“Offering the Only Value-based Solution in the PBM Industry”

The healthcare system's problems and the challenges facing employers are tremendous and require transformational change across the healthcare continuum. 49% of healthcare coverage and 82% of healthcare costs in the U.S are employer-sponsored. Yet, most employers continue to face tough choices between cost and access when purchasing healthcare benefits while also receiving subpar service from their healthcare partners. Additionally, the cost curve is constantly increasing and showing no sign of abating.

In the PBM industry, the challenges are exacerbated by misaligned incentives. The way traditional PBMs operate is through volume-based purchasing and arbitrage. PBMs buy for x, sell for y in order to make a profit. This sounds like retail, but this is the healthcare business. Traditional PBMs make money when prescription volume increases and when more drugs are pumped into the patient population - not when patients receive better or the right care. That is not healthcare.

"guarantees and stand behind them. We analyze a client's member population to generate a clinical-savings guarantee. If we don’t hit it, we pay the difference dollar-for-dollar"

EmpiRx Health offers the only value-based solution in the PBM industry with an approach founded on three performance pillars: Financial , Clinical, and Service.

“We make guarantees and stand behind them,” says Karthik Ganesh, CEO of EmpiRx Health. “We analyze a client's member population to generate a clinical-savings guarantee. If we don’t hit it, we pay the difference dollar-for-dollar. We tailor clinically appropriate strategies by empowering pharmacist-physician partnerships with our industry-leading, AI-backed population health management solution.”

EmpiRx Health uncovers therapies that optimize utilization, improve outcomes, and bend the pharmacy cost curve.

“Unlike any other PBM, we wrap our clinical innovation and savings guarantees in white-glove service. Our aim is to deliver outstanding results that are stress-free for clients and members,” says Karthik, who believes in fostering a resilient mindset, not only for himself but for the organization and its leadership. To continually disrupt itself and break new ground, they have had to build elasticity into the company culture—a “bend but don’t break” mindset.

According to Karthik, typically, population health efforts focus on a specific condition or disease. This is a solid step, but it leaves both financial and health opportunities on the table. EmpiRx Health’s population health model delivers true risk stratification whereby they identify their clients’ “red flags” that could drive costs up. They can also predict future costs at an individual-member level without relying on a specific condition diagnosis. “Our industry-leading population health approach uses the Johns Hopkins ACG model, which allows for broad data consumption, including not only Rx claims information but also behavioral and medical claims data,” adds Karthik. “We provide our clients a true view of risk stratification, both current and future. It also enables our members to receive the personalized care they need. This is core to our model and is not a buy-up; it’s available to every client we serve. It’s also how we can provide a clinical-savings guarantee.” The company identifies opportunities for clinical intervention through a unique population health solution.

EmpiRx Health recently added pharmacogenomics (PGx) to its population health model, offering an even more personalized approach. EmpiRx Health’s new offering uses the science behind the role of genetics in drug interactions and is powered by OneOme, an entity co-founded by the Mayo Clinic.These insights are strengthened by EmpiRx Health’s population health management approach and helps to identify members who would benefit most from genetics-guided drug selection. “Identifying the member cases is only the first step. For those with high-risk and complex cases, we elevate them directly into our Complex Care Management program, where they are supported from Day 1 with proactive outreach and personalized care,” says Karthik.

Looking ahead, EmpiRx Health wants to bring value-based pharmacy benefits to more people in more places, one that can lower costs and still do the right thing from a healthcare POV. “As we grow and strive to provide even better service for our clients, we will continue to advance our clinical concierge service for complex members. Service is core to who we are and what we do,” adds Karthik..IE