How HealthNet leverages referral prescription savings to fund better healthcare
For a quarter century the 340B Drug Pricing Program has helped hospitals and health centers fund vital community health programs, making it one of the more successful public/private partnerships in the industry. While the program provides enormous benefit, some providers limit their participation to exclude prescriptions written by referral physicians because of compliance concerns. Andrew Gonzales is the director of pharmacy services at HealthNet in Indianapolis, a network of community-based, comprehensive primary care health centers, school-based clinics, dental clinics and a mobile health center. He faced the referral capture decision himself and provides some of his insights.
HealthNet
Tell us a bit about what you do at HealthNet.
Gonzales: I’m the Director of Pharmacy Services at HealthNet Community Health Centers in Indianapolis, Indiana. HealthNet has over 60,000 active patients on an annual basis, most of which are underserved or underinsured. Our mission is to improve lives with compassionate health care and support services, regardless of ability to pay, and we’ve been doing that for our inner-city neighborhoods since 1968.
What is noteworthy about the demographics of your community?
Gonzales: Over half of our patients are under the age of 30, about 78% are at 200% or less of the federal poverty level and about 14 or so percent are at or below 100% of the federal poverty level. HealthNet network of community-based health centers and support service programs are located throughout Indianapolis to help improve the health status of the community. As the largest Federally Qualified Health Center in Indiana, we serve 12% of all patients treated by FQHCs in the state. So HealthNet’s access to the 340B program is crucial for sustaining its healthcare mission.
How has R1 helped you compliantly expand your 340B program value?
Gonzales: Before working with R1, we struggled to determine if we would include referral prescriptions in our 340B program. I know many health centers and other 340B covered entities handle that process on their own through some internal means, but by partnering with R1, we found a solution to the issue of referral prescriptions so we could include them in the program. Our partnership enables underfunded and otherwise unfunded programs to exist to better serve our patients. With the current push by some stakeholders to reduce access to 340B program savings, every additional compliant claim is more important than ever.
What kind of results are you seeing since partnering with R1?
Gonzales: R1 has helped us maximize our 340B potential. In our time using R1 340B Recovery, they have identified over 2,000 additional prescription claims that we wouldn’t have found without them. That amounts to an average annual reimbursement increase of 96% over the past three years. R1 also assisted us in the return of dozens of consult notes, which really improves the care for our patients because then our clinicians can see the full referral record and history.
How has increasing 340B savings impacted your healthcare delivery?
Gonzales: By using R1 340B Recovery, we’re able to expand our reach and really maximize the use of 340B to its fullest intent. In 2021, HealthNet centers accounted for over 200,000 patient visits, we delivered almost a thousand babies, provided prenatal care for 2,300 women and delivered health services for more than 1,300 city residents through our Homeless Initiative Project. R1 has really done a lot for us, and they’re probably one of my favorite vendors to work with. But for me, the most important thing is that they deliver on the things they say they can do.
To learn more about compliantly capturing referral prescriptions to optimize 340B savings, read our whitepaper, 340B Program Compliance in regard to referrals for consultation.
