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The Prescription for a Healthier Member Experience

Client: Blue Cross, Blue Shield of Kansas City

Eighty percent of Blue Cross and Blue Shield of Kansas City (Blue KC) members use their pharmacy benefit each year. It’s extremely important for that member experience to be easy and valuable to members. Blue KC has partnered with Rx Savings Solutions to bring their clinical expertise and clarity to the member experience. This will empower members to get the prescriptions they need at prices they can afford.

Danette Wilson is fiercely protective of the member experience at Blue Cross and Blue Shield of Kansas City (Blue KC). Wilson believes that taking impeccable care of Blue KC members – providing the best member experience – is the key to Blue KC’s current success, and it’s future.

The combination of their clinical and claims expertise is the right blend. They know the health plan world well, but more importantly, they know prescription benefits and how to help our members make the best choices for their lives and their budgets.

Danette Wilson,
President and CEO,
Blue Cross Blue Shield Kansas City

As president and CEO of Blue KC, Wilson spends most of her time thinking about ways to design and deliver the best healthcare for Blue KC’s nearly one million members in the Kansas City area. Blue KC is always pushing to create innovative programs and set new standards for quality experiences.

“We have a 75-year tradition of helping individuals and families get healthy and stay healthy and we’re always exploring ways to do it better,” says Wilson. “There’s no substitute for treating people well and making healthcare more understandable, accessible, and affordable. It sounds simple but it requires a daily commitment and it’s one we take pretty seriously.”

Blue KC’s newest initiative to support that commitment is the addition of Rx Savings Solutions’ personalized prescription guidance and savings tool for members. Blue KC is rolling it out first to its own employees and their families.

Bryan Camerlinck, CFO of Blue KC, is responsible for the business case and investment return.

“We know that about 80 percent of our members have a pharmacy claim each year which is why it’s so important for us to look at that pharmacy benefit experience and find ways to make it the best it can be,” says Camerlinck. “Rx Savings Solutions brings a new level of personalization and proactive communications that is very member-friendly and easy for members to understand and use. We’re excited about the potential.”

A Better Way: Clinical expertise and Cost- Conscious Prescription Guidance for Members


Calculating and analyzing the cost and quality of care is a never-ending exercise at every health plan in the country, and Blue KC spends as much time as anyone looking for creative ways to promote quality care while keeping cost trends under control.

“Avoidable costs are hot topics in healthcare today and hospital stays, readmissions, and complications still account for most of those avoidable costs,” says Camerlinck. “But we also see tremendous opportunity in smarter spending on prescriptions which is why we’re putting Rx Savings Solutions in place.”

Some industry experts estimate the industry-wide overall savings opportunity at $100 billion per year. That number is a complex calculation of drug pricing variation, generic versus brand-name pricing, cash and co-payments, and pharmacy provider locations.

In fact, there are so many variables that it’s nearly impossible for a member to accurately, and safely, research alternative therapies that are both clinically sound and cost effective.

We like that the Rx Savings Solutions tool is designed by pharmacists so our members can trust the clinical guidance on therapeutic equivalents,” says Camerlinck. “And the guidance is personalized for each member because it’s based on their pharmacy claims.”

Rx Savings Solutions brings a new level of personalization and proactive communications that is very member- friendly and easy for members to understand and use. We’re excited about the potential.

Bryan Camerlinck,
CFO,
Blue Cross Blue Shield Kansas City

Delivering on the Promise of Safer, Simpler, and Smarter Pharmacy Benefits


Wilson says the Rx Savings Solutions team is an ideal partner in the prescription benefits and prescription guidance space. It’s a niche not easily filled.

“The combination of their clinical and claims expertise is the right blend,” says Wilson. “They know the health plan world well, but more importantly, they know prescription benefits and how to help our members make the best choices for their lives and their budgets.”

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