About us
FutureRx (FRx) offers a first of its kind healthcare platform for health plans and pharmacy benefits managers (PBMs) that combines technology and access to pre-vetted fully integrated services providers on a single platform. FRx is a cloud-based, modular, user-configurable technology solution that was built from the ground up to meet complex and continuously evolving compliance requirements in today’s Medicare and Medicaid environment. As such, it is 100% compliant with government-sponsored regulations out of the box. If additional service support is needed, FRx Marketplace provides access to a comprehensive network of pre-vetted partners that deliver a full range of specialized services including formulary and rebate management, prior authorization, appeals and grievance management, mobile low-cost drug alternatives, and more. FRx Marketplace service partners are fully integrated with the FRx technology solutions for rapid go-to-market and hassle-free service changes. An added benefit to our customers is they can utilize their excess capacity or specialized skill set to sell their services on the FRx Marketplace without retraining their staff and gaining a revenue stream. FRx Marketplace lets health plans take back control of their business processes and prevents vendor lock-in by offering the flexibility to scale services up or down as needed with pre-configured connections that eliminate the costs and challenges involved with service provider integrations.
- Website
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https://www.futurerx.com/
External link for FutureRx
- Industry
- IT Services and IT Consulting
- Company size
- 51-200 employees
- Headquarters
- Tampa, Florida
- Type
- Privately Held
- Founded
- 2019
- Specialties
- PBM, Medicare, Medicaid, Prescription Drugs, Health Plan, Marketplace, Grievance, Part D Stars, Drug Management, Formulary, DMP, Appeals, and PBM
Locations
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Primary
Get directions
PO Box 18131
Tampa, Florida 33679-8131, US
Employees at FutureRx
Updates
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Medication Therapy Management: A Pillar of Patient-Centric Care in Medicare Programs
Medication Therapy Management: A Pillar of Patient-Centric Care in Medicare Programs Today’s timely and provocative Health Affairs article calls for the removal of medication adherence measures in the Medicare Star Rating System. It prompts a crucial discussion about alternative avenues for improving health outcomes. Amidst these considerations, Medication Therapy Management (MTM) continues to shine as a robust and patient-centric program that addresses many of the challenges highlighted in the article. Centers for Medicare & Medicaid Services mandates the inclusion of MTM programs in Part D sponsor plans, emphasizing the program's role in ensuring optimum therapeutic outcomes, reducing adverse events, and fostering collaboration with licensed pharmacists and physicians. MTM programs, developed with the input of healthcare professionals, describe the necessary resources and time for implementation, thus providing a comprehensive approach to medication management. In contrast to concerns about the financial incentivization driving gaming behavior, MTM programs focus on patient-centered care, aiming to enhance medication use for targeted beneficiaries. MTM programs, delivered by qualified providers, offer a personalized approach to medication management, distinguishing between ambulatory and institutional settings based on individual patient needs. Modern MTM programs seamlessly integrate with patient care management plans, aligning with chronic care improvement programs (CCIPs). This holistic approach ensures that the patient's overall well-being is at the forefront of healthcare initiatives. Next generation MTM systems are leveraging data availability and electronic mechanisms for remote therapy monitoring (RTM), such as electronic pill caps, offering real-time feedback on actual pill-taking behavior. This approach represents a meaningful improvement over traditional pharmacy claims-based measures. Today, MTM remains a vital tool to drive population health. It is single weighted by CMS and perhaps could be reevaluated in the calculation of the three triple weighted medication adherence Star measures. #medicationtherapymanagement #mtm #medicationadherence https://lnkd.in/g3a33mpy
Why The Star Ratings Medication Adherence Measures Must Go | Health Affairs Forefront
healthaffairs.org
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‘Tis the season to spread joy and cheer! 🎄✨ Let the magic of Christmas fill your heart with warmth and happiness. From our #FutureRx family to yours, Merry Christmas and Happy Holidays! 🎅❄️ As we bid farewell to this year, let's welcome the New Year with open arms and hopeful hearts. May it bring new adventures, exciting opportunities, and endless blessings. 🎉✨ Wishing you all a year filled with smiles, laughter, love, and success. Cheers to a fantastic year ahead! 🥂🎉 #HappyNewYear from #FutureRx! #MerryChristmas #christmas #christmas2023 #festiveseason
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FutureRx reposted this
Ouch...according to MGMA's recent 2023 regulatory survey, 97% of physicians' patients have experienced patient delays or denials for medically necessary care due to prior authorization requirements. 89% list PA (A&G is a close second) as their top regulatory buren. This member abrasion leads to member grievances and impacts members outcomes and important Agency for Healthcare Research and Quality CAHPS scores. The table below is a powerful incentive to invest in modern pharmacy technologies and continue to support Gold Card Acts. #cahps #priorauthorization
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FutureRx reposted this
I am alarmed that 1 in 5 new prescriptions are never filled in the US today... Conversational #AI is making strong inroads into patient engagement that will benefit health plans when it comes to improving medication adherence. Xtelligent Healthcare Media reports on a recent study that found conversational AI was pivotal in achieving optimal insulin dosing for patients with diabetes and helped them achieve a 32% improvement in insulin medication adherence. That’s significant, given an earlier JAMA Network Health Systems & Recruitment article that found 1 in 5 adults with diabetes didn’t maintain use of glucose-lowering medications, 17% did not consistently take their blood pressure medication and 43% didn’t take their lipid-lowering medications. In fact, according to Centers for Disease Control and Prevention, 1 in 5 new prescriptions are never filled. Of those that do, half of the medications are taken incorrectly. In all, suboptimal medication adherence costs anywhere from $100 billion to $300 billion every year. Providers and health plans alike can benefit from finding innovative ways to leverage #ai to improve patient outcomes, starting with medication adherence and #mtm – we’ve already integrated it into several of our pharmacy modules and would love the chance to show you how it works. https://lnkd.in/ga69RtfE
AI-Based Voice Assistants Poised to Support Chronic Disease Management
patientengagementhit.com
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FutureRx reposted this
If the rumored Humana Cigna Healthcare merger successfully addresses anti-trust concerns, the deal would raise the collective claims managed by the top three PBMs to 88% -- a 10% increase. Take a look at Drug Channels Institute's powerful 2023 market share graphic below. With increased scrutiny on quality measures and greater pressure by #CMS on #PartDStar ratings (e.g. Tukey outlier, weightings, etc.), health plans must continue delivering extraordinary outcomes specifically related to the triple weighted Diabetes, Hypertension, Cholesterol, and Blood Pressure Star measures (which combined represent ~43% of the Part D score), prior authorization, and medication therapy management. Consider the following 2024 Star rating data: --Only 12 #MAPD contract plans received 5 Star ratings across all of these specific Star measures. --The average overall MAPD Star rating decreased to 4.04 stars (down 0.10 stars), the lowest overall Star rating in the last 4 years. --5 Star MAPD health plans for 2024 declined to 31 individual contracts, compared to 57 in 2023. Let’s aspire to increase that number next year by partnering with organizations using the latest in technology, #AI, and the #gigeconomy. The impact it can have on medication adherence will be immeasurable for patient health and satisfaction.
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GLP-1s like Ozempic, Wegovy, and Saxenda hold great promise for the more than 1 billion adults and children worldwide, our CCO, Eric Grossman wrote this timely article describing how health plans can get out in front of the $100B benefit spend. #weightloss #obesity #diabetes #GLP
Avoid Getting Crushed by the $100 Billion AOM Market Weight
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Gratitude is in the air! It's Thanksgiving Day and we're so grateful for all the blessings we've received this year. Let's all take a moment to reflect and give thanks for everything we have. What are you most thankful for this year? Share with us in the comments! #happythanksgiving
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Your patients deserve simply the best, so choose FutureRx to dramatically increase your medication therapy management productivity and member outcomes. #medicationtherapymanagement #mtm #healthplans #pbm #healthcare
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