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Who We Serve

Pharmacy Benefit Managers

White label patient adherence and MTM cost management for PBMs seeking to increase revenue by helping payer clients achieve targeted client STAR cut points & HEDIS ratings

Pharmacy Benefit Managers occupy a unique niche within the medication management ecosystem. On the one hand, their customers value medication cost management, Star goals, and HEDIS measure improvements. On the other, PBMs profit through high levels of medication utilization. CSS Health helps PBMs who provide MTM services operate more efficiently, while also enabling a wide range of profitable services that augment traditional PBM offerings.

Essential Cost Control

PBMs do not typically consider MTM and similar services as core operations. However, customers and sales prospects increasingly demand these functions. Operational cost control becomes a critical element in deploying adherence, Star rating, and HEDIS improvements programs. CSS Health’s 19 years of MTM experience helps PBMs deliver advanced adherence through MTM for Medicare and Medicaid via intuitive, market-leading applications that cost little in terms of infrastructure or personnel to operate.

CSS Health’s software solutions operate across the full range of claims information. These highly cost-effective systems unify and replace manual systems or multiple offerings from multiple vendors. These premium capabilities support PBMs of all sizes, with the latest features quickly deployed with minimal disruption to normal daily operations.

Unified Services, Enhanced Revenue

PBMs using CSS Health gain a unified technology platform for delivering a variety of MTM and adherence services that create new revenue opportunities. Typical applications include:

• Improved adherence (more medications consumed at lower cost)
• Identification of alternative therapies that are equivalent in cost and efficacy but more profitable for the PBM
• For-fee outsourced MTM operations for clients, including consolidation of MTM operations from multiple vendors
• HEDIS/Star target support and consulting
• Part D cost management consulting and services
• Loss leader offerings to retain current customers or win new accounts

Focus resources on wellness and profitability, not IT or data processing

CSS Health’s PBM solutions scale to millions of patients, with comprehensive support for changing industry, state, and federal regulations. PBM customers receive intuitive information to manage population health more effectively, without the PBM or the client having to incur the complexity or expense of developing similar systems in-house.

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