Use case
Utilization Management
The Concern
I have so many members and their prescription needs are constantly changing. It’s nearly impossible for me to analyze, in real-time, utilization performance let alone make needed adjustments. I don’t know if the actual utilization is better than or worse than I was expecting. Creating spreadsheets to analyze the data is time consuming and can lead to errors because of manual processes. Using stale or outdated information doesn’t allow me to change, modify, manage, or impact performance and cost.
The XEVANT Solution
Xevant’s automated process will evaluate your plans’ utilization in minutes. You can set utilization expectations and then run reports as often as you would like to measure performance. These reports can be set up in AlertLogic so you can get daily emails when performance is outside your parameters. Additionally, you can take advantage of some pre-defined utilization measures already in the Xevant platform.
The Xevant Result
1
Brand Plan Paid
Shows the total plan paid amount for brand drugs, along with percentage increases or decreases over the previous period.
2
Generic Plan Paid
3
Retail 90 Plan Paid
Shows the total plan paid amount attributed to those claims filled through a pharmacy for over 83 days as designated as a maintenance medication.
4
Mail Order Plan Paid
Mail Order Plan Paid
Shows the total plan paid amount attributed to those claims filled through a mail order pharmacy.
5
Generic Dispensing Rate or GDR
Shows the dispensing rate or GDR. GDR is the percent of total claims represented by generic drugs. The GDR equals the number of generic claims divided by the total of all claims.
The Xevant How to:
1. Log into Xevant
2. Open the tab on the left-hand side
3. Go to ScripLogic
4. Click Utilization
5. From here, you can view Scorecard, Plan Paid, Channel, or Product Mix
6. View each tab for different analytics regarding utilization