Pharmacy Benefit Managers (PBMs) play a pivotal role in ensuring access to cost-effective, quality treatments for self-funded employers and their members. One PBM stood out for its commitment to transparency and advanced clinical management, but they faced a challenge – explosive growth that their existing processes couldn’t keep up with. Discover how Agadia’s end-to-end prior authorization solution, PAHub, became their secret weapon, resulting in a remarkable 386% increase in PA volume while reducing FTEs by 25%.

The Client:

Our story begins with a PBM renowned for its commitment to transparent pricing and innovative clinical management. They specialized in helping members achieve their healthcare goals while optimizing financial resources for self-funded employers. This PBM’s reputation for delivering cost-effective treatments and stellar service was well-deserved.

The Challenge/Business Need:

As the PBM experienced a staggering 30-50% year-over-year growth rate, they faced a critical juncture. Their existing prior authorization (PA) workflow, cobbled together from a mishmash of business tools like internal fax servers, word templates, and Excel spreadsheets, was buckling under the pressure. The growth was simply too rapid, and they risked overwhelming their workforce.

Solution Provided:

Enter Agadia and its game-changing prior authorization solution, PAHub. Recognizing the pressing need for transformation, the PBM partnered with Agadia to implement this comprehensive end-to-end prior authorization management system.

Key Benefits:

  1. 386% Increase in PA Volume: The most striking outcome of this partnership was the jaw-dropping 386% increase in PA volume. PAHub’s efficiency turbocharged the PBM’s ability to process authorizations, making them more responsive and patient-friendly.
  2. 25% Decrease in FTEs: Despite the dramatic increase in PA volume, the PBM achieved a 25% reduction in Full-Time Equivalents (FTEs). This reduction in labor resources was a testament to the efficiency gains made possible by PAHub.
  3. Streamlined Processes: PAHub didn’t just boost numbers; it streamlined processes. Clinical review became faster and more precise, ensuring members received prompt decisions regarding their healthcare.
  4. Enhanced Service: Clients of the PBM also reaped the benefits. Faster authorizations and reduced administrative burden translated into improved service and satisfaction.

This case study serves as a testament to the power of strategic partnerships and technological innovation in healthcare. With Agadia’s PAHub, this forward-thinking PBM not only met but exceeded the challenges of rapid growth, setting a new industry standard for efficient and client-focused prior authorization management.

Is your organization ready to transform its healthcare processes? Contact Agadia today to explore how our solutions can drive efficiency and success in your healthcare journey. Schedule a demo. 

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