Companies today are disillusioned by their experience with a conventional volume-based PBM arrangement. Their pharmacy costs have risen, yet their population isn’t healthier. They’ve received rebates, yet they haven’t saved money. Employers pay more than 80% of all healthcare costs, but conventional PBMs consistently let employers and members down with models that behave like retail. Volume-based PBMs that pump more drugs into the population driven by “sophisticated” drug pricing paradigms fail to improve health or lower employer costs. The PBM profits regardless.
As the industry’s most clinically advanced and only value-based PBM, EmpiRx Health disrupts the volume-based paradigm with a pay-for-performance, clinical-first model perfectly aligned with employers and members. The way to reduce costs and improve health is by optimizing the drug mix within an employee population (fewer brands and specialty, more clinically appropriate lower-cost alternatives), providing high-touch care to members with health and service complexities, and holding ourselves accountable our customers with cover-the-difference savings guarantees.
“If we don’t deliver on our savings guarantees, we cover the difference. Value is only achieved by financial alignment―a value-based model aligns the PBM’s income to our customers’ outcomes and improves healthcare outcomes,” says Karthik Ganesh, the CEO of EmpiRx Health.
EmpiRx Health’s core clinical strategy is client-tailored Population Health Management―a proprietary, market-differentiated solution powered by Johns Hopkins ACG, AI, and business analytics to maximize clinical and financial outcomes. Leveraging all available healthcare data, EmpiRx Health’s solution examines unique employee populations and customizes clinical interventions for their members that improve health and lower costs.
Ganesh’s success in leading a company to nearly 30% YOY growth is a direct reflection of his deliberate focus on three key guiding principles:
Clinically Advanced Healthcare
The EmpiRx Health clinical model is essentially strengthening whole-person care with a focus on population health and complex care management:
The bottom line is working with prescribers to find the right medication for each member improves health outcomes and drives out wasteful spending in an employer’s drug mix. In tandem with a concierge patient experience, EmpiRx Health achieves optimal value and deep sustainable savings for an employer’s plan.
EmpiRx Health’s ability to innovate, grow, and disrupt a volume-based PBM marketplace is unmatched. They are accountable for managing employers’ healthcare spending with pay-for-performance models that take downside risk. 90% of their contracts are risk-bearing, pay-for-performance with hard-dollar and fully transparent clinical savings guarantees to lower drug spending.
“PBMs have had nothing to offer for too long besides alternate pricing models that steer a benefits conversation away from healthcare. Healthcare is the only business that is not judged on value, yet the value is the ONLY measure of healthcare efficacy,” says Ganesh. “We are the only PBM to use a true Population Health Management model that is tailored to a client’s population. Driving proven cost containment through clinically-advanced models―not financial gymnastics―is the only way to lower spend. We take costs out of system by eliminating waste and unnecessary spend from the employer’s drug mix with a focus on their populations’ unique risk factors.”
Shoppers of healthcare benefits have been conditioned to believe that cost and access are mutually exclusive. Restricting access to pharmacy channels and medications are used as cost-savings mechanisms, but the reality is you don’t have to sacrifice to save. EmpiRx Health removes barriers to access through a broad network and open formulary models. They are channel-neutral and don’t believe in disruption―members’ convenience is paramount.
Towards the Future
Being a vital, innovative part of the healthcare continuum requires Ganesh and his team to invest in their technology continually. EmpiRx Health’s investment roadmap focuses on tech-enabled and human-delivered innovation, with a distinct focus on population health and complex care management. They are making deeper AI-related tech investments in population health while significantly expanding the footprint of their Member Care Advocacy team, a specialized team that delivers on the clinical concierge and personalization commitment EmpiRx Health has made to their most vulnerable members. 2.6% of their membership (categorized as vulnerable) consume over 45% of their services.
These are the people who want to be engaged by their healthcare partner, which is why EmpiRx Health is implementing secure text messaging as part of their Member Care Advocacy model. EmpiRx Health team will expand the breadth of support via a very personalized yet comfortable engagement―without compelling disclosure of personalized health information as apps and other digital platforms require.
“In 2022 and 2023, we are increasing our investment in Databricks to further streamline our data integration flexibility. We are an extremely elastic enterprise in terms of our flexibility and scalability, and the Databricks investment will only further that strategy,” elucidates Ganesh. “We are national in scope and the perfect fit for a self-funded employer, labor union, TPA, or health plan. As a PE-backed entity that is also a category-creator in our space, we are constantly on the lookout for niche, point-solutions that will allow us to bring even more innovation to the industry’s only value-based PBM solution.”