Mitchell County Regional Health Center

Mitchell County Regional Health Center (MCRHC) began in October of 1951 as a hospital in northern Iowa, not far from the Minnesota border. At that time, it included 33 beds, an obstetrics department, an operating room, laboratory, business office and other service departments. Today, Mitchell County Regional Health Center is a Critical Access Hospital (CAH) serving three core communities in Mitchell County, Iowa: Osage, St. Ansgar, and Riceville, as well as neighboring counties.

The designation as Critical Access provides protection by the Centers for Medicare and Medicaid Services (CMS), which helps protect rural hospitals through cost reimbursements, in areas that would otherwise not have hospitals.

The mission by which MCRHC operates on a day-to-day basis is “to improve the health of its communities”. To achieve this mission, MCRHC looks to “Accountability, Compassion, Community, Innovation, Trust and Teamwork.” These are their core values — the promise made to their patients and the community at large.

As is common with medicine today, the road to health doesn’t end with MCRHC, although it often begins there. In keeping with its strong commitment to understanding and helping its patient population, the hospital recognized the lack of convenient pharmacies in its network limited patients’ access to the ongoing care needed.

Serving a small population, within a broad geographic area is a challenge for any critical access hospital. Embarking on the path of strategic pharmacy contracting added yet another level of difficulty. Yet, MCRHC was experiencing a decline in patient visits, which negatively impacted their bottom line and ability to operate at breakeven; they needed to find a way to assist and hopefully gain customers, and also find any potential funding sources.

In a rural area with many long and windy roads, Wellpartner offered a streamlined solution, delivering 340B services that improved pharmacy access and claims classification.

Implementation

In September of 2014, MCRHC asked Wellpartner to help grow and optimize its 340B program. Wellpartner started with its unique approach to implementation, which entails performing a customized analysis to understand current needs and forecast future possibilities. Next, Wellpartner developed a plan of action, which resulted in an implementation timeline that was tailored to ensure responsibilities and deadlines were clearly defined and understood. Key deadlines were carefully managed by MCRHC’s Wellpartner Account Manager, and implementation went as planned.

“MCRHC has had a positive experience working with Wellpartner from the initial meeting with its Sales Representative, through implementation and ongoing support from Account Management,” said Gregory Burkel, MCRHC’s CFO.

Results

MCHRC’s concern that the old process of capturing and matching claims was not capturing the full scope of eligible 340B Drug Discount Program eligible claims, and this was fully validated by Wellpartner’s analysis. To solve this issue, Wellpartner executed a dedicated provider carve-in methodology that drastically increased the number of claims captured and resulted in added value to the program, while ensuring compliance with 340B program rules.

Utilizing Wellpartner’s 340B Clarity® web portal, MCRHC was able to take control and better manage all aspects of its 340B program. Wellpartner provided in-person training on the technology, and MCRHC’s team quickly understood the many benefits of having a user-friendly, web-based system that tracks overall program performance through a dashboard view, while also allowing staff to make determinations on individual claims.

The Keys to 340B Program Implementation

Operational Efficiency: With direct and open communication with Wellpartner’s dedicated Account Manager and Operations Team, any issues or obstacles encountered were rapidly addressed and resolved.

Contract Pharmacy Services: Despite an excellent geographic match between MCRHC’s patients’ homes and their Wellpartner pharmacy network, Wellpartner continues to proactively identify opportunities, and negotiates contracts with additional pharmacies, always looking to add value to the Entity.

Audit and Reporting: Wellpartner’s conservative approach to claims classification is an asset to preventing issues, such as diversion. To add another layer of assurance, Wellpartner’s 340B Clarity allows the trained staff at MCRHC to proactively conduct its own internal audits, while creating the necessary reports to comply with 340B regulations.

Compliance: MCRHC has successfully undergone audits by two different auditors, both of whom praised Wellpartner’s portal and operational functionality.

Maximizing Savings: With Wellpartner’s support, MCRHC has steadily updated its dedicated provider list, added electronic prescription claims to its data feed and maintained efficient file transfer functionality to avoid any potential gaps in data, ensuring a smooth flow of information to Wellpartner for ongoing claims savings.

Lessons Learned

MCRHC was able to grow its 340B program, generating more savings which can be channeled towards community services.

Managing a 340B program is not a passive activity. The rules and regulations, and the complex relationship structures create the need for a specialized approach, and continual oversight as changes occur. Engaging the services of a third-party administrator empowers Covered Entities to access the technology and human resources to optimize savings and minimize compliance concerns.

The right partnership yields better results. Wellpartner’s team-oriented approach includes a dedicated Account Manager who provides in-person training, then continues to carefully monitor and suggest improvements through the life of the contract. It involves active engagement. In the words of Burkel, “Your overall results will be contingent on how much work and effort you put into it.”

Key Takeaways

1. Be involved: Engaging in program oversight yields better results
2. Be active: Strive for continual process improvement
3. Be focused: Analysis and technology provide insight
4. Dedicate resources: The right team leads to success.