Pharmacy Benefit Managers (PBM)

Pharmacy Benefit Managers (PBM) are challenged with identifying risk factors and prioritizing evidence-based recommendations to manage their client’s formularies.

BST empowers PBMs to bring value to clients with the ability to optimize their costs and employers’ quality of care through a combination of proprietary technology, advanced analytics, and machine learning.

Problems BST is Solving for PBMs

  1. Advanced Risk Scoring
  2. Data Quality
  3. Understanding What Drives Costs
Advanced Risk Scoring

PBMs want to better understand and interpret their client’s future risk. BST categorizes risk into five levels, enabling PBMs to make optimized formulary recommendations against client risk.

Data Quality

PBMs are looking for a trusted data source with accurate reporting. Known as the most trusted source of data ingestion from carriers leveraging AI and ML algorithms, BST leverages unmatched extract, transform, load data validation/integration processes that allow us to provide custom reports within less than 48 hours of ingestion.

Understanding What Drives Costs

PBM’s have little to no insight into key cost drivers and more importantly, what should be done about them. BST applies modern data science methods from actual claims data and the Plan Optimizer generates a pro forma financial statement to project next year’s performance.

How We Support PBMs…

  1. Data Warehouse
  2. Quality Analytics
  3. Descriptive Analytics
  4. Predictive Analytics
  5. Prescriptive Analytics
Data Warehouse

PBMs can provide partners with a robust data warehouse that captures more data than other platforms and posts for their client’s benefit every 30 days with the capabilities to:

  • Accept feeds from Benefit Administrators/Carriers.
  • House client-specific databases.
  • Normalize continuous in-depth data analysis.
  • Maintain Multi-period/lifetime storage/data blending.
Quality Analytics

BST’s technology solves discrepancies in data, inconsistency with member matching, outdated data validations, and slow processing time by:

  • The utilization of advanced data science to ingest data into a modern engine.
  • Comparisons among data sets to measure the quality and rationale of newly ingested data.
  • Optimal machine learning-based approaches that maximize true member matches and identify hard-to-match records.
  • The leveraging of computer power and speed to load monthly files in under an average of 3 minutes.
Descriptive Analytics

BST can predict what will happen next through advanced data analytics, predictive modeling, and plan design optimization allowing PBMs to:

  • Gain access to large data sets quickly. With our tools, employers will see fresh, relevant, monthly data quicker than competitors, with access to data within 30 days of us receiving it.
  • Uncover emerging risks throughout the year.
  • Make unbiased, transparent, and cost-effective decisions.
  • Meet HIPAA/ERISA compliance standards.
  • Be accessible anywhere through a secure (SOCII/SAAE16) cloud-based platform.
Predictive Analytics

BST stratifies risk down to the member level and what each member will likely cost the plan allowing PBMs to:

  • Implement a financial forecasting model that can identify the drivers of next year’s formulary offerings in an efficient, automated, unbiased, transparent, and cost-effective way.
  • Use data to drive formulary decisions without sacrificing clinical efficacy.
Prescriptive Analytics

BST considers billions of scenarios, arrives at an optimal plan design, and prescribes specific action allowing PBMs to:

  • Cutting-edge plan optimization tool that solves for a best plan based on budget constraints and health plan goals.
  • Apply advanced analytics and optimization techniques to identify drivers of clients’ plan for the following year.
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