Genzyme Sanofi Renasssit Program.
One of the major and overwhelming changes that has occurred within a real life case of the Genzyme Sanofi Renassist Program is the marked increase in applications for this program. In May, we received 87 applications for patients that were in their 90D Waiting Period. That is a 32% increase over the number of applications received in May 2012. In May of 2012 only a total of 66 applications were received (66 applications). Helping patients is nothing new to Renassist. According to their official website, "the Renassist® team has been helping patients with and without prescription drug coverage identify the Renvela® (sevelamer carbonate) reimbursement solution that is right for them…" (renassist.com, 2013). To be clear, the Renal Patient Assistance Program (RPAP) was designed specifically for patients who had significant financial needs but were not covered for Renvela under and specific prescription drug plan or cmmerical insurance, including government plan (renassist.com, 2013). In this particular case study, we're examining all the factors and changes which are attached to the Part D assistance Program (PDAP). "PDAP provides a free supply of Renvela® (sevelamer carbonate) to eligible patients with Medicare Part D who cannot afford their copayments or co-insurance for their prescriptions: The 2013 Renvela® Medicare Part D Assistance Program opens on March 1, 2013. Refills must be requested by the healthcare professional. If less than 3 months remain in the year, the patient will receive enough medication to last until December 31, 2013" (renassist.com/partd, 2013). These are part of the eligibility requirements that need to examined and assessed closely, when processing all applications for eligibility.
For instance, starting in 2013, there's been almost a 50% jump in the 90D applications received; this means if the current rate of applications continues, in 2013 there will be just under 1,000 applications that will need to be processed. Currently, the team workload timeframes operates under the following schedule:
Pre-entry
Pre-entry of Dailies: same day
Pre-entry of Apps: 1 day out
Pre-entry of TPGs: 2 in-queue for pre-entry
VoBs
Dailies: 3 day turn-around
TPGs: 4-week total turn-around
Applications
RPAP applications in-house: 2-week turn-around
RPAP applications with AKF/Diplomat/delivery: 1 week turn-around
As these notes reflect, in order to meet the higher demand for the drug within this set reimbursal program, several things need to happen. First there needs to be an overall increase in efficient. The turn around time for RPAP applications in house is 14 days on average. This is far too long. If anything this number demonstrates a severe lack of efficiency. However, in order to improve it all of the factors connected to it must be adequately improved. For instance, staff members need to be better trained in processing applications and there also need to be more staff members hired to do this process. In order to hire more staff members and in order to train the current staff members more efficiently, there needs to be money carved out of the budget to accomplish such endeavors. For instance, as organizations like healthit.gov have found, with health care organizations working through better compliance and business models, cutting costs becomes a must. "Increased cost savings through effective infrastructure planning. Cost savings can be realized by correctly predicting resource utilization, appropriate use of site of service and improved care delivery team communication" (healthit.gov, 2010). Improving team communication is truly essential to ensure that the team is not only strong and that there's a high level of visibility, but to ensure that applications get processed as quickly as possible. Furthermore, even if money is carved out of the budget to streamline the entire application processing routine, this advancement of the general process will all be for nothing unless there's strong communication to take advantage of those changes.
For example, with certain health care organization, the advancement of the processing methods includes, "Provision of higher specificity of coded clinical data in payor contracting to obtain appropriate reimbursement, improved outcome management and monitoring of key revenue cycle effectiveness...
Health History And Screening of an Adolescent or Young Adult Client Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include the relevant data for your client. Biographical Data Patient/Client Initials: Julio Molina Phone No: XXX-XXX-XXXX Birth Date:1/28/1999 Age:15 Sex: Male Birthplace: Tucson, AZ Marital Status: Single Race/Ethnic Origin: Mexican-American Occupation: Student Employer: N/A Financial Status: (Income adequate for lifestyle and/or health concerns. Is there a source of health insurance?
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