CareMetx Solutions: The Broadest Range of Services for Radically Efficient Patient Access
2,673,38
0
Patient transactions in a year *
CareMetx Solutions: The Broadest Range of Services for Radically Efficient Patient Access
2,673,38
0
Patient transactions in a year *
At CareMetx, we put patients first. Facilitating the patient journey is at the heart of everything we design. Whether you’re looking to upgrade a single function or overhaul your entire hub operation, each of our technology-enabled eService modules is designed to support today’s complex access ecosystem with agility and radical efficiency. Click on any category to learn more.
Agile Access Services to Get Patients on Therapy Faster
Uniting highly skilled teams with timely access to real-time data yields efficiencies that benefit patients using your therapy. Armed with data, providers are able to treat patients and facilitate timely access to your treatment.
Case managers are carefully selected for their passion to serve patients potentially overwhelmed by their diagnosis and all the administration that goes along with it. Our teams use automation technology that enables radical efficiency that speeds patient access to therapy. The impact: program quality and responsiveness improve while costs go down.
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Leverage proprietary technologies and combine with
targeted high-touch services to optimize therapy access - Accelerate patient time to therapy
- Improve scalability by reducing manual workflows
- Recruit the best talent across the US in virtual call centers
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eServices
Engagement Channels
- Healthcare provider portal
- Field portal
- Embedded provider workflows (EMR, PMS, patient apps, etc)
Automated Transactions
- eBV (medical and Rx)
- ePA (medical and Rx)
- eEnrollment/consent
- Copay (medical and Rx)
- ePAP
CRM, Telephony, and Analytics
- Purpose-built case management system
- Fully integrated data across engagement channels; telephony and data captured in CRM
- Integrated with cloud-based enterprise telephony platform
- Enterprise data lake for advanced reporting and analytics
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Radically Efficient Service Center
- Customer support
- Benefit verification
- Prior authorization and appeal support
- Copay enrollment and adjudication
- Pharmacy triage
- Provider experience teams
- Field reimbursement teams
- Nursing support
- Claims review
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CareMetx@Work
Virtual Call Centers Built Across the Nation
- 100% remote training and hiring
- Hire the best, regardless of location
- Training certification programs built for a virtual team
Holistic Affordability Solutions
The cost of a specialty medication presents real challenges for patients. Research shows that many patients will delay or forgo therapy because of treatment cost.
That’s why CareMetx is making it easier for providers and patients to understand and access financial support. As a client, you can select services that range from end-to-end Copay and PAP Administration, to specialized Bridge Dispensing Programs, and more.
- Breakthrough innovative programs to drive new efficiencies and cost savings to improve patient affordability
- Digitally powered and electronically connected workflows ensure speedy, accurate data is shared with all stakeholders
- Ability to blend new technologies with traditional approaches for optimized results
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Automated Transactions
Medical Copay
Our Medical Benefit Copay programs utilize the medical billing and payment systems used within provider offices. We support electronic or paper submission with custom business rules to provide financial support to patients.
Pharmacy Copay
Virtual copay card with electronic claim adjudication and settlement has the ability to electronically accept enrollments, render real-time eligibility decisions, and deliver copay adjudication via POS, EFT, and virtual debit cards.
ePAP
Assessment and eEnrollment for patients seeking financial assistance has the ability to accept enrollments, render real time eligibility decisions based on income, LIS status, and other brand-specific criteria.
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Engagement Channels
Digital—Provider Portal
- The CareMetx provider-facing portal can be configured to assess and enroll qualified patients into copay and financial assistance programs
- Innovative solutions such as our MedeCopay provide better alternatives to traditional paper-based, manually driven copay programs
Alternative Channels—Phone/Fax/Mail
- The CareMetx service model can also support more traditional channels for copay/affordability management
Digital Enablement for Next-Gen Patient Services
While each patient is unique, they all share a common desire to get better, fast. Our best of breed eService transactions ensure that common administrative pretreatment hurdles are streamlined and compressed, enabling patients to rapidly access vital therapies.
- Convert manual, disconnected Hub processes reliant on old technology into automated, streamlined, real-time digital transactions
- Reduce expenses
- Accelerate time to therapy
- Realign resources to enable high quality patient encounters
CareMetx is not only the industry leader in automated Benefit Verifications, but we also perform manual Benefit Verification services more accurately and efficiently than our competitors. Our proprietary process combines our extensive payer connectivity and rules engine with specialized benefit verification team members to generate scalable benefit verification results that are consistently 2x more efficient than industry standards.
Greg Morris, Chief Strategy Officer
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Engagement Channels
Provider Portal
- A provider-facing digital asset purpose built to enable self-service patient access solutions
- Configurable services architecture, based on client specifications and desired patient access experience
- Integrated smart “off-ramps” ensure high-touch patient services engage when necessary
Field Portal
- A web portal designed to deliver brand-specific benefit and usage intelligence around key metrics associated with access, patient and provider activities, and reimbursement
- Empowers Field Sales with actionable reimbursement insights and timely data to effectively engage providers and patients
Embedded Provider Workflows
- Specific use cases where providers directly access CareMetx e-transactions to perform service requests from their native technologies (EMR, PMS, etc.)
Learn more about the CareMetx range of eServices—schedule a meeting today!
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Real-Time Transactions
Medical eBV
Product-specific, automated medical benefit investigation
10+ years in market; most-proven
transaction of its type; integrated with
on-demand, high-touch services
Medical ePA
Closed-loop digital process for completing a medical prior authorization
Ability to access payer requirements,
complete and electronically submit
prior-authorization
Medical Copay
Supports electronic or paper submission with
custom business rules to provide financial
support to patients
Our Medical Benefit Copay programs
utilize the medical billing and payment
systems used within provider offices.
Pharmacy eBV
Real-time benefits transparency for pharmacy-covered brands
Delivers benefits information for products
covered under commercial policies and
robust, additional details for
Medicare patients
Pharmacy ePA
Quickly understand and address prior authorization requirements
Fully digital experience for PA request,
submission, and response
Pharmacy Copay
End-to-end pharmacy copay solution
Transforms front-end business processes
for candidate assessment and enrollment
to accelerate workflows and improve
operational outcomes.
eEnrollment/Consent
Complete a manufacturer/brand-specific
eEnrollment form and capture consent via
eSignature
Simplifies provider workflows, eliminates manual
forms, reduces amount of bad data; increases
number of patients enrolling in Hub services
ePAP
Integrated assessment and eEnrollment for patients
Digitally integrates candidate assessment for
PAP into existing Hub workflows
Learn more about the CareMetx range of eServices—schedule a meeting today!
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CRM, Telephony, and Analytics
CRM
Purpose built for patient services
Flexible data and workflow architecture that grows with your program and integrates directly with our real-time transactions, ultimately driving toward a workflow model that leverages automation and enables Case Managers to focus on complex cases.
Flexible data and workflow architecture that grows with your program and integrates directly with our real-time transactions, ultimately driving toward a workflow model that leverages automation and enables Case Managers to focus on complex cases.
Telephony
Enterprise-grade, cloud-based telephony platform with multichannel capabilities
Deeply integrated with our CRM to allow for multichannel inputs via phone, fax, or chat interfaces that are intelligently routed to our case management teams.
Deeply integrated with our CRM to allow for multichannel inputs via phone, fax, or chat interfaces that are intelligently routed to our case management teams.
Data Analytics and Integration
Robust data architecture built on an enterprise-grade data lake, allowing for data interchange and robust analytics
Our data lake serves as a foundation to drive detailed patient journeys and program performance analytics, leveraging enterprise business intelligence tools and real-time API-based data interchanges.
Our data lake serves as a foundation to drive detailed patient journeys and program performance analytics, leveraging enterprise business intelligence tools and real-time API-based data interchanges.
Solutions for Expensive Emerging Therapies
Competing interests present challenges for manufacturers seeking to align stakeholders and improve access to therapies.
Providers are looking for an efficient way to onboard and manage patients requiring gene therapy, manufacturers are interested in removing barriers to patient access, payers are focused on cost containment, and patients want timely access to therapy and personal support during a confusing and scary experience.
CareMetx can deliver novel solutions that align the interests of all stakeholders through 3 unique offerings.
- Drive payer therapy adoption through patient outcome support
- Improve patient access to curative and costly therapies
- Lower patient out-of-pocket expense
Learn more about CareMetx OutcomeRx— schedule a meeting today.
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Therapy Management Solutions
Patient Support Services
Our solution combines the best health and data technology with high-touch stakeholder engagement to fully support the provider, payer, and patient from initial therapy administration, tracking along the continuum of care to wellness.
Financial Solutions
CareMetx OutcomeRx helps manufacturers align their interests with the payers by offering financial and insurance products to support innovative, value-based models.
Technology Solutions
Proprietary technology to guarantee high-touch patient experiences and seamless logistics for cell and gene therapies.
Posttherapy Patient Monitoring
Specialized, expert human resources matched to the therapy’s unique patient journey.
Data Capture for FDA Requirements
Data monitoring and FDA-mandated outcomes reporting tools to engage with the providers, patients, and payers throughout the patient’s experience over time.
Value-Based Contract Administration
Value-based contract administration and adjudication to ensure patient results are achieved.
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Therapy Warranty
Next-Generation Outcomes-Based Contract
A therapy warranty works much the way a new car warranty does. You buy the car from the dealer and the manufacturer warranties the core components of the vehicle. The car owner holds the warranty in the event one of the core components breaks down during the warranty period. The manufacturer repairs the part rather than paying the owner a rebate for the part.
The therapy warranty establishes an insured warranty for clinical interventions against potential adverse outcomes. The warranty pays for an alternative therapy should the warrantied therapy established target metrics/endpoints go unmet. In this way the warranty promotes payer adoption, an important barrier to access, and eases coverage rules.
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Patient Access to Costly and Curative Therapies (PACCT)
Carve-Out Insurance for Uncovered or Partially Covered, High-Cost Therapies, Diagnostics, and Devices
Patient Access to Costly and Curative Therapies (PACCT) promotes patient coverage by filling a key gap in reinsurance for costly therapies. We believe that using first dollar reinsurance coverage will increase payer adoption by improving risk predictability.
- Underwriting/rating performed per covered plan with rates for commercial and Medicaid plans
- Backed by A-rated carriers: Crum & Forster and Liberty Mutual
- Distributed through payers, TPAs, reinsurance, and stop-loss carriers
