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As the complexity of managing 340B programs continues to increase, there is a growing need for advanced tools and technologies to ensure compliance integrity and optimize financial stewardship. In this article, we’ll explore the scope of analytics and artificial intelligence (AI) in enhancing 340B programs. By leveraging AI capabilities, such as active decision-making and passive information generation, covered entities can unlock the potential for improved efficiency, accuracy, and cost savings.
Scope of Analytics & AI in 340B
Analytics and AI technologies offer significant opportunities to augment 340B programs and drive better outcomes. Active AI enables the automation of real-time decisions and actions within 340B software, based on pre-defined parameters set by a 340B program expert. While real people are still essential to your 340B program, active AI can be used to make the efforts of your 340B team more effective and efficient.
On the other hand, passive information AI generates reports and insights to build analytics regarding key performance indicators (KPIs). Passive AI can help you organize your data in a meaningful way to convey the story you’re trying to tell.
KPIs can help determine the success of your 340B program based on quantifiable measurement. Your KPIs should be meaningful to you and your program. It’s important to focus on compliance and financial integrity, allowing your covered entity to identify trends, anomalies, and performance issues. By measuring and enforcing KPIs, 340B programs can achieve improved transparency and optimize their operations.
Wastage Analysis
Within the split bill space, wastage refers to the portion of medication from single-dose vials (SDVs) that remains unused or unadministered. Often, these single-dose vial drugs are incredibly expensive. Wastage analysis presents an important area of opportunity where AI can improve 340B program performance. AI-powered automation can capture wastage from SDVs and ensure compliance with hospital policies & procedures. Leveraging electronic medical records (EMR) and unique charge codes, wastage can be accurately tracked and quantified. It’s also an opportunity to work with your third-party administrator (TPA) to ensure charges are adequately accounted for, and how to identify those charges in the event of an audit.
A regularly timed summary check is also a great way to avoid missed opportunities. Whether it be monthly or quarterly, it’s a good idea to look at patient encounters — the combination of those SDV drug dispenses should add up to a multiple of the full vial size. If they do not, you could be leaving savings on the table.
High & Low Dispense Limits
AI and analytics can also play a pivotal role in setting and monitoring dispense limits for reasonable charge quantities. By applying pre-set parameters to individual codes or National Drug Codes (NDCs), your covered entity can optimize your purchasing and compliance efforts. Dispense caught outside of these ranges can highlight charging issues of billing unit crosswalk issues. Talk with your TPA and ask if their software has the capability to proactively report dispenses outside of limits. This could help your organization identify areas for improvement and guide long-term changes. Additionally, AI intervention can help alert you while managing dispense limits, enhancing efficiency and accuracy of your 340B program.
Purchasing Optimization
Implementing AI intervention in purchasing optimization can empower your covered entity to make data-driven decisions, ultimately achieving more cost savings. It could be that WAC or GPO pricing is cheaper than the 340B pricing. Work with your TPA to see if they can implement active AI. By automatically splitting orders to the cheapest account based on accruals, organizations can maximize the benefits of the 340B program.
It’s helpful to automate an alert to your buyers if a drug is being purchased on an unexpected account as well as the savings justification. AI alerts can also be used to recommend to buyers alternate cheaper NDCs or highlight upcoming high WAC losses. Comprehensive reporting, considering the purchase mix and availability of cheaper alternatives, enables fruitful collaboration among buyers and the pharmacy team. Careful analysis of wholesaler backorder reports helps eliminate false opportunities and optimize purchasing decisions.
Dispense vs. Purchase Analysis
Across the industry, there are various ways to identify dispense vs. purchase. However, it’s difficult to overcome the hurdle of outpatient charges against 340B wholesale purchasing. Likely the easiest way to do this is to conduct a report, applying the billing units to the number of packages that were purchased. This will help you flag any anomalies or issues that need to be addressed.
Beginning the AI and Analytics Journey
When embarking on your AI and analytics journey for your 340B program, it is essential to solidify resources and project champions. Collaboration among the TPA, IT department, and administration is crucial for successful implementation. Identifying KPIs based on general industry standards and specific program requirements is the next step. These KPIs should be clearly defined and reported to all stakeholders to ensure alignment and accountability. Finding the right balance between active AI automation and informative AI insights is key to leveraging the full potential of these technologies.
Conclusion
Integrating analytics and AI capabilities into your 340B programs holds a huge opportunity for enhancing compliance integrity, financial stewardship, and operational efficiency. By automating decisions, generating targeted insights, and optimizing various aspects of your 340B program, you can unlock significant benefits. It’s important to approach the adoption of AI and analytics strategically, ensuring that the technology aligns with the organization’s goals and objectives.
Harrison Garrett, Operations Manager at Cervey, can be reached at hgarrett@cervey.com
