Eliminate Wasteful Healthcare Spending and Maintain Program Integrity
We estimate that the United States loses $275 billion annually in healthcare spending through administrative inefficiencies, as well as fraud and abuse — that’s nearly $9,000 per second. Leading-edge employers are partnering with their claims administrators and pharmacy benefit managers (PBMs) to address this healthcare waste and inefficiency and implementing strategies to hold them more accountable.
From identification and prevention to investigation and recovery, Truven Health Analytics offers powerful, flexible Payment Integrity Enterprise solutions to help uncover and eliminate wasteful spending. Backed by more than 20 years of experience, our team of payment integrity experts, proven methodologies, and cutting-edge technology can be applied to:
- Retrospective audit
- Event audit (e.g., new vendor and/or new plan design)
- Continuous monitoring
- Waste, fraud, and abuse analytics
- PBM RFP contracting and evaluation
Driving Real Value
Our results speak for themselves. Recent client successes include:
- More than $4 million in savings identified due to errors and noncompliance with benefit plan design.
- Recovery of 4% of a client’s annual gross drug spend though a PBM discount validation audit, resulting in an ROI greater than 10:1.
- More than $6 million in savings identified and members incented to use the most cost-effective and highest quality distribution channel for prescription drugs.