System could trim Medicaid costs

A new product has hit the market that makers claim will not only save money for state Medicaid agencies, but could cut fraud and improve patient care.

This week Electronic Data Systems Corp. and Heritage Information Systems Inc. introduced EDS interChange Pharmacy Services, a suite of services that builds on the sort of technology that states have used for years to automate claims processing and analyze them for both patient and administrative needs.

The new system is designed to help officials manage patients' drug therapy and ongoing treatment for disease. With Web-enabled reporting and analysis capability, the system can help identify cases in which Medicaid beneficiaries could be misusing prescription drugs or benefits. The system can also monitor pharmacies for unusual billing patterns or other inconsistencies.

"They get the maximum cost savings but can make sure the drug therapies are appropriate and cost-effective," said Chris Johnson, a drug utilization review pharmacist for EDS. Finding the most cost-effective drug therapiesis critical for states as the cost of prescription drugs continues to rise.

Johnson says the new system is also more user-friendly and offers more detail to enable high-level cost analysis for administrators and specific trend information that could help physicians. It's also available through a secure Web site so users don't have to be at a certain office to tap the information.

"The science and technology has changed so much, but it's been difficult to create systems to analyze patient drug therapies or to determine what is the cost benefit," Johnson said. "This system gives us that capability."

EDS now has a pharmacy presence in 13 states and provides Medicaid administrative support services to 18 states. EDS also supports the Medicare program in seven states through its wholly owned subsidiary National Heritage Insurance Co.