Zynchros

In this Issue

• Musings, by Bob Pinkerton
• RxHub Certifies Zynchros Formulary Exports
• Zynchros Welcomes New Customers
• Part D: Retrospective/Prospective, by David Smith
• Zynchros December 2007 Upgrade Features
• Tips and Tricks:How to Update User-Defined Fields, by Scott Pillsbury

Musings

by Bob Pinkerton, COO

Happy New Year from Zynchros

With the New Year upon us we are fired with optimism that 2008 will deliver even greater rewards than 2007. It seems appropriate to also look back at 2007 and to thank each and every one of our customers, partners and employees for making the past year the tremendous success it was for our company. We end 2007 with more than 40 customers using our Zynchros.com solution and having grown our business by more than 300% over 2006. From all of us at Zynchros a heartfelt, “Thank You”.

As for 2008, we are excited to expand on our successes and I wanted to share our focus and thinking around the enhancements and new capabilities we will deliver in 2008:

The Five Keys to Collaborative Pharmacy Program Management

Formulary Management – as the cornerstone of our application suite, we will continue to enhance our basic formulary management capabilities and provide an additional metaphor for managing formularies for your other lines of business that is based on rules rather than specific drug selections.

Regulatory Compliance – In late December we released enhanced validation capabilities for Medicare Part D formularies and will continue to extend these capabilities in Part D and other publicly-funded healthcare programs as well as in commercial. Look for additional capabilities providing comparative and analytical insights to your formulary strategy.

Member Acquisition and Retention – effectively communicating pharmacy benefits to potential and current members is critical to differentiating your benefit designs. Look for Zynchros to enter the formulary hosting market and to develop strong integration between our application and providers of member portal and formulary query services.

Provider Outreach – cost-effective Pharmacy Program Management requires digital collaboration between your organization and the provider network. Zynchros is exploring new ways to support formulary enforcement and education, as well as helping to build electronic bridges to enhance communication with your providers.

Electronic Prescribing – Is 2008 the year when e-prescribing finally delivers the safety improvements, efficiency and cost controls we all have been led to believe are imminent? From the advanced pilots we are seeing across our customers, we’re starting to think it may well be. Look for more technology and data integration with leading e-Prescribers and other technology vendors.

If you have specific interests, concerns or suggestions in any of these areas or, come to think of it, in any other applications you’d like to see Zynchros deliver, I’d love to hear from you. I can be reached via e-mail at bob@zynchros.com or by phone at 206.792.4102.

Once again a resounding Thank You from all of us at Zynchros and may I take this opportunity to wish you and yours all the very best for 2008.

Bob

RxHub Certifies Zynchros Formulary Exports

by Doug Stoddard, Director, Business Development

On December 27th, RxHub confirmed that we have completed certification for our formulary and benefit exports to their system. The functionality certified includes loading and updating Formulary Status Lists and Coverage Lists. Coverage types supported are Age Limits, Drug Exclusion, Gender Limits, Medical Necessity, Prior Authorization, Quantity Limits, Step Medication, Step Therapy, and Text Message.
This certification ensures formulary information is delivered to the RxHub system in the proper format, eliminating errors and significantly improving the quality and accuracy of formulary data across multiple systems, without the need for human intervention.

We continue looking for opportunities to expand the reach of your formulary information and the RxHub Certification is just the beginning. More specifically, we have recently launched the Zynchros Certified Export Program, which enables us to rapidly partner with best-of-breed technology vendors to ensure the formulary information coming from Zynchros.com will be delivered in the required format. In the coming months the list of certified exports will grow to meet the increasing demand for formulary information.

If there are specific vendors that you currently need to provide formulary information to but you do not have a Zynchros.com certified export, please email doug.stoddard@zynchros.com to discuss your needs.

Zynchros Welcomes New Customers

Total Longterm Care was established in 1991 as Colorado’s first PACE provider. PACE (Program of All-inclusive Care for the Elderly) is an innovative system of care designed to meet the needs of nursing-home eligible individuals. Today, Total Longterm Care is one of the nation’s-best PACE providers. It features five metro area Day/Health Centers and a network of transportation to ensure that all participants have an easy ride to and from their homes. The program continues to grow, and the goal of the program, to help each individual in a personal way, remains constant. Total Longterm Care is using Zynchros.com to manage their Medicare Part D formulary.

As an integral part of ProMedica Health System and one of the largest health plans serving northwest Ohio and southeast Michigan, Paramount Health Care, a community-based managed health care organization, works in collaboration with employers, individual members, physicians, health care providers, and community and governmental agencies to continually improve the health of its members by providing comprehensive health plans with unsurpassed levels of customer service, quality and cost effectiveness. Paramount Health Care is using Zynchros to manage their Medicare Part D, Medicaid and commercial formularies.

Thank you for your business and welcome to the Zynchros.com family.

Part D: Retrospective/Prospective

by David Smith, VP, Product Management

There's an ancient Chinese saying, "May you live in interesting times."  When it comes to the Medicare Part D program in 2007, you could say we've had an interesting year.  Now that the 2007 Part D plan year is behind us, and your formularies for the 2008 plan year submitted and accepted with monthly maintenance begun, I believe this is a good time to reflect on our shared experience with Part D and Zynchros over the past year.

Monthly maintenance of 2007 Part D formularies was a smooth operation over the past year.  Now that CMS has introduced a regular schedule for proxy list updates and submission windows, it's been much easier to plan our software update schedules around these windows to minimize any potential disruption for our customers around these critical times.  We've generally been able to update the proxy list in Zynchros.com within 24 hours of CMS posting the update, and very few issues have arisen with the monthly HPMS submissions.

For the 2008 Part D process things have been somewhat more ... interesting.  While most of our health plan and PBM customers had a hassle-free process using Zynchros to create and submit their new formularies for 2008, a few of our customers have not. As a company with the highest standards for quality and customer service, that's not acceptable to us, and we deeply regret any problems that may have occurred.

In the past year, the new therapeutic classification and class fields for proxy NDCs (fields 10 and 11 of the 2008 HPMS file) have presented us with a difficult challenge.  I know from talking with many of you that you were as surprised as we were when CMS announced that these and other new fields would be added to the HPMS file less than a week before the submission window opened on March 26th.

With an impossibly short time-schedule, our development team worked around-the-clock to add the new Prior Authorization Group, Specialty Pharmacy and Drug Type fields to Zynchros.com.   It was at this point, however, that we made what turned out to be a fateful decision regarding Fields 10 and 11: rather than forcing each of our customers to provide their own classification for each proxy NDC on every 2008 Part D formulary, we called on our Pharmacy Services team to provide USP classifications as a resource for all of our customers, and use those classifications in the HPMS file for the many plans that used USP as the classification system.

We were proud that despite the short timeframe for the update, almost all initial submissions were accepted by CMS on the first try.  So, we were caught off-guard in subsequent submissions with CMS's reticence in allowing changes to Fields 10 and 11, even to make corrections to classifications based on feedback from plans.  A technical glitch in the HPMS file generation for a few customers didn't help matters, either.  We've upgraded our processes and software to resolve those problems and have learned some valuable lessons. We've already introduced a key improvement based on this experience: the HPMS Formulary Comparison tool, which you can use to compare changes to your formulary as CMS sees them by using your last submission file as a reference.

Looking ahead to the 2009 Part D program, we're confident that the lessons we've learned in the past year will lead to a straightforward and successful submission process.  In a welcome change from last year, CMS has pre-announced the planned changes to the 2009 HPMS submission file in a Paperwork Reduction Act filing.  We have some concerns about the burden some of the new fields will put on our customers (which we've communicated in our response to CMS), but we are confident that we have plenty of time to plan and implement updates.  We've also got a new system already designed and in development for Fields 10 and 11, which will allow you to update and lock in those fields directly, while still providing you Zynchros-provided classifications as a resource. Barring any last-minute surprises from CMS, we expect to have everything you need for your 2009 submission preparation available in Zynchros.com by mid-March.

Finally, on a personal note, I'd like to thank everyone who has provided feedback to me and others on the Zynchros team over the past year.  We're driven by your comments, suggestions and criticisms and our primary goal is to make you, our customers, happy and satisfied with our service.  Anytime you've got something to say about Zynchros.com, please let me know at david.smith@zynchros.com or 206-792-4108.  I'm always happy to hear from you.

Happy New Year.

David Smith

Zynchros December 2007 Upgrade Features

HPMS comparison tool for Part D 2008 formularies

You can now upload your most recent 2008 HPMS submission file and compare its contents to the work-in-progress Zynchros formulary. Select the “Validate” tool on the “Manage Your Formularies” screen and choose the "HPMS Submission Comparison" link to get started. We recommend you use this tool before each CMS submission.

User-selectable USP classifications for 2008 Part D proxy NDCs

Some Proxy 2008 NDCs now offer more than one USP classification. If required to maintain compliance with a previous submission, you can edit an NDC and select which classification will be used in the HPMS export file.

Tips and Tricks: How to Update User-Defined Fields

By Scott Pillsbury, Director, Customer Service and IT

As you may know, Zynchros.com gives you the flexibility to record, update, sort, and report on up to twenty data elements that are not captured in the standard Zynchros.com drug database or through general coverage details. These data elements that you define, on a “per NDC” basis, are called “user-defined fields”. User-defined fields allow you to track customized data like pricing, maintenance supply, custom classifications, and GCN.

Once created, you are able to update your user-defined fields using a couple of different methods. The first and most obvious way is to select “Modify User-Defined Fields” from the main screen. This method allows you to update your data on a “per NDC” basis.

If you need to update a large number of NDC’s, an easier and more efficient way would be to make “bulk” updates to the user-defined data by importing an NDC list from an Excel spreadsheet. To begin this process, click on “Import User-Defined Field Values” from the main page. From the next screen, click on “Download Template” button and save this file somewhere that you can easily locate (i.e. the My Documents folder). This will create and download a Microsoft Excel template that you can complete for use in the upload process.

For this example, I have downloaded my “User Defined Template” and populated it with 2 NDC’s along with their corresponding user-defined data fields. See figure 1.

When this spreadsheet is uploaded to Zynchros.com, the following would take place:

NDC: 0002060440

Revisions – this cell (B2) is blank. Any data for this NDC in Zynchros.com for the user-defined field “Revisions” would be deleted and the field left blank.

STC – value updated to “W1G”

GCN – value updated to “41250”

AHFS1 – value updated to “081604”

NDC: 00002140701

Since all cells in this row are “blank” (B3, C3, D3, & E3), all user-defined fields for this NDC would be deleted and the fields left blank.

Tips:

1. The only “required” column needed in the upload is the “NDC” column (column A).
2. User-defined data is per NDC and is applied across all of your formularies.
3. Zynchros.com allows you to manage up to 20 different user-defined fields within your account.
4. In the example above, if you didn’t want NDC 00002140701 user-defined fields to be blank, simply do not include this NDC in the upload (delete row 3 completely).
5. In the example above, if you didn’t want to update any of the data in the user-defined field “Revisions”, simply do not include this column in the upload (delete column B completely).

If you have any requests for future installments of “Zynchros Tips and Tricks” please send them to scott.pillsbury@zynchros.com. We look forward to hearing from you.