The Intersection of AI in Healthcare and Transparency in the Pharmacy Benefit Management Industry

Ben H.

Ben H.

Sep 20, 20233 min read

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The Intersection of AI in Healthcare and Transparency in the Pharmacy Benefit Management Industry

Introduction:

In recent years, advancements in technology have revolutionized various industries, including healthcare and pharmacy benefit management (PBM). Two key areas of focus have emerged: the use of artificial intelligence (AI) to generate clinical notes from patient-clinician conversations, and the push for greater transparency in the PBM industry. Surprising data has shed light on the discrepancies between employer-reported figures and the pass-through percentages described by PBMs. This article explores the common points between these two developments and offers actionable advice for healthcare software vendors and employers.

AI in Healthcare: AWS HealthScribe

One of the most significant advancements in the healthcare industry is the use of AI to generate clinical notes. AWS HealthScribe, a HIPAA-eligible service, empowers healthcare software vendors to build clinical applications that automatically analyze patient-clinician conversations and generate clinical notes. This technology streamlines the documentation process, enabling healthcare professionals to focus more on patient care. By leveraging AI, AWS HealthScribe improves efficiency, accuracy, and overall patient experience.

Transparency in the PBM Industry: Employer-PBM Rebate Pass-Through Arrangements

The push for transparency in the PBM industry has gained momentum, with efforts to mandate full pass-through of rebates to plan sponsors. Surprising data reveals that only about 60% of employers report that their PBM passes through all rebates on traditional and specialty drugs. Furthermore, one-third of employers prefer spread pricing for their pharmacy network. These figures highlight a significant discrepancy between employer-reported pass-through percentages and those described by PBMs.

Connecting AI in Healthcare and Transparency in the PBM Industry

While seemingly unrelated, the use of AI in healthcare and the push for transparency in the PBM industry share a common goal: improving patient outcomes. AI-generated clinical notes provide accurate and comprehensive documentation, enhancing the overall quality of care. Likewise, transparency in the PBM industry ensures that employers have access to the full benefits of manufacturer rebates, leading to cost savings and better coverage for employees. Both developments aim to optimize healthcare processes and promote better patient outcomes.

Actionable Advice for Healthcare Software Vendors and Employers:

1. Healthcare Software Vendors:

- Embrace AI technologies like AWS HealthScribe to enhance clinical note generation and improve the efficiency of healthcare applications.

- Collaborate with healthcare providers to understand their specific needs and develop AI-powered solutions that address their pain points.

- Ensure HIPAA compliance when building clinical applications to guarantee the security and privacy of patient data.

2. Employers:

- Evaluate PBM options carefully, considering those that offer full pass-through of rebates to maximize cost savings for your organization and employees.

- Seek transparency in PBM contracts and agreements to gain a comprehensive understanding of how rebates are distributed and utilized.

- Consider partnering with PBMs that prioritize cost-effective pharmacy network strategies, such as direct pricing, to optimize drug coverage and minimize expenses.

Conclusion:

The integration of AI in healthcare, specifically AI-generated clinical notes, and the growing demand for transparency in the PBM industry highlight the industry's commitment to improving patient outcomes and cost efficiency. By leveraging AI technologies like AWS HealthScribe, healthcare software vendors can streamline clinical documentation processes. Simultaneously, employers can benefit from transparency in PBM contracts, ensuring access to the full benefits of manufacturer rebates. By taking actionable steps to embrace AI and demand transparency, the healthcare industry can continue to evolve, driving better patient care and cost-effective solutions.

Resource:

  1. "Generate clinical notes with AI – AWS HealthScribe – AWS", https://aws.amazon.com/healthscribe/ (Glasp)
  2. "Surprising Data on Employer-PBM Rebate Pass-Through Arrangements in 2023", https://www.drugchannels.net/2023/08/surprising-data-on-employer-pbm-rebate.html (Glasp)

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