Clarkston Consulting’s data and analytics experts partnered with a pioneering biopharmaceutical firm that specializes in treating rare diseases to address significant challenges surrounding the misuse of the company’s copay assistance program. The data reporting project aimed to identify improper claims code swapping behaviors at the pharmacy level. Ultimately, the project improved the efficiency and clarity of data preparation procedures, drove up data reliability, and reduced manual efforts. The resulting dashboard allowed for dynamic investigation of $13M of misuse of the program across 404 pharmacies.
The first goal was to translate existing manual data management and preparation procedures into efficient automated processes. The team developed a new pipeline designed to ingest, join, and filter data for reporting with no manual effort required, transforming their operational efficiency. The team translated payer behaviors into technical reportable metrics and applied complex joining and filtering methods to multiple datasets to ensure adherence to critical business rules.
Clarkston’s solution provided a historic and current report of payers’ behaviors, enabling the company to track changes post-intervention effectively. The team further created a reporting dashboard designed to expediently identify payers exhibiting signs of program misuse. The dynamic data exploration capability provided by the new system offered a high level of operational visibility and organizational accessibility to information.
The engagement resulted in significant benefits for the biopharmaceutical firm. The new dashboard not only delivered a comprehensive overview of claims and payment behaviors, highlighting $13M of improper use of the company’s copay assistance program, but also reduced the manual effort previously required to investigate as well as offered more in-depth and flexible avenues for analysis on top of a robust data model. The project made crucial strides in reducing the misuse of the company’s copay assistance program, highlighting Clarkston’s ability to deliver high-impact, value-driven solutions for its clients.
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Contributions from Shannon O’Hara