Best Practices for Implementing BPOs in Pharmacy Benefits Management (PBM)
Pharmacy benefits management (PBM) is a key process in the healthcare field. There are a variety of options when it comes to PBM and ensuring that you choose the right one is essential in ensuring that all parties involved receive the best services possible.
In this article, we’ll discuss outsourcing PBM and the benefits that can come from it. Let’s get started and dive deep into some of the reasons why you should consider outsourcing pharmacy benefits management.
Understanding the benefits of outsourcing pharmacy benefits management can help you decide if it’s the right choice for your business. Let’s go over some of the most notable benefits to consider.
Did you know that outsourcing can actually save you money? Outsourcing can save your team time and reduce potential errors, making it a very budget-friendly option. By outsourcing PBM, you can save money and increase efficiency.
While outsourcing can be an exceptional option for many businesses, that doesn't mean there aren't some challenges it can present. Being aware of potential challenges is important so that you can have an accurate understanding of what exactly outsourcing this area of your business could mean.
Communication is one of the biggest challenges that can come from outsourcing PBM. Communication can depend on various factors, including how your in-house team is involved, where your outsourced staff is located, and what tasks you're outsourcing.
If you're concerned about the communication factor of outsourcing, then it's best to have clear guidelines before you begin. Having expectations in writing can ensure that everyone is on the same page and that you get the results you're looking for.
Defining Goals and Objectives for Outsourcing PBM
There are a few different goals that are common for companies that are going to be outsourcing PBM.
When creating KPIs, it's important to consider small and large details. Consider asking yourself the following questions:
- How would you like outsourcing to increase your revenue?
- What impact do you want outsourcing to have on your current staff?
- How are you measuring customer satisfaction?
- What ROI do you want to achieve?
Key Selection Criteria the Right BPO Partner
When it comes to outsourcing, not all BPO partners are the same. Carefully evaluating partners is the best way to ensure you're making the right choice and selecting a partner that will help you accomplish your business goals.
There are a few different criteria that are essential to consider when it comes to selecting the
right BPO partner. Thinking about the following factors is a great way to be sure that you're on
the right track when it comes to finding a partner that makes sense for your business.
We've already discussed the importance of communication. Asking potential partners about their communication standards is a good way to understand their priorities and ensure that your expectations would be met if you chose them.
Understanding how a BPO partner will communicate with you is important, but it's also essential to understand how they with others such as physicians and pharmacies. This level of coordination is often essential to PBM, so ensure you understand their communication philosophy and strategies.
There are a few different red flags that you should watch out for if you’re in the process of evaluating potential outsourcing partners.
If an outsourcing partner isn't open to you asking them questions, they might not be the right choice. On the other hand, if a partner can't answer your questions, consider other options. You should get detailed, extensive answers to all your questions to ensure you're selecting the right partner.
Most outsourcing partners can provide you with testimonials and case studies. If an outsourcing partner can't prove past success, they might not be the right choice for your business. Being able to look at past reviews is important, so don't be afraid to ask for sales collateral.
When looking at past testimonials and case studies, be sure to request some that are specific to PBM. Many BPO providers work in multiple fields, so seeing results from PBM projects is important.
Establishing Effective Communication Channels and Performance Metrics
Setting clear communication standards is important, but it's also essential to consider what software and technology you'll use for communication. Having open communication channels for both your outsourced and in-house staff is a good way to ensure that everyone is on the same page and has the resources they need to succeed.
Fostering a Collaborative Relationship Between the BPO and In-House Teams
We’ve briefly touched on the relationship between BPO and in-house teams, but let’s dive deeper now.
Your two teams' relationship can significantly impact business processes and outcomes, so it's important to consider. Fostering a collaborative relationship can encourage success, communication, and unity, so it should be considered and worked towards.
Below are a few things you can do to encourage collaboration and ensure that the transition process to outsourcing goes as smoothly as possible.
Managing Data Privacy and Security
One of the biggest concerns many people have when outsourcing is managing data privacy and security. This is undoubtedly important in protecting your business and remaining within regulations and guidelines.
Putting clear privacy and security measures in place is essential, which can mean utilizing the right software and developing secure practices. Doing this will ensure that your BPO partner is protecting your organization and not putting you at risk for a breach or leak.
Auditing Security Measures
Most BPO partners will already have security measures in place when you're interviewing them. Asking them detailed questions about these measures is a good way to understand their dedication to privacy and security, so don't be afraid to get the answers you need to make an informed decision.
Ensuring Regulatory Compliance
Regulatory compliance is an important piece of this discussion, especially concerning PBM. The healthcare sector is extremely specific about regulations; failing to conform to them can put your business at risk.
Both organizations and their BPO partners need to have regulatory compliance standards to stay within their legal rights and provide the best services to their customers.
BPO partners should clearly understand HIPAA, HITRUST, PCI and AICPA. Ensuring that a potential partner has a deep grasp of these guidelines can provide you with peace of mind and assurance that your business operates within legal regulations.
Asking potential providers for their healthcare compliance plan is an excellent way to understand what practices they have in place for maintaining compliance. Carefully detailing this plan and asking any questions you may have will help you learn more about the partner and their dedication to regulations.
Healthcare compliance software can play an important role in ensuring that your potential partner is on the right track and maintaining a high standard of compliance. Utilizing the right software is a good way to ensure you're checking all the required boxes and remaining within your legal rights.
If a potential partner cannot provide you with information about their regulatory compliance standards, then it may be time to move on with your search. This is an essential component of maintaining your business's integrity and ensuring that you remain protected.
Effectively Outsourcing PBM
When it comes to outsourcing PBM, there are many different options. The way that you go about outsourcing can significantly impact the results you achieve, so it’s essential to make sure that you follow best practices and set your team up for success.
In summary, here are some things to consider when you're at the beginning of the outsourcing process:
- Develop clear goals and objectives
- Carefully select and evaluate BPO partners
- Establish consistent communication and thoughtful performance metrics
- Implement data privacy and security measures
- Prioritize regulatory compliance
- Foster collaboration between your BPO and in-house teams
By doing the things above, you can improve the efficiency and cost-effectiveness of your PBM operations.