Challenge
Recognized as a statewide primary care leader, Rhode-Island based Thundermist Health Center is a federally qualified facility serving more than 50,000 patients per year at three locations. Thundermist employs over 150 family medicine, dental and ancillary care providers and has more than 100 contract pharmacies in its 340B program.
According to Corrine Hill, chief administrative and compliance officer at Thundermist, the 340B program significantly impacts how the facility is able to care for patients. “We’re able to do two things we couldn’t otherwise do,” says Hill.
“Number one, we generate revenue that can go back into patient care and that is really the most important thing for us. Number two, it gives us the freedom and the ability to help patients pay for their medications when they have financial difficulties.”
In order to maximize 340B program savings, Thundermist wanted all its contract pharmacies and third-party administrators to provide referral prescription data, including its retail contract pharmacy, which serves as its own TPA and provides referral prescription data exclusively through R1. While the hospital employs two infectious disease doctors to treat HIV and hepatitis-C patients, specialty drugs prescribed by other providers were being missed within their claims data.
Solution
When Thundermist learned that R1 340B Recovery — which increases 340B savings by finding missing prescriptions written by eligible and referred-to providers — matches claims data with outgoing referrals and requests and reviews the returned consult note from the prescriber on behalf of the client, the health center immediately saw the value. Thundermist puts a premium on compliance to minimize the risk of a manufacturer payback or exclusion from the program.
After speaking with a R1 340B client, Thundermist began the implementation process, including the standard request for 12 to 18 months of historical outgoing referral data. In addition to this standard EHR reporting, Thundermist also had a report that indicated for which referrals they had already received back a consult note.
Thundermist worked with R1 to incorporate this report into its operations in order to prevent redundant requests. “The relationship has been really symbiotic in terms of evolving our benefit,” Hill said. “Incorporating that report improved the process overall and creates an efficiency in the healthcare system.”
Results
Since implementation, R1 has helped Thundermist Health Center include over 750 new claims in its 340B program and grow its program savings by 25% in just the first six months. Today, more than 70% of Thundermist’s specialty claims are possible because of its partnership with R1.
“The benefit that we’ve realized through R1 has been fantastic because we would not have been able to realize it in any other way through our retail pharmacy stores,” Hill said. “There are so many prescriptions that we could not realize written by referral providers. On top of that, some of the value of the drugs has been surprisingly high.”
Since R1 makes the returned consult notes available to clients via a secure portal, Thundermist also seized on another opportunity to improve patient care. “Now we have a fully closed loop on those referrals, the referral prescriptions, and getting that information back from the referral provider. R1 ultimately benefits us on the 340B side, but really gives us better care for the patient because we know from providers outside of ours what is really happening for that patient,” said Hill.
