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LexisNexis® Risk Solutions: Bringing Intelligence to Pharmacy Management

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Craig Ford, VP of Sales, Pharmacy Markets, LexisNexis® Risk SolutionsCraig Ford, VP of Sales, Pharmacy Markets, LexisNexis® Risk Solutions
The evolution of pharmacy has seen a multitude of renditions over its 4,000-year-old history. The long journey of the institution from papyrus scrolls in 400 BC to modern day electronic prescriptions was an arduous one. Even today, pharmacies continue to evolve from being entities that merely dispense medication to playing a critical role as providers of care. This transition is leading the pharmaceutical sector to realize the need for the integration of workflow data and analytics to enhance the efficiency at the point of sale and improve the ability of pharmacies to engage with patients. However, due to the impacts of the growing regulatory complexities, pharmacies are being forced to move into the clinical area of healthcare in search of newer sources of revenue. This transition of pharmacies into healthcare destinations is increasing the inefficiencies in patient engagement due to disorganized workflows and difficulties in the integration of patient information.

Georgia-based LexisNexis® Risk Solutions offers products that support pharmacies to tackle the effect of regulatory changes on workflows and ensure proper linking of medical records to improve patient outreach. “LexisNexis helps pharmacies remain compliant and offers a robust patient engagement data analytics offering to enable them to better understand patients,” says Craig Ford, VP of sales, pharmacy markets at LexisNexis. Initially, LexisNexis offered services to help pharmacies integrate prescriber demographic and licensure data into their workflow. Today, the company offers solutions that leverage patient insights and analytics to aid clients in reducing risks while enhancing compliance and adherence.

The company has developed solution suites—Provider Intelligence Suite, Fraud Waste Abuse suite, and Patient Identity Intelligence Suite—to resolve the core challenges in the Pharmacy and Pharmacy Benefits Management (PBM) market. The Provider Intelligence Suite offers prescriber data and real-time prescription validation to assist pharmacies in staying compliant with state and federal prescriptive authority requirements. This suite offers three solutions—Provider Data MasterFile, Provider Data Enhancements, and VerifyRx—to assist pharmacies in operating efficiently through the growing regulatory complexities.

Provider MasterFile is a golden-record that is consolidated from hundreds of prescriber sources delivered to the clients through API, batch file delivery, and a web-based user interface. Meanwhile, Provider Data Enhancements is a robust data augmentation and management solution that enables customers to report on data requests that clients want to validate with LexisNexis’ extensive and well-defined auditing processes. Finally, VerifyRx allows pharmacies to validate prescribers in real-time, support internal and external audits, and configure checks to reject claims, send warning messages, and capture requests for reporting. “VerifyRx is a real-time compliance solution that performs over 65 state and federal level checks to enable pharmacies to strike the optimum balance between compliance and relevant workflow requirements,” explains Ford.

Together, these solutions offer prescriber compliance by enabling best-of-breed provider insights.

LexisNexis helps pharmacies remain compliant and offers a robust patient engagement data analytics offering to enable them to better understand patients

With the LexisNexis fraud, waste and abuse suite, the company helps clients accurately identify the individuals and businesses involved in fraud schemes. The main offering, LexisNexis® Relationship Mapping, connects the dots among individuals, providers and businesses to help mitigate rising fraud schemes like opioid abuse.

Additionally, their Patient Identity Intelligence Suite helps stem identity theft related fraud by corroborating the identities of individuals that customers interact with. Products such as LexID®, TrueID®, and Instant Authenticate® Q&A anchor their identity authentication and patient record matching applicability. “LexID provides current demographic data for each individual and identifies where customer databases may have duplicate records of the same individual,” adds Ford. Moreover, the TrueID and Instant Authenticate Q&A solutions offer clients the ability to validate the legitimacy of a person logging into a customer system or presenting IDs in person. By utilizing these products, pharmacies can minimize the impact of fraudulent activities, ensure patient records are matched correctly and protect access points to personal information.”

Lastly, LexisNexis provides a collection of scores and attributes hinged on the company’s social determinants of health data to strengthen statistical models in client organizations and assist them in identifying social influencers impacting health outcomes. Categorized into four categories—social isolation, address stability, education, and financial health—these insights are based on hundreds of attributes that were created from extensive data sources that have been statistically and clinically validated to predict health outcomes. Within LexisNexis’ social determinants of health suite, the company offers a hospital readmission score and total healthcare cost score as well.

At the heart of LexisNexis Risk Solutions’ unique position in the PBM market is the customizability of their product portfolio, particularly the company’s VerifyRx solution that allows customers to personalize real-time checks based on third-party partnerships and store locations. In addition, the ability of LexisNexis’ solutions to tap into vast data sources and provide analytics that can be integrated into the workflow in real-time is key in the delivery of their solutions.

In the coming months, LexisNexis plans to add a medication adherence score to their social determinants of health suite to not only identify why patients need assistance with adhering to medication, but also indicate the drivers of such behavior to offer personalized services. In terms of organizational objectives, the company will continue to remain laser-focused on expanding their clientele and growing alliance engagements. “Our customers trust and believe in our commitment to deliver data-driven insights and solutions that can solve their greatest challenges,” concludes Ford. LexisNexis is passionate about developing and delivering solutions that will help customers continually innovate, and overcome organizational and regulatory challenges with a vision to shape the future of the pharmaceutical industry for the better.