ExaLink services Pricing and contracts

Transcription

1 Pricing and contracts

2 Focus on maximizing your revenue, not running your software systems. Client experience that feels like an extension of the team. Adopting managed services is known to be an efficient way to stay up-to-date on technology, have access to necessary skills, and address a range of issues related to cost, quality, and risk. Business decisions are often stalled due to lengthy software updates and slow system response times. The multi-services platform is scalable, secure, and mobile. We are an integral part of Deloitte Risk and Financial Advisory s Managed Risk Services. Deloitte s s focus on risk mitigation and commercial performance for government pricing and commercial contracts. Talent Our specialists have backgrounds in government programs, commercial contracting, finance, technology, data analytics, and managed services. No software hassles You remain in control of business performance, methodologies, and processes while eliminating system maintenance and upgrade expenses. Our blend of flexible, innovative services help organizations more efficiently stay up to date on technology; access necessary skills; and address a range of issues related to cost, quality, and risk. Process We understand methodology and procedure, and we have a deep knowledge of the correlation between contracts and government programs. Minimal wait times The client portal allows immediate and mobile access to integrated business insights. Our services ExaLink subscription services: Access to a multi-services, hybrid cloud technology platform for government pricing, commercial contracts, and Integrated Business Insights Risk We assess risk to understand the implications and build methodologies to mitigate and increase business insight. Nearly unlimited data scale The technology has a horizontal scaling platform that outperforms competitors vertical server stacking by integrating data within one platform. ExaLink managed services: Our advisors and pricing and contracts operations team work together with clients to help them solve contract complexities, resource gaps, and technology limitations Cost efficient We can help save money and reduce dependence on costly systems and infrastructure. Enhanced data security Data is encrypted in a cloud-based environment and backed by data security supported by more than 300 Deloitte cyber security specialists. ExaLink Integrated Business Insights (IBI): We help our clients remain in control through a mobile-enabled portal that functions like a control panel and empowers decision makers to be less tactical and more strategic every day Tech nology A multi-services, hybrid cloud technology platform that offers data security and scalability, operational managed services, and access to business information. Business transformation Rethink business and operating models to deliver breakthrough value, reduce operational costs and transactional processes, and redeploy employees to focus on areas that are more strategic to the business. 2

3 The cost, complexity, and hassle of keeping systems afloat is no longer viable. Our multi-services technology platform offers data security and scalability, operational managed services, and access to business information. Features Innovative technology that transcends legacy enterprise systems Hybrid, cloud-based platform Client portal with anytime, anywhere access Alert, task, and status notifications Access to industry specialists and compliance knowledge Integrated business insights, leveraging geospatial intelligence, third-party data integration, and access to data analysts Mobility for phones, tablets, and wearables Data security, privacy, and controls Standardized processes Integrated Business Insights are now in the palm of your hand. Government Program Advisory Support Medicaid Claims Government Pricing Integrated Business Insights Dashboards On-Demand Reporting Scenarios Gross-to-Net Rebates and Fees Chargebacks Memberships Commercial Contract Advisory Support 3 Pricing Data Third Party Data Contract Data

4 Government Pricing Medicaid Claims Rebates and Fees Correct, timely, and consistent price reporting We support your methodology implementation, data verification, calculation processing, and price reporting for a broad suite of government programs in a format that is auditable, scalable, and reliable. Our streamlined workflow includes configuring price type calculations based on your specific definitions and incorporating transactional data from your sources, third-parties, and within Exalink. We process the calculations and compile the results. You receive continuous insight into the project status and access to your data via the client portal. Using the portal, you have the ability to review and approve the calculations before we assist with filing reports with the state and federal agencies. Price reporting for state and federal government programs including: Medicaid Drug Rebate Program (AMP, BP, CPPD, NP, URA) Medicare Part B (ASP) Statutory State Price Reporting (New Mexico, Texas, Vermont) Contractual State Pharmaceutical Assistance and Supplemental Programs (State Reporting) Public Health Services 340B Program (PHS) Department of Veterans Affairs (Non-FAMP, IFF, FCP) Historical analyses and government pricing recalculation support General ledger reconciliation assistance Efficiently process and pay government invoices Avoid the time-consuming burden of invoice processing, payment reporting, and continuous follow-up with state agencies. Our streamlined workflow includes receiving invoices directly from the states, entering and reviewing invoices on an ongoing basis, calculating payments, processing the invoices and/or supporting dispute resolution, providing manager-level analysis of the information, and delivering the results to you via our client portal. We submit payment and required documentation to the states within the regulated timelines. Medicaid and state programs processing includes: Medicaid Fee-for-Service and Managed Medicaid Programs State Medicaid Supplemental Programs State Pharmaceutical Assistance Program (SPAP) Aids Drug Assistance Programs (ADAP) State Children s Health Insurance Programs (CHIP) Standard payment reconciliation reports: Reconciliation of State Invoice (ROSI) Prior Quarter Adjustment Statement (PQAS) Invoice summary line level and claim level transaction testing Dispute tracking, reporting, and resolution Coverage Gap Discount Program (CGDP) TRICARE (standard and additional discount programs) Reduce the challenges of prescription verification and rebate calculation Managing large and disparate prescription utilization files, multiple formats, changing verification rules, and complex rebate structures is a burden for our clients that requires investment in systems and resources. We support the processing of rebates, administration fees, and other contract fees. Formulary rebates and admin fees (MCO/PBM): Commercial (HMO/PPO/Exchange) Commercial Managed Medicaid Medicare Part D Group Purchasing Organization (GPO): Administrative fees, rebates Trade/Distribution/Retail: Rebates, fee-for-service, shelf stock adjustment 4

5 Chargebacks Membership: Class of Trade Membership: Public Health Services Help maintain compliance and avoid revenue leakage We evaluate chargeback transactions and administer contract terms and conditions, products, pricing, rebates, and administrative fees. Our streamlined workflow provides membership managed services and EDI capabilities, connections with major and regional wholesalers, and standard reports to support GPO administration fees and rebate requirements. We can help you reduce error rates, decrease the potential for revenue leakage, and gain compliance with contract terms and conditions. Contract administration Membership administration Chargeback processing Rebate calculation Administrative fee calculation Class of Trade Help mitigate issues and solidify government programs compliance Valid Class of Trade (COT) assignments are the foundation of government programs compliance, as COT is the critical first step in establishing accuracy in statutory pricing across Medicaid, Medicare, Federal Supply Schedule (FSS), and Public Health Service (PHS) programs. We have developed a proprietary customer master database and created a COT schema, decision tree, and methodology for analyzing COT assignments. Our specialists leverage this information to evaluate and assign COTs to help you achieve a strong foundation for government program calculations. Standardized COT schema Perform customer classification assignments Data quality report and recommended actions 340B eligibility for compliance and risk mitigation If you participate in the Medicaid Drug Rebate Program (MDRP), the program requires you to provide only eligible 340B covered entities with PHS pricing. Providing a PHS price to an ineligible entity can adversely affect your statutory pricing calculations, potentially resulting in payments associated with the rebates claimed by the states, while also exposing you to a False Claims Act violation. Our proprietary customer master database contains industry identifiers and current and historical Office of Pharmacy Affairs (OPA) data to support the PHS verification process. We confirm historical and current eligibility of PHS entities for both primary covered entities and contract pharmacies. Evaluate Public Health Services (340B) covered entities eligibility and participation Liability analysis 5

6 s for pricing and contracts Integrate commercial and government data for reporting, discovery, analysis, and decisionmaking Medicaid Claims Integrated Business Insights enables you to unlock the hidden intelligence lost within disparate transactional and pricing data from government and commercial channels. Government Pricing Rebates and Fees We can help you shift from using systems merely for transaction processing to gaining unprecedented insights that can transform your business and give you a competitive edge in the fast-moving life sciences sector. Third-Party Data Integrated Business Insights Chargebacks Unlock hidden intelligence lost within disparate transactional and pricing data Spend less time managing data and more time acting on insights Memberships Achieve full visibility and access to cross-functional data Identify and understand contract performance through transactional and third-party data Convert transactional data into a configurable calculation engine supporting forecasting, accruals, and gross-to-net Integrated Business Insights help improve business performance by aligning internal and third-party data to explore and understand real-time contract performance, anticipate future financial results, and evaluate new business drivers. 6

7 Integrated Business Insights Greater clarity into business performance anytime, anywhere Our Integrated Business Insights provide data analysts and commercial operations specialists with deep knowledge of commercial contracts and government pricing data to help you proactively identify risk, improve product pricing, and analyze complex, business challenges. We provide tailored insights into pressing issues from product profitability and trade relations to commercial contract effectiveness, supply chain, and beyond. You gain 24/7 access to information through a mobile client portal that provides dashboards, reports, tasks, and workflow updates. Features Dashboards: data visualizations help you track transaction processing progress, trends, and contract performance: Workflow management analysis Key Performance Indicator (KPI) measurement Payment and deduction management Contract effectiveness leveraging syndicated data On-demand report builder: build custom reports to support ad-hoc business evaluation needs Scenario modeling: pre-established calculation models that measure and track the impact of variable changes to historic data: Pricing strategy Pre/post deal analysis Best Price (BP) impact evaluations Gross-to-Net tools: custom, configurable, and flexible calculation engine that supports financial modeling: Gross-to-net analysis Forecasts and accruals A mobile-enabled, single source of visibility functions like a control panel and empowers decision makers to be less tactical and more strategic every day. By 2020, it is predicted that nearly 21 billion Internet of Things devices will be connected including mobile devices, smart phones, tablets, wearables, and sensors. 1 Thus, the importance of mobile is pretty clear, as is the need for a strong mobile framework and strategy. Our mobile, interconnected, and integrated capabilities allow us to get information to you faster. We can pull in large amounts of data from across the manufacturing process, and we can query the system to get an answer almost instantaneously through a phone, tablet, PC, or wearable. 7 1 Nathan Eddy, Gartner: 21 Billion IoT Devices To Invade By 2020, InformationWeek, 2015.

8 Scale and industry excellence Among the largest life sciences and health care (LSHC) practice in the world Global leader in risk advisory services Deloitte Risk and Financial Advisory s Managed Risk Services brings together people, processes, and technology to provide clients with world-class risk management solutions on an ongoing and long-term basis, so that business leaders can focus on critical challenges that are core to their growth mission. The value for our clients: end-to-end solution management, reduced risk, stronger compliance, and a lower total cost of operations. #1 Market leader M&A Cyber Anti-Money Laundering Business Valuation FCPA Forensics Finance Transformation Corporate Governance Securitization Regulatory Consulting 13,000 professionals 13k 10 of the 10 large biotech (Forbes) 12 of the 12 large pharma (Forbes) 9,000 LSHC specialists 1,000 companies served in 90 countries Nearly 95% medical device manufacturers (Medical Product Outsourcing) Serve 80% Fortune Global 500 LSHC companies Subject matter specialists and deep industry experience Commercial Contracts Government Pricing Customer Management GP & Commercial Contracts Advisory Account Managers Medicaid TRICARE Chargebacks Rebates Repeatable processes, standardized methodologies, greater efficiencies Strengthen compliance, decrease risk, achieve operational excellence Help clients effectively govern and break down silos Secure and scalable technology platform to manage complex commercial operations Ongoing assessment and visibility into risk and compliance needs to decrease risk and exposure Substantial investments in innovation, state-of-art technology, and data security 8

9 Look forward If you re ready to explore how ExaLink can help transform your business, we should talk. For more information or request a demonstration, please visit deloitte.com/exalink. This document contains general information only and Deloitte is not, by means of this document, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This document is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor. Deloitte shall not be responsible for any loss sustained by any person who relies on this document. As used in this document, Deloitte Risk and Financial Advisory means Deloitte & Touche LLP, which provides audit and risk advisory services; Deloitte Financial Advisory Services LLP, which provides forensic, dispute, and other consulting services; and its affiliate, Deloitte Transactions and Business Analytics LLP, which provides a wide range of advisory and analytics services. These entities are separate subsidiaries of Deloitte LLP. Please see for a detailed description of our legal structure. Certain services may not be available to attest clients under the rules and regulations of public accounting. Copyright 2017 Deloitte Development LLC. All rights reserved.