Switching to a new pharmacy benefit manager (PBM) doesn’t need to be complicated. In fact, it can be done with minimal disruption to HR teams and members, says Jim Berg, vice president of business development and client management at Alluma. A PBM with a hands-on, tailored process that addresses the unique needs of its health system partners can ease the concerns and burdens of internal teams during the switch. Berg details how innovative PBMs like Alluma are breaking barriers by offering high-touch services, managing complex transition details, and tapping an advanced clinical team.
“We shoulder the burden of occasionally complex and time consuming implementation processes, allowing health systems to focus on their most important goals.”
Q: What are the perceived factors or barriers that organizations fear when considering a change to a new PBM?
Jim Berg: HR teams have several concerns, including how to manage a PBM transition while dealing with the impact of COVID-19 and associated furloughs and layoffs. HR leaders may feel they cannot devote the time necessary to do a PBM transition. There are perceived concerns over potential member disruption, increased member communications, and additional work they may have to do during the transition.
Q: How do most PBMs manage transition? Do they tailor their process to the client?
Berg: The amount of direct attention a traditional PBM provides during the transition is mostly determined by the size of the member population. Smaller groups of up to 5,000 lives will receive less personalized attention because the PBM’s business model targets significantly larger populations. They will treat smaller groups as a block of business as opposed to individual clients. It follows that these PBMs will also limit how much they tailor the process for a smaller group because the revenue just isn’t there. Additionally, larger PBMs working with smaller groups will expect that group or their consultant to be more involved in the plan setup. For example, self-insured health systems may have to spend more time and effort providing information related to their summary of benefits, which can be cumbersome.
Q: What makes your process unique? How do you apply high-touch services, such as managing complex data transitions and advanced clinical reviews, to ease concerns?
Berg: Alluma treats each group, regardless of size, as an individual. Our approach is tailored and high touch, especially in managing the transition. It isn’t just a matter of taking what they have and running with it; we really try to understand their goals. In many cases, what they have today is only what their previous PBM could provide, and not what they wanted. We are structured and methodical in our approach, spending more time walking clients through the implementation process, asking pointed questions, and making sure they are engaged in decisions. Alluma also removes key burdens off of the health system by managing EDI connectivity to the TPA. We will work directly with the medical payer to ensure that we have electronic connectivity, so we can share eligibility information and accumulator files. At the same time, we provide data analysis that goes beyond a claims report. We help them understand the “why” behind the data and what actions they can take. Providing clinical expertise is another critical component. Understanding the clinical impact of pharmacy benefit decisions can be challenging. Our account management team, including an account manager, a clinical pharmacist, and a clinical operations support person, hold regular calls with clients to ensure they understand their plan activity and options available to them, something other PBMs rarely do, especially for smaller groups.
Q: How does Alluma take the burden off the internal team, and how does this achieve a seamless transition?
Berg: Pharmacy benefits management and benefit plans can be a challenge to understand because there are so many nuances. We offer an effortless transition by helping the internal team understand what is most essential about their plan options and making specific recommendations. We also let them know about the flexibility that is available to them. Finally, we shoulder the burden of occasionally complex and time consuming implementation processes, allowing health systems to focus on their most important goals.