Health plans and pharmacy benefit managers (PBMs) face a myriad of challenges, coming from multiple directions, and seemingly all coming at the same time.

 


 

EXL Health partners your way to find a better way to empower Pharmacy leaders to improve operational effectiveness, enhance clinical and financial outcomes and reduce member and provider abrasion.

EXL HEALTH PHARMACY SERVICES

EXL Health’s Pharmacy Services embodies human ingenuity to proactively and comprehensively help our clients manage their pharmacy programs. We deliver services that resolve the most complex problems of pharmacy leaders by focusing on what matters most – improving member outcomes and quality, containing costs, and ensuring members and providers receive the best experience possible.

Our predictive and prescriptive analytics solutions, clinical, quality and utilization management services, workflow technology, and prescription claim auditing capabilities help enhance pharmacy operations, drive digital transformation, turn raw data into a strategic asset, and provide powerful population health insights that let our clients stay competitive and achieve market growth and expansion.

"EXL Health is a long-term, true partner. They have collaborated with us on the best strategy and execution of our care management platform, and positioned us for success in automating our processes. EXL empowers us to deliver complex and technical solutions needed to exceed our customers' expectations."

Frank Maguire, MD Chief Network Officer TriWest Healthcare Alliance

PROVEN OUTCOMES

A top national PBM needed an efficient process to review pharmacy claims for discrepancies/errors prior to payment. EXL Health’s auditor expertise, predictive analytics and IT resources developed a scalable and repeatable program across all lines of business to avoid inappropriate payments. As a result, the client:


 

A large healthcare company was looking for a cost effective way of managing the volume of pre-certification requests for its specialty pharmacy business and its complex and expensive distribution, administration and patient management environment. Our Pharmacy Services utilization management solution employed a multi-pronged approach, including developing a process for pre-certification requests for specialty medications.

HUMAN INGENUITY: BRINGING “TOGETHER, WE WILL DO THIS” TO LIFE

At EXL Health, human ingenuity is the catalyst with which we solve your complex problems. Our experts look and go deeper, to find a better way to improve outcomes in terms of clinical outcomes, quality, total cost of care, and member/provider experiences. Our team is also nimble, willing and able to adapt to dynamic industry trends and to adopt new techniques and technologies to accelerate your transformation and to support your continued growth and success.

EXL Health associates take a consultative approach that adapts to your evolving needs. We collaboratively engage with you to fully understand your current and dynamic business challenges and to develop innovative solutions to address those challenges. This approach results in much more than a transactional interaction. It establishes and nurtures a long-term business relationship, a partnership. Together, We Will Do This is more than just a marketing headline – it’s a commitment, a promise.

"They have really deep, deep, analytical knowledge. They are easy to work with. They bring a wealth of data science knowledge to the table. If you want to have a really good analytical discussion about your data with somebody, they're the people to talk to"

Director of Care Management Blues Plan

WHY PARTNER WITH EXL HEALTH?

Our diverse, global resources and delivery models allow us to provide capacity on demand, on- and off-shore.

Our practical experience provides us with unique perspectives, knowledge and applied learnings across the healthcare continuum, offering timely insights to complex challenges.

Our cross-market expertise – Fully- and Self-insured Commercial segments, Medicare Advantage, Managed Medicaid, Health Information Exchanges – allows us to drive relevant, member and patient-centric insights, recommendations and outcomes.

Our innovation is “always on,” whether it’s developing more efficient processes or finding and leveraging new data assets, new technologies, new analytics methodologies and techniques.