HealthPlan Data Solutions

HealthPlan Data Solutions (HDS) creates guardrails that keep pharmacy expenditures in line with your contract and ensures your plan design is implemented by the PBM. The pharmacy distribution system is complex and opaque, which makes it difficult to detect and fix PBM errors that are costing health plans millions. In the past, payers have not had contract clarity or the objective payment integrity tools they need to identify and address the real issues. Using innovative technology, HealthPlan Data Solutions is changing the way the market is using pharmacy data. HDS proprietary software continuously compares objective data about PBM performance to the terms of the contract and treatment protocols. HDS enables the plan to pinpoint problems in real-time, proactively negotiate fixes, and attain ongoing payment integrity without disruption to the plan. Unlike other solutions with limited applications, HDS is much broader in scope. We monitor every single claim and, when issues are identified, we have the data to support our customers findings, putting PBMs on notice that they are serious about payment integrity.