A robust, full-service approach that drives maximum ROI and reduces your clinical & administrative burden

What is our Comprehensive approach?

Comprehensive is a full-service grouping of capabilities that seamlessly connects tools for controlling drug spend, ensuring compliance and delegating some – or all – of your utilization management (UM) responsibilities.

How does it work?

Comprehensive applies all of the necessary checks and balances to ensure you are defended against the clinical risks and administrative challenges posed by medical drug spend. This combination generates the most savings — with a contractually guaranteed 3:1 ROI.

What capabilities are included?

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Fully delegated UM
Managed via the OnePA Platform on your behalf

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Comprehensive claims management
Prepayment review
Medical claim edits

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Standardized medical policies with built-in dosing

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Site of Care redirection
Accredo Specialty Pharmacy

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Medical rebates

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Dedicated medical support teams

Comprehensive approach savings calculator

To find out how much you could save by implementing our Comprehensive approach, answer the questions below.

Our longest-standing clients who have leveraged these particular capabilities experience total savings that often go well beyond the guaranteed 3:1 ROI

Estimated Annual Savings:

Estimates only. Actual savings will vary based on relevant factors and data analysis.

Connected for Better

Click to explore how Comprehensive can connect you for better:

Better Savings

One plan saved
$2.33 PMPY
in medical drug rebates by fully delegating their medical contracting strategy in 2018.2
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  • Better Savings

    Site of care redirection and rebate management are two of the many ways Comprehensive helps you drive maximum value

    • Site of care redirection programs help avoid drug administration at more costly sites of care when other options exist.
    • Your dedicated rebate management strategy team will focus on your plan’s pharma contracting, working to lower your net drug cost while maximizing value on the medical benefit.
  • Better Savings

    Result: Site of care redirection

    • $22,840 average savings for each case proactively redirected to a lower-cost site of care
    • Redirecting members to the most cost-effective and clinically appropriate sites of care helps your members avoid distracted providers and inconvenient scheduling
    • Patients whose plans use Accredo benefit from seeing an Accredo infusion nurse in the comfort of their own homes, at the day and time of their choosing

    Accredo field nursing has had at least a 96% patient satisfaction rate for the past 8 years1

    1. Accredo infusion nursing rates 2017

  • Better Savings

    Result: Rebate management

    • Value comes in savings and reduced administrative work
    • Get the flexibility you need: start small with one or two drugs —
      or delegate all your medically billed drugs for the most value.

    The same plan that earned $2.33 PMPY in medical rebates in 2018 expects to achieve a 213% increase in value for 2019, for a total savings of $5 million.1

    1. Case information and data provided by health plan client with Comprehensive offering as of May 2018. Star rating announcement referenced came in September 2018.

Better Control

Members pleased additional visits to MD office for PA
no longer
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  • Better Control

    Integrate your strategy across all claims

    Using our claims processing system further protects your plan from inappropriate payment in a number of ways, capturing savings in areas that are often overlooked:

    • Managing across PA and dosing — comprehensively ensure billing practices align with the originally intended, approved use of the medication
    • Claims prepayment review — align and validate drug units and dosing for claims prior to payment of the physician
    • Claim edits — enforce FDA guidelines around maximum dosing and off-label use for medical drugs that are managed outside of the standard PA review

Better Efficiency

Another health plan’s PA turnaround time dropped from 10 days to as little as
10 minutes3
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    Comprehensive is supported by the full-service application of OnePA, our newest UM technology

    OnePA, which we will manage on your behalf, integrates medical and pharmacy drug prior authorization and claims data into a single platform in order to drive more accurate, efficient and compliant decisions.

    The plan whose PA time dropped to as little as 10 minutes also reports favorable reactions from physicians on their P&T committee.1

    1. Case information and data provided by health plan client with Comprehensive offering as of May 2018. Star rating announcement referenced came in September 2018.

Better Compliance

One plan achieved
87% CMR
completion rate
and maintained 5-star rating in just months after target moved up 30+% points.3
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    Preparing for regulatory change

    We have a long history of being able to manage a high volume of guidance, and the complexity of regulations. Our compliance expertise is demonstrated in two specific ways: flexible program development and audit performance. Click the arrows to explore

    The Centers of Medicare and Medicaid Services (CMS) regularly release new guidance for plans – 467 guidelines in 2019 alone.


    Flexible program development

    • Launched multiple initiatives to address more stringent UM requirements based on Medicare-focused clinical policies
    • Developed robust processes for an enhanced member and physician communication strategy

    Deepened evaluation of Step Therapy capabilities within the Medicare line of business to expand our clinical evaluation and promote more effective cost management and savings for clients.


    Audit performance

    • On average, we support over 500 total audits annually across all of our Medicare clients
    • Zero sanctions imposed over the past 3 years1

    Audit scores consistently better than the industry average (.90 vs. 1.10)2

    1. ESI BoB data as of Jan 2020



    One plan that achieved 87% CMR completion and maintained their 5-star rating did so in a year when CMS moved the target up 30+% points in the third quarter.

    With our support, the plan was able to reallocate their clinical team’s time handling PAs toward other strategic initiatives.1

    1. Case information and data provided by health plan client with Comprehensive offering as of May 2018. Star rating announcement referenced came in September 2018.

If you'd like more information, please contact
[email protected]