IMD: 10 hospital leave Eliminate - Nursing Depending on supply of beds, patient Communication: Providers days & 36 therapeutic Facility: 10 hospital may not have a place to return to, or Document: SPA Leave Days (cont.) leave days leave days & 36 have to go to another facility ICFMR: 25 hospital therapeutic leave leave days & 52 days therapeutic leave days Eliminate - IMD: 10 hospital leave days & 36 therapeutic leave days Eliminate - ICFMR: 25 hospital leave days & 52 therapeutic leave days SAVINGS for Short-term strategies $70.8M $26.6M Mid-Term Pharmacy Rebates Competitive for crossover bid for $2.1M $0.8M Pros: May duplicate care Implementation Timeline: claims specialty pharmacy Aggressive pricing discounts (due to management 12+ mo. Supplemental rebate volume purchasing) organization efforts Savings Realization Timeline: agreements Additional benefits (i.e. clinical 12-18 mo. Restrictions on narcotics outreach to providers & members to Changes: Systems use to begin 1/1/2013 ensure proper medication use) (potential) PAs for more costly to Communication: Providers, begin 1/1/2013 Members Tried & failed CMS waiver approval requirements Document: RFP process, Additional step therapy Contract development, Restrictions on scripts to Potential 1115 waiver 1/1/2013 Increase generic $3.6M $1.4M N/A Implementation Timeline: Pros: dispensing rate by Reduce costs from brand name 3-6 mo. prescriptions
Leave Days (cont.) IMD: 10 hospital leave days & 36 therapeutic leave days ICFMR: 25 hospital leave days & 52 therapeutic leave days Eliminate - Nursing Facility: 10 hospital leave days & 36 therapeutic leave days Eliminate - IMD: 10 hospital leave days & 36 therapeutic leave days Eliminate - ICFMR: 25 hospital leave days & 52 therapeutic leave days Depending on supply of beds, patient may not have a place to return to, or have to go to another facility Communication: Providers Document: SPA SAVINGS for Short-term strategies $70.8M $26.6M Mid-Term Pharmacy Rebates for crossover claims Supplemental rebate agreements Restrictions on narcotics use to begin 1/1/2013 PAs for more costly to begin 1/1/2013 Tried & failed requirements Additional step therapy Restrictions on scripts to 1/1/2013 Competitive bid for specialty pharmacy $2.1M $0.8M Pros: Aggressive pricing discounts (due to volume purchasing) Additional benefits (i.e. clinical outreach to providers & members to ensure proper medication use) May duplicate care management organization efforts Implementation Timeline: 12+ mo. Savings Realization Timeline: 12-18 mo. Changes: Systems (potential) Communication: Providers, Members CMS waiver approval Document: RFP process, Contract development, Potential 1115 waiver Increase generic dispensing rate by $3.6M $1.4M Pros: Reduce costs from brand name prescriptions N/A Implementation Timeline: 3-6 mo.
recommendation-report12-15-2012.docx