Case Study

New England Health System Expands 340B Savings Through Referral Capture

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New England health system expands 340B savings through referral capture

Challenge

A New England health system that includes disproportionate share and critical access hospitals provides a continuum of programs and services connecting patients with the care they need. Like many smaller health systems, they wanted to optimize pharmacy discounts through the HRSA 340B Drug Pricing program to help fund community health initiatives like specialty clinics and dialysis centers.

The health system’s 340B experience had convinced them that there were additional savings opportunities in capturing prescriptions from referral providers, but they lacked the internal expertise and infrastructure to pursue them. The health system frequently refers patients to outside specialists who write prescriptions that can be claimed for 340B pricing but capturing those scripts and turning them into savings proved to be a daunting task.

Solution

The healthcare provider realized they needed a strategic partner to help capture 340B savings from referrals. But they also knew that compliance was paramount because they simply could not afford discount pricing losses or program exclusion. During their vendor search, the health system noticed the Cloudmed difference.

“The number one thing we look for is quality. There were a few points along the way that stood out – the track record of 100% successful HRSA audits without findings and the ability to offer a compliant product that helps protect and grow our program.” – 340B Program Manager

The health system ultimately selected Cloudmed 340B Recovery to help achieve their goals. Cloudmed’s technology-enabled service recovers 340B savings written by eligible and referred-to providers with an audit-first solution that others simply can’t match.

Results

Since going live in 2021, Cloudmed has provided more than 600 specialty consult notes that helped close the loop on outgoing referrals. Daily feeds from the EHR into the Cloudmed service flag any claim without a matching referral. Those claims are routed to the client team for review. In just over a year, Cloudmed 340B Recovery helped the provider capture enough savings to fund several new community health initiatives. While impressed by the advanced technologies enabling comprehensive referral capture, the health system credits Cloudmed’s service excellence for driving program success.

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