Uncertainty is risky: Is your organization’s clinical services partner on stable ground?

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Uncertainty and change in healthcare are pervasive.  Whether in technology, care delivery, or health insurance, we’ve grown accustomed to groundbreaking clinical discoveries, new legislation, and CMS guidelines that create newfound opportunities. Most of us keep a close eye on the never-ending legislative and regulatory updates, while often remaining blissfully unaware of the many financial machinations that can increase performance risk.   Put simply, mergers, acquisitions, divestitures, and leadership changes in your clinical pharmacy partner can be invisible risks, impacting your ability to perform.

In the last year alone, we’ve seen an abnormal concentration of mergers and acquisitions activity in the clinical services market. Early on, major players experienced significant stock value devaluation while private service providers went up for sale. The invisible problem for consumers of these services (at-risk organizations, health plans, and provider groups to name a few) is that a sizable portion of performance and revenue is tied to the health of their vendor partners, which is often interrupted by a sale of the organization, change of control, or lack of capital.

This presents a critical – yet often invisible – risk.

Why all the shakeup?

Current market trends can largely be attributed to two main factors:

  1. Stale, legacy operating models suffering staffing shortages, increased costs, and poor member experience.
  2. A tightening of capital markets, resulting in a need to divest precious operating cash.

 

Struggling call centers 

While many clinical service providers still use call centers, they’re losing their appeal. By nature, they’re inflexible, struggling to manage variability in call volume which is critical when it comes to the ebbs and flows in member eligibility. This inflexibility creates inefficiencies: low call volume leads to overstaffing and high administrative costs, while high volume bogs down the call center, leaving it unable to complete consultations in a timely manner.

To maximize cost efficiencies, call centers increasingly rely on robo-dialers and outsourcing, contributing to poor member experience—unfortunate timing as the value of member experience continues to climb. And the “Great Resignation” hasn’t spared call centers, leading to downward spiraling employee retention and consistent turnover. The factors coalesce to create a perfect storm for poor member experience – which trickles down to a poor bottom line for health plans.

Slice and dice

In early 2022, a whipsaw in the equity markets saw start-ups and growth companies shifting nearly overnight from a “spend until you make it” mentality to focusing on judicious spending.  Many market players are finding that they can’t operate as effectively in tighter markets and are either selling entirely or divesting divisions to shore up the balance sheet. Some organizations cease operations entirely, even after a merger gone “right.”

What does this mean for health plans?

Uncertainty is risk.  Leaving your plan’s member experience, performance, and subsequent reimbursement in the hands of an organization with an uncertain future sounds like risky business.

Perhaps a restructuring toward vendor requirements to focus more intently on using newer technologies that allow for flexible operating models and reductions in overhead? A consistent reputation of delivering high quality, cost-effectiveness, and historical performance will never go out of style, and neither will the search to consistently identify risks and advancements in the market.

As of the time that I write this, Aspen RxHealth is the only clinical pharmacy partner to crowdsource clinical pharmacists – eschewing traditional call centers in favor of deploying the largest network of over 7,000 pharmacists operating in a gig economy. This approach supports the volume variability of clinical consultations and easily adapts to the ebbs and flows. Our workforce is elastic, delivering an improved, proven member experience. The Aspen Clinical Engine (ACE) and proprietary algorithms are intelligent enough to match pharmacists and patients based on clinical and social factors such as disease state, language, and location to create the most productive conversation possible, leading to a long-term relationship between pharmacist and patient – driving improved medication adherence rates and health outcomes.

Support for your in-house team

If your health plan is already operating with an in-house pharmacy team to conduct member outreach, but struggles with the administrative and technological burdens of member follow-up, quality assurance, and maintaining a sound telephony platform, there is another option. Alliance by Aspen RxHealth is a hybrid model that allows in-house pharmacy teams to conduct member consultations through Aspen RxHealth’s technology platform. This avenue allows health plans to operate with risk impunity, focusing on your members first. Should priorities or eligibility change, and your in-house team is unable to conduct the volume of outreach needed, our Pharmacist Community is standing by, ready to augment your efforts and get your members the care they need.

Find the right clinical pharmacy partner

As you weigh options for your 2023 and 2024 clinical pharmacy partner, have you considered the risks associated with unstable partners? If you have, you’re ahead of the curve. If not, we’d love to have a conversation with you.

By Clayton Walberg, Chief Commercial Officer, Aspen RxHealth