Fast Company, the world’s leading business publication, has ranked Prime Therapeutics LLC (Prime) #2 in the Health category of its prestigious 2020 Most Innovative Companies (MIC) List. The magazine recognizes the pharmacy benefit manager’s first-of-its-kind initiative leveraging artificial intelligence (AI) technology from SAS to fight fraud, waste and abuse (FWA), helping Prime’s health plan clients save a total of $279 million in FWA in its first year.
Prime launched its enhanced FWA program in mid-2018, combining for the first time pharmacy and medical claims data from prescribers, pharmacies and members to create a holistic view of potential FWA across the health care system. Prime’s platform – powered by SAS® – fully integrates this data and applies robust AI and machine learning capabilities, helping Prime quickly and efficiently detect FWA regardless of cause or source.
Beyond mere cost savings – which have more recently risen to exceed $355 million in recovered payments and cost avoidance – the SAS platform is also helping Prime save lives by reducing the harms of the nation’s opioid epidemic for its 30 million members. Visual link analysis, for example, shows connections between providers, pharmacies and members, helping spot many forms of opioid FWA, such as pharmacists that alter prescription orders, providers that prescribe drugs beyond guidelines, or patients that go “doctor shopping.” This visualization makes it easier for Prime’s investigators to share evidence with health plan clients and law enforcement.
“Prime’s purpose is to make health care work better by helping people get the medicine they need to feel better and live well,” said Jo-Ellen Abou Nader, vice president of fraud, waste and abuse & supply chain optimization at Prime. “Thanks to our ability to acutely study the traits and behaviors of pharmacies, providers and members, we are able to fulfill that purpose, reduce waste and costs, and help keep people safe. I’m extremely proud of our team and the strong analytics team from SAS, for collaborating to design such an innovative program that not only greatly reduces fraud, waste and abuse, but also helps save people’s lives.”
One of its most highly anticipated editorial efforts of the year, Fast Company’s Most Innovative Companies list honors businesses making the most profound impact on industry and culture. This year’s MIC list features 434 businesses from 39 countries.
“At a time of increasing global volatility, this year’s list showcases the resilience and optimism of businesses across the world. These companies are applying creativity to solve challenges within their industries and far beyond,” said Fast Company senior editor Amy Farley, who oversaw the issue with deputy editor David Lidsky.
“Prime’s novel approach marries integrated data and the latest analytic technologies to identify fraud, waste and abuse more quickly and efficiently while transcending the silos that too often hamper investigations,” said Stu Bradley, vice president of fraud and security intelligence at SAS. “This Fast Company distinction further establishes Prime as an industry leader and underscores that the road to innovation in the anti-fraud arena is paved with AI and machine learning.”
“Fraud schemes are ever changing. Prime remains committed to its industry-leading innovative FWA program in collaboration with SAS,” added Abou Nader. “Together, these two forward-thinking organizations will stay ahead of FWA by continuing to focus on the goal of preventing patient safety issues, driving out waste and preventing fraudulent behavior.”
About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 30 million people. For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.