Accelerate PBM Migrations with Smart Onboarding: Seamless Integration, AI-driven Efficiency, and 99% Accuracy!

• Fast Track PBM migrations by 30% - 40% 
• Digitalize your Benefits as part of migration 
• Capitalize on seamless integration between PBM and Client
• Reverse Engineer history claims and predict Plan Benefits 
• A truly AI-driven approach that drives, repeatable steps, efficiency & accuracy at 99%

Explore Smart Onboarding: Download the PBM Migration Whitepaper for Expert Insights

Revolutionize Pharmacy Benefits with a Single Source of Truth

• Offers a Single Source of truth to streamline Pharmacy Benefits
• Manages your costs at a "cost per plan" level
• Highlights "duplicate benefits" and allows leaner benefit plan management
• Serves as a centralized source of client and PBM benefit users for effective Benefit Change management
• Tracks and reports all changes with date and time stamps and captures ‘before’ and ‘after’ images
• Acts as a user-friendly digital platform for effortless management of new wins, renewals, and changes through template design
• Delivers a promising Benefit Accuracy of 99%

To learn how the Single Source of Truth can efficiently streamline and optimize the benefits management process for your organization, 

• Eligibility & Enrollment
• CDH - Accumulator Integration & Reconciliation
• Prior Authorization Modernization
• Formulary Clinical Management: Drug Trends & Reports
• Digital Therapeutic Management
• Cloud Migration
• Legacy to API-driven Approach
• Product Management
• Data Visualization
• Data Warehouse Streamline
• Downstream Reporting
• Generative AI

Manage your Specialty Rx and Streamline Drug Review

• Specialty pharmacies face several challenges that hinder patient access and affordability. Here are some of the major challenges that they face:
• • Limited accessibility
  • High Costs
  • Insurance complexities
  • Medication shortages
  • Lack of coordination
  • Data security concerns
• e-Zest believes that by embracing patient education, patient interoperability, and biosimilars, specialty pharmacies can enhance patient care, improve outcomes, and create a more inclusive and efficient healthcare system, while overcoming the above-mentioned challenges.
• Patient education programs play a crucial role in empowering patients to understand their conditions, treatment options, and medication administration techniques, thereby improving quality of care and minimizing adverse effects
• Patient interoperability, achieved through interoperable systems and platforms, facilitates seamless exchange of patient information between healthcare providers, pharmacies, and insurance companies, streamlining processes and reducing administrative burdens
• The emergence of biosimilars- an affordable alternative to costly biologics- offers increased accessibility and competition, driving down costs in the specialty pharmacy market
• Our innovative enables easy access to healthcare and empowers specialty pharmacies to optimize operations, improve patient care, and enhance overall efficiency.

Our expertise lies in:

• AI Powered Data Engineering
• Streamlined Documentation and Process Mapping
• AI Insights and Predictive Analytics
• Process Review and Optimization

Manage 340B Programs & Audit

• Unlock the full potential of 340B Program within a PBM setting
• Implement a comprehensive solution that maximizes the benefits of your 340B program while effectively addressing IT-related obstacles
• We offer an exclusive workshop led by our 340B experts, as we delve into potential challenges, the necessity for customized IT solutions for 340B, and ultimately revolutionize your 340B operations

We focus on following 340B areas, and more if required.

• Eligibility Verification & Enrollment
• Contract Pharmacy Management
• Data Integration & Reporting
• Split Billing & Inventory Management
• Compliance and Audit

Value-based care is a transformative approach that prioritizes patient outcomes, cost-effectiveness, collaborative care and coordination, and quality in healthcare delivery. This model is particularly effective in managing chronic diseases and reducing hospital readmissions while emphasizing preventive care, population health management, and patient engagement. It has shown promising results in terms of improved patient outcomes and cost savings. By shifting the focus from volume to value, this approach is driving the transformation of healthcare delivery towards a patient-centered and quality-driven system.

e-Zest's has years of experience in providing pointed solutions and services while continually emphasizing on VALUE. We believe that value is created through transformation, hence, our approach to value-based Care is through transformative technologies like AI.

• Data Analytics: AI can analyze large volumes of patient data, electronic health records, and other healthcare information to identify patterns, predict outcomes, and optimize treatment plans. This enables healthcare providers to make data-driven decisions and tailor care plans for individual patients, ultimately improving value-based care
• Predictive Analytics: AI algorithms can predict the risk of certain diseases or complications based on patient data, facilitating early intervention and preventive measures. This helps healthcare providers proactively manage population health and allocate resources efficiently
• Personalized Medicine: Generative AI can generate patient-specific treatment plans by considering individual characteristics, genetic information, and medical history. This supports precision medicine approaches, ensuring that patients receive the most appropriate and effective care for their unique needs
• Decision Support Systems: AI-powered decision support systems can assist healthcare providers in making evidence-based treatment decisions by providing real-time clinical guidelines, research findings, and patient-specific recommendations. This promotes the delivery of high-quality, value-based care
• Remote Monitoring and Telehealth: AI technologies enable remote patient monitoring, allowing healthcare providers to track patients' vital signs, symptoms, and adherence to treatment plans. This facilitates proactive interventions, reduces hospital readmissions, and improves patient outcomes, particularly in value-based care models
• Workflow Optimization: AI can automate routine administrative tasks, streamline workflows, and reduce administrative burden for healthcare professionals. This allows them to spend more time on patient care, enhancing the overall quality and efficiency of value-based care delivery
• Fraud Detection: AI algorithms can analyze healthcare claims and identify patterns of fraud, waste, and abuse. This helps in preventing fraudulent activities, optimizing resource allocation, and ensuring that healthcare funds are used appropriately, supporting the sustainability of value-based care models.

We provide cutting-edge digital solutions to help you excel in your role as a PBM Account Manager/Client Success Manager/Client Relationship Manager.

Are you struggling with CSAT scores, SLA management, PGs, audits, benefit management, accuracy, spreads, and rebates?

• Our digital platform offers a Single Source of Truth, allowing Client Benefit Users and User Groups to easily manage their benefits. Whether it's adding, changing, or deleting benefits, our portal streamlines the process and enables effective benefit renewal. It eliminates manual tasks and allows you to embrace a more efficient way of managing benefits
• To simplify your day-to-day operations, our platform also provides intuitive dashboards that offer real-time projections of spreads & rebate. With this valuable information at your fingertips, you can confidently communicate with client teams, ensuring transparency and accurate reporting. The dashboards give you the insights you need to make data-driven decisions and provide exceptional service to your clients
• Our platform includes claims surveillance capabilities as well. It sends notifications about possible differences and anomalies, allowing you to track and address issues promptly. Effective communication and triage become easy using these centralized digital tools

Still using spreadsheets to manage your contracts, quotes, pricing models, renewals, and more?

The possibility of seamlessly transitioning all your Excel-based processes to a modern digital contract management portal can save significant amount of time and resources. This transformation can be achieved effortlessly and quickly using e-Zest's innovative accelerator. This tool empowers you to harness the full potential of a digital contract management portal in no time.

With this cutting-edge technology, you can convert all your existing Excel spreadsheets into web-based solutions, ensuring a smooth transition and eliminating the need for manual data entry. It can quickly migrate your data, formulas, and functionalities from Excel to the web, all while preserving the integrity and accuracy of your information.

With this modern solution, you'll gain access to an array of powerful features, including automated alerts to remind you of important contract milestones, insightful analytics to optimize your pricing models, and a wide range of customizable options to tailor contracts to specific needs. Furthermore, this portal can streamline the entire contract lifecycle, from creation to negotiation, execution, and renewal.

Embrace the future of contract management and unlock a new level of efficiency and convenience.

The Centers for Medicare and Medicaid Services (CMS) provides Appeals and Grievances (A&G) rights to members and providers associated with a health plan in the Medicare system. This process has a substantial impact on the Medicare Stars Rating System, which measures the quality and performance of Medicare Advantage (MA) plans. All 28 measures, included in the MA plan Stars Rating system, have an associated weight that varies from 1 to 5 in value. The higher the weight, the more the impact of that measure on the MA plan Stars rating. The total weight of all 28 measures was 67. A&G directly or indirectly impact 9 of these 28 measures. These 9 measures have an aggregated weight of 36, which means A&G process has an over 50% (36 out of 67) impact on the overall Medicare Stars Rating.

Optimizing the A&G process, leveraging technology solutions, and focusing on member satisfaction and timely resolution of appeals and grievances are crucial for improving the Medicare Stars Rating of MA plans.

To learn more about how to efficiently execute the A&G process to maintain and improve Medicare Stars Ratings,