Key Takeaways from Envolve at Medicaid Innovations Forum to Help Address the Future of Pharmacy Benefits

Date: 2019-02-13

Dr. Ross Hoffman, Chief Medical Officer of Envolve’s Pharmacy Solutions division, joined other industry leaders on a panel discussing “The Future of Medicaid Pharmacy Benefits for Lowering Medicaid Drug Spending While Ensuring Safe and Effective Utilization” at the 10th Annual Medicaid Innovations Forum held February 4-6 in Orlando, Fla.

Dr. Hoffman and the panel spoke about the need to explore and implement new strategies to lower drug spend but increase utilization management initiatives. The panel discussed value-based contracts focused on patient outcomes, complex care programs and their value, new technologies including cloud-based patient and provider engagement, and risk-based contracting.

Dr. Hoffman’s main focus centered on emerging technologies: “Our goal on the pharmacy side is to really be patient-centric and to see everything as patient care…there are enormous opportunities and needs for simplification.” He continued by stating: “Let’s think about the key users of healthcare and implement solutions that make better sense to them.” Some initiatives and ideas he shared that can help address complexities of care include:

  • Cloud-based technology: Implementation of cloud-based technology provides a unified platform for information sharing and should be considered for programs such as Medicaid where there may be multiple prescribers for one member.
  • Clinical Decisions Support Pathway: In the field of Oncology, this pathway solution takes the prior authorization process and codifies in software algorithmic clinical decisions. For example, a remnant single drug prior authorization can authorize an entire pathway of care within minutes. This is backed up by a full time team of board-certified oncologists to ensure we’re delivering the highest level of service to the providers.
  • Member Questionnaires: To keep people more engaged, this is a technological solution that marries multi-channel communications with psychographic profiling. One of our trails allows members to answer straight forward questions in a 90-second questionnaire placing them into six different arc-types or psychographic profiles (verified by Proctor & Gamble). This allows us to use data to customize communications in terms of timing, context, language, and cadence with specific profiles.

Many healthcare organizations have zeroed in on the fact that tools supporting proper medication utilization management not only save money but also help keep individuals adherent mitigating future or more severe illnesses and side effects. Envolve partners with organizations to customize the best approach to managing the pharmacy benefit for their unique population. Learn more about our PBM and Specialty Pharmacy Solutions.

About Envolve, Inc.®

Envolve, Inc.® is a family of health solutions, working together to make healthcare simpler, more effective and more accessible for everyone. As an agent for change in healthcare, Envolve is committed to transforming the health of the community, one person at a time. Envolve unifies specialty pharmacyPBMvisiondental24/7 nurse advice servicesdiabetes managementMSO solutions, and more. For more information, please visit our website or contact us at