Making 340B Referral Capture Work for the Community

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 was faced with the referral capture decision himself and provides some of his insights.

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’s 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 Cloudmed helped you compliantly expand your 340B program value?

Gonzales: Prior to working with Cloudmed, we ran into a lot of issues trying to determine if we were going to include referral prescriptions in our 340B program. I know a lot of health centers and other 340B covered entities would do that process on their own through some internal means, but by working with Cloudmed, we were really able to use their platform and their service to find a solution to the issue of referral prescriptions so we could include them in the program. Our partnership makes it possible for underfunded and otherwise unfunded programs to exist to better serve our patients. With the current push by some stakeholders to reduce assess to 340B program savings, every additional compliant claim counts more than ever.

What kind of results are you seeing since partnering with Cloudmed?

Gonzales: Cloudmed helps us maximize our 340B potential. So far in our time using Cloudmed 340B Recovery, they’ve helped us to identify over 2,000 additional prescription claims that we wouldn’t have been able to identify without them. That amounts to an average annual reimbursement increase of 96% over the past three years. Cloudmed also assisted us in the return of dozens of consult notes, too, 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 Cloudmed 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. Cloudmed 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 they’re able to deliver on the things that they say they’re able to 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.