By: McKesson Health Systems Editorial Team
Read time: 4 minutes
Nicole Mayo, PharmD, MBA, MSHI
Lead Analytics Consultant
Nicole Mayo, PharmD, MBA, MSHI, Lead Analytics Consultant with McKesson Pharmacy Optimization RxInsight team discusses her background in the healthcare industry and provides insights on operational challenges facing hospitals. Read her latest Q&A to learn more about McKesson’s suite of products and solutions designed to optimize drug reimbursements, reduce claim denials, and streamline patient enrollment into drug assistance programs.
Q: What is your healthcare background? What is your current role at McKesson?
A: The majority of my professional experience has been spent as a clinical pharmacist in the hospital setting, including private centers, Veterans Affairs Hospital, and a Level 1 Trauma teaching hospital. Over 17 years, I gained valuable experience in retail pharmacy, home infusion, and managed care consulting. Prior to joining McKesson, I worked for a major payer supporting their population health programs as a provider consultant. I also established partnerships with oncology practices to assist with their transition to value-based care payment arrangements. I have also earned a master’s in health informatics with a focus on healthcare data analytics.
I believe it’s a combination of these professional experiences that help me understand and identify the challenges facing health system customers.
As a member of the McKesson Pharmacy Optimization RxInsight team, I support health system customers in making key decisions using the McKesson Utilization Analytics tool. Equipping health system pharmacies with these data insights allows them to collaborate with revenue cycle, finance, and supply chain stakeholders and contribute to critical decisions which impact the entire health system.
I’m there to assist customers with navigating the complexities of the emerging biosimilar market and payer reimbursement nuances to ensure their pharmacy business remains financially viable. It is vital for pharmacies to understand the lifecycle of drugs through their health system, as well as monitor the constantly changing healthcare landscape.
Q: Now that many health systems have navigated the obstacles presented by Covid-19, what are some of the new challenges your health system customers are facing?
A: Pharmacies, like many other hospital departments, have watched as the cost of goods have risen while operational budgets have decreased. There is uncertainty regarding how to effectively collaborate with other departments to communicate factors impacting pharmacy drug spend and revenue and recruiting assistance from other hospital groups.
When it comes to biosimilar medications, some of the challenges health systems face include:
- Payer biosimilar preferences and requirements for authorization
- Uncertainty about billing, coding, and reimbursement
- Buy-in from providers and patients
Q: What McKesson tools and solutions are available to help customers with these challenges?
A: McKesson offers a suite of products and solutions for our health system customers designed to optimize drug reimbursements, reduce claim denials, and streamline patient enrollment into drug assistance programs. Historically, health systems have only had access to drug acquisition costs and quarterly CMS reimbursement limits.
McKesson now offers health system customers a tool, Utilization Analytics, which ties together acquisition cost, real drug administration utilization, and payer reimbursement data. With the Utilization Analytics tool, our customers now have a complete line of sight into payer reimbursement trends—allowing for better informed decision-making by pharmacy leadership. The Utilization Analytics tool combines purchasing, dispensation, and reimbursement data to fully illustrate the lifecycle of a drug. This capability is unique to McKesson health system customers.
With these resources available to customers, we can help customers quickly and easily identify episodic costs at the drug, diagnosis, and provider levels.
Learn how partnering with McKesson can help your health system achieve more.
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