What We Offer
- Specialty Pharmacy Payer Contracting
- Specialty/Infusion Operations and Clinical Development
- Employee Benefit Consulting
Keystone Healthcare Advisor’s capabilities can level the playing field by gaining access into the PBM’s very exclusive specialty pharmacy networks. Whether your focus is across all therapeutic categories or a niche pharmacy we have proven experience gaining access to payer/pharmacy contracts. KHA’s executives have helped clients expand their footprint as a regional or national provider by securing home infusion and specialty contracts including national and regional payer markets.
Keystone Healthcare Advisors understands that each of our clients has unique business goals and service offerings therefore it’s imperative to customize our services to meet our client’s specific objectives. KHA’s years of experience can be leveraged to enhance a pharmacy’s service offering via a business model and strategy that takes into account payer dynamics and the clinical focus of the pharmacy. Operations, reimbursement and clinical support are intertwined thus requiring an approach which addresses a comprehensive operational platform in order to ensure a pharmacy’s future success. The four critical areas of operations include the following: Intake, Clinical Management, Fulfillment and Outcomes.
Developing a comprehensive intake process including defining the specific roles of pharmacists, nurses and pharmacy technicians is critical in the onboarding process. With the complexities of benefit coverage in the healthcare industry, insurance investigation is a key component in order to strive to minimize a patient’s out of pocket expense as well as to ensure coverage and payment for services rendered.
The key to growing revenue is developing business models and strategies to grow profitable business. Develop proforma’s to plan staffing models, profitability and throughput. A comprehensive business plan is critical for those pharmacies desiring to expand into new markets or further penetrate existing markets.
The benefits you offer your employees can make a marked difference on your bottom line. Whether you’re harnessing benefits’ powers to recruit and retain top talent, manage costs, or influence overall morale, effective benefit plan management is a large contributor to your success as a company.
But it’s difficult to control rising costs, stay compliant, and handle the administrative workload. You face increasing healthcare and financial program costs, evolving federal government regulations, and a myriad of messages from carriers competing for your business – all of which need to be reconciled with your unique business needs and your long-term goals. For more information regarding Employee Benefit Consulting, contact Mike Gowen at email@example.com or call 215-806-1205.
Challenges Within The Industry
The consolidation within the PBM sector coupled with the competition from payer owned programs such as Aetna, WellPoint, Cigna, United Healthcare Group and Prime Therapeutics will continue to erode specialty pharmacy business opportunity and revenue. It is estimated Express Scripts, Inc (ESI) / Medco Health Solutions, Inc. manages over 50% of the market from a PBM perspective and represents a significant competitor in the specialty pharmacy space.
KHA executives have significant experience leveling the playing field. The principal worked for several PBM’s and large payers building out the specialty pharmacies. KHA’s proven track record has allowed our clients participation in payer Specialty Pharmacy Networks, (SPN’s).
Keystone Healthcare Advisors is a boutique consulting firm focused exclusively in providing services in specialty pharmacy contracting. Keystone’s flexibility allows for a customized approach to developing strategies and projects to meet the specific needs of our clients.
- New Contract Procurement
- Growth Strategies
- Opportunity Assessment
- Specialty Business Pro Formas
- Merger and Acquisition
- Enhanced Specialty Platform
- Organizational Readiness
- National Service Expansion
- Closed Network Penetration
- Home infusion contracting
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