To ensure compliance, maximize savings, and streamline operations, consider these five best practices.
1. Proficiency in Data Management
To effectively manage your 340B program, it’s crucial to comprehend how data is created, stored, and transmitted to your Third-Party Administrator (TPA). Typically, data is extracted from your Electronic Health Record (EHR) system to generate a flat file. This file is then ingested by your TPA, who calculates your accumulations for 340B savings, Group Purchasing Organization (GPO), and Wholesale Acquisition Cost (WAC) pricing.
A central aspect of effective data stewardship involves interpreting the data elements. Whether it’s Charge Description Masters (CDMs), National Drug Codes (NDCs), or a combination, understanding the codes and quantities is essential for correct accumulation and compliance. Analyzing charge data includes grasping the NDCs sent to your TPAs, deciphering charge quantities, and accounting for various units such as mL, mg, or shots administered.
To get to the place where you feel like a true steward of your data, your IT team is an invaluable asset – their expertise can guide you through the intricacies of your EHR.
2. Prioritizing Audit Consistency > Size
We have found that audit consistency holds more weight than sheer volume. Smaller, frequent audits reveal more compliance issues and savings opportunities than larger, infrequent ones. While your sample size on a regular basis may be smaller, you are getting a deeper analysis of your data which benefits your program long-term. By analyzing claims consistently and maintaining a rigorous audit cadence, you can proactively address compliance concerns and uncover potential savings.
3. Nurturing Your Network
Collaboration extends beyond the internal team. Establish strong relationships with TPAs, wholesalers, Apexus, and other stakeholders. These connections provide valuable insights, shared experiences, and foster continuous learning and growth. Many of us come across challenges that we may not immediately know the answer to, and our relationships are incredible resources when approaching these day-to-day operational challenges.
4. Right-Sizing Your Team
The size of your team plays a pivotal role in your 340B program’s success. A well-staffed team ensures quicker identification and capture of opportunities, vital for optimizing the program. Striking the right balance between resources and workload prevents overloading a single person and mitigates compliance risks. There is an incredible ROI opportunity that comes with investing in your 340B staff.
5. Leveraging Steering Committee Involvement
Establishing a steering committee composed of daily operations experts and key C-Suite individuals is essential. Regular meetings with a dynamic agenda promote a culture within your program of transparency and alignment. These interactions provide C-Suite leaders with a comprehensive understanding of your 340B program’s performance, enabling them to offer timely support and resources. Optimizing a mixed-use program requires a strategic blend of data expertise, audit consistency, relationship-building, team optimization, and steering committee involvement. By implementing these five best practices, we believe that you can confidently ensure compliance, maximize savings, and build program excellence. To explore these strategies further and gain insights from Austin’s real-world experiences, we invite you to tune in to our latest podcast episode.
Austin Shady is senior director of client success, mixed use at RxStrategies. He can be reached at email@example.com