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Predictive analytics for financial optimization

Formulary intelligence | Real-time financial tools | Predictive pharmacy analytics

Client challenges

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Forecasting accuracy

Developing predictive models to accurately forecast DIR fees and improve adherence planning required sophisticated modeling and analytics capabilities.

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Margin erosion

Persistent monthly financial losses due to unfavorable PBM contracts and payor plans affected profitability across over 1,500 prescriptions.

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Lack of decision support

Absence of centralized formulary and decision-support tools left pharmacists without necessary guidance, impacting cost-effective decision-making.

Data driven decision making

Data integration complexity

Integrating diverse pharmacy financial data to enable deep analysis and identify root causes of margin leakage posed significant challenges.

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"Partnering with Calibo, we are excited to innovate our approach to pharmacy management. We're already seeing the potential of predictive analytics in guiding better financial decisions and optimizing our formulary."

Chief Information Officer

Pharmacy

Industry: healthcare/pharmacy management

The client

A prominent multi-site pharmacy franchise, operates within the healthcare and pharmacy management sector, catering to various accountable care organizations across the region. With a focus on innovation, they have been addressing challenges related to margin erosion driven by complex payor contracts and decentralized decision-making processes.

Solution

Calibo enabled deep data analysis to isolate root causes of margin leakage. Predictive models were developed to forecast DIR fees and improve adherence planning. Additionally, real-time tools were designed to assist pharmacists during transactions and a data-driven formulary structure was proposed to guide ACO prescriptions and reduce cost exposure.

Technologies used: 
Calibo platform, pharmacy financial data pipelines, predictive modeling, prescriber dashboards.

Status: in innovation mode.

 

 

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Business impact goals

  • Recover ~$67K/year in near-term margin losses 
  • Save $250K+/year via formulary optimization and predictive analytics 
  • Cut ACO prescription spend by 15% with intelligent decision tools 
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