Organizing for the Future of Medical Drug Management

  What does it take to ensure sound reimbursement policies on physician administered drugs?  In a phrase, it takes “good data.” We, at RJ Health Systems, consider our data to be the industry standard for evaluating Medical drug reimbursement policy – a position we’ve earned over the past 16-years (average customer tenure is a whopping 7-years!). Because of this responsibility to deliver consistent, yet relevant information to our clients in a less than transparent world, we must evolve and organize our team for the future. In short, we have been preparing for the impending reimbursement policy game-changers (shifting utilization guidelines, value-based evaluation, “preferencing” and prior authorization impact, new drug budgeting, etc…) by organizing around five core competencies.
  1. Data Application – How do we make our data more actionable?In 2016, we began conducting reimbursement analyses to evaluate Payors’ overall medical pharmacy policies, as well as deep-dives into therapeutic class, drug, place-of-service, and NPI trend drivers. Currently, this analysis is done by our staff using client’s historical claims data and fee schedules. In 2017, we plan to provide a “DIY” application that lets you crunch your own claims data and perform your own trend analysis.
  2. Data Delivery – How do you get to the answers you need faster?Whether its reducing clicks on, giving Providers a tool to get their billable code NDC unit facts straight, or delivering our pricing and coding data accurately and securely through new methods, RJ Health Systems’ data delivery options will save you time and money in the months and quarters ahead.
  3. Benchmarking – Are you making progress?With 15-years of pricing history and the most comprehensive crosswalks in the industry, improved accuracy from RJ data can realistically save you $0.05 PMPM with the right policy adjustments. And with the vast majority of Payors and most major PBMs licensing RJ Health Systems data, we are poised to show you how you stack-up against industry benchmarks.
  4. Customer Service – How do you navigate the overwhelming amount of data “at your fingertips”?The reality is you need a human touch from your data providers, so we are organized to give our clients ready access to RJ Health Systems’ leadership team, pharmacists, claims and coding analysts, IT, product and client relations staff. Your timely and efficient use of our data is the lifeblood of RJ Health Systems’ plan – please contact us when you have questions or ideas about how we fit.
  5. Accountability – How do we all become smarter about taming the exploding cost of Medically Covered specialty drugs?As a community, we are at the very early stages of proper accountability – accurate data is available, but it’s not being leveraged because of the perceived costs to implement new programs and policies. The RJ Health Systems team will become increasingly more accountable for providing independent, actionable data that our clients use to contain the cost of Medical Pharmacy products.
Our organization values these skills because our clients require them for success. When these skills are combined with our unbiased, practical methodology, we can begin to solve this complex issue together. If you would like to discuss how our data can help your organization, please reach out to me at