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From the Margins to the Mainstream: The Criticality of Standards for Digital-first Healthcare

Standards are often overlooked, but are a critical component of the pharmacy and prescription drug industry. They are fundamental to improving the exchange of information and supporting the millions of transactions that occur from the manufacturer to the end user. Most importantly they help our health system save billions of dollars in costs, increase patient safety and optimize the quality of care patients receive.

However, as the industry becomes more disrupted by technology, our standards cannot remain stagnant – they must evolve to help pharmacies, pharmacists, payers and other healthcare ecosystem players manage care in a digital-first world.

To help our clients manage this change and improve the digital interactions they have with constituents, I applied for and was recently awarded an Emerging Professional Fellowship by the National Council for Prescription Drug Programs (NCPDP) to help shape the next wave of standards that will guide the pharmacy benefit industry.

As part of my fellowship, I will be responsible for developing standards and standardized processes to optimize communication within the industry. My new role allows me to not only to shape the future of our industry, but also become an expert advisor to Conduent and our customers. Standards are the lynchpin of our industry, but they only work when there is a bridge between the intent of the standard and industry best practices from a real-world setting. Conduent now has a path to fill this gap.

For example, in 2010 NCPDP evolved the telecommunications standard for claims processing. Previously, the industry used a paper form for claims processing that often led to inaccuracies and inefficiencies in how long payment took to be processed. Now, due to work by NCPDP, claims are submitted and processed electronically in seconds. More details are included in transactions between pharmacies and payers to ensure records are kept up to date and authorization details needed to meet more stringent requirements of government programs, such as Medicare and Medicaid, are included to speed up time to approval. This has revolutionized claims processing and the industry is now preparing to move to the new version, F.2.

In my role, I will help define the new version and I’ll be at the forefront of translating the standard for our clients. Furthermore, as new players and technologies enter the market, I will provide the organization with the voice of the industry to develop new standards as new needs emerge. 

Digital brings cost savings and efficiency, but can also initially make our industry more complex. Standards provide our people and organizations with a basis for mutual understanding to define new terms, facilitate communication, effectively measure and standardize processes. At the same time, they allow us to be more efficient and add new patient benefits, such as real-time transaction processing to ease approvals and minimize disruptions in care. I’m excited to have a platform to play a central role in maintaining and implementing standards and making industry complexity one less thing hindering the progress of our drug programs.