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National Full-Service PBM
Extract and consolidate information across all departments of the PBM, providing plan sponsors with a 360° patient view that enhances critical health/financial decision-making and results in best outcomes.
Model, design, and manage custom drug formularies to maximize clinical and financial outcomes.
Customize and automate utilization management programs across prior authorization, step therapy, quantity limits, and more to yield the optimal balance of clinical efficacy and cost management.
Model, design, and manage custom pharmacy networks, while simplifying pharmacy contracting and credentialling.
Adjudicate pharmacy claims in real-time across all lines of business.
Automate creation and submission of encounters and PDEs.
Empower plan sponsor staff, pharmacists, and prescribers with the needed tools to work collaboratively to produce low cost and high-quality MTM outcomes.
Model, design, and manage pharmaceutical rebate contracting processes to optimally balance clinical efficacy and financial outcomes.
Deliver actionable intelligence to the point-of-care and point-of-sale to improve health and financial outcomes without disrupting professional workflows.
Integrate pharmacy, medical, and lab data to provide market-leading reporting and analytics.
Manage the most unmanaged portion of managed care by creating a hospital-like care setting at home.
Convert “buy & bill” to a value-based and outcomes-driven specialty management model.
Provide comprehensive actionable intelligence and transaction information to members, providers, pharmacists, and other care constituents through apps and portals.
Build and manage the product, plan, benefits, and pricing lifecycle.
Automate all possible sales channels from quote-to-card and quote-to-contract.
Automate eligibility, enrollment, and membership reconciliation for all lines of business.
Price, bill, receive payment, reconcile multiple payment buckets, and pay commissions to brokers and agents.
Cloud-native platform to administer medical and behavioral health claims adjudication for all lines of business.
Compute statistically valid cost, quality, and utilization performance of physicians, hospitals, and networks.
Identify top-tier physicians and hospitals, contract with them, help to manage the risk collaboratively, and manage financial reconciliation.
Optimize preventive, episodic, and chronic care and manage the overall disease burden.
Integrate the data universe, including claims data (medical claims, behavioral health, pharmacy claims, lab claims), contractual data (physician contract pricing terms, hospital contract pricing terms, network/repricing terms), pricing data (drug pricing, medical services pricing, bundling/unbundling, premium), and operational data (enrollment, actuarial, risk score).
Prospectively manage quality scores and tie quality scores to outcomes and incentive payments.
Create a platform-driven hospital-like care setting at home to reduce hospital visits and manage the managed portion of the managed care population (5-7%).
Collaborative enterprise-wide service integration to optimize first call resolution for members, employers, brokers, prescribers, pharmacists, and other care constituents.
Provide comprehensive actionable intelligence and transaction information to members, employers, brokers, providers, pharmacists, and other care constituents through apps and portals.
Since 2013, the RxAdvance team has been dedicated to disrupting the healthcare industry, specifically in pharmacy benefit management. After 3 years of development, we went live with our first client in 2016 and delivered groundbreaking pharmacy benefit management services. Now that we have proven success year-after-year, we have decided to expand our impact beyond just the PBM industry—onto the payer industry. These two industries alone control the majority of the healthcare spend in the United States, including the $900+ billion of waste generated annually. With our expansion into a new portion of the industry, we have outgrown the RxAdvance name, since it does not accurately capture the scope of our healthcare reach and mission. We are excited to announce our new name and brand—nirvanaHealth. The RxAdvance name has served us well for many years and will continue to do so under nirvanaHealth.