Some healthcare policymakers have called for the pharmacy benefit management industry to get a new look, and a New Jersey company is mixing things up by focusing less on rebates and more on clinical care management.
EmpiRx Health is taking on financial risk to manage members who are using low-cost alternatives instead of pricey drugs that drive up rebates. It offers an analytics-driven platform to provide actionable insights to its partners on their drug spend performance.
The platform is also available for plan members to track their medication adherence and costs.
The key? EmpiRx says that they're making waves because they treat their health plans as loyal partners. Collaboration between all stakeholders is crucial, and the data available facilitates those relationships.
And the financial benefits are notable, too. EmpiRx says its program has found an average of between 8% and 15% in savings on pharmacy spend for its partner health plans.
The big idea: Leveraging pharmacists to align healthcare
Headquarters: Montvale, New Jersey
CEO: William Resnick
Annual revenue: Gross 2017 revenue is $60M
Funders/funding: Privately held and funded. Five core investors.
Fierce insights with EmpiRx Health CEO William Resnick
FierceHealthcare: What is your best piece of advice for launching a healthcare company that challenges the status quo?
William Resnick: Always doing the right thing, even if the right thing doesn’t add to your bottom line. Doing the right thing is the basic blocking and tackling of healthcare. That includes operating first and foremost with the interests of the client, advisor, member, and provider always aligned. In order to challenge the status quo, you’ve got to have skin in the game.
EmpiRx is revolutionary because it assumes true risk to deliver tangible value for all constituents—including plan sponsors, members, and physicians—so that all parties benefit, but not at each other’s expense.
FH: What is the failure you’ve learned the best lesson from?
WR: I’ve worked in the healthcare system for over 20 years and early on, I drank the Kool-Aid. I believed in the million-dollar mission statements of these companies—that their business models reflected the health and well-being of their members and clients. But I quickly realized that it just wasn’t true. The market is used to seeing things in a misaligned fashion, so they don’t always grasp the fact that things aren’t being done right.
I’ve learned from my experience that just because the big healthcare providers do things one way doesn’t mean we should do the same. We’re not going to give drugs to someone just because that’s where the rebates are.
FH: What is one change you predict in healthcare that people wouldn’t expect?
WR: A lot of the predictions people are making about artificial intelligence becoming an integral part of the healthcare continuum are off the mark. AI might play a role in clinical decision-making for serious health conditions, but you can’t put all your faith in a decision-support model based on an algorithm and expect to get the highest quality of care. People are expecting too much from AI without valuing the human element.
Companies that are focused on doing the right thing will be going back to the basics, and one way to do that is by leveraging the clinical expertise of a pharmacist at the center of healthcare. AI is fine when it comes to business acceleration or innovation, but when it comes to data analysis on a clinical level, you need the knowledge and intuition of a human expert.