About TPG Data Services
TPG Data Services and our team of senior healthcare and clinical consultants are transforming the way providers and payors monitor healthcare information to control costs and enhance efficiencies.
The TPG-DS team are experts at leveraging medical and pharmacy data to render advice and solutions for better patient care and to manage better outcomes. Given the emergence of new delivery and reimbursement models and the convergence of payers and providers, access to robust clinical analytics can play a major role when making clinical decisions.
TPG-DS delivers meaningful insights into patients and members care including cost, resources, and efficiency measures via clinical validated models and data attributes to help improve outcomes, with the goal of improving financial performance.
We deliver strategic insights to C-suite level executives at payors and employers to better address specific patient populations and render advice to assist with clinical decisions. Our tools also work to support Medication Therapy Management (MTM) and Comprehensive Medication Review (CMR) programs
In a complex and ever-changing healthcare environment leveraging analytics has the power to transform healthcare. Trust TPG Data Services (TPG-DS) experts and our proprietary suite of data analytics tools to help payors and employers make smarter decisions to better manage limited resources and reduce costs.
Fraud, Waste, and Abuse (F/W/A) Prevention
Given the recent trend of CMS becoming more vigilant in the Fraud, Waste, and Abuse arena, get proactive and implement the latest tools and expertise to combat F/W/A practices. The TPG-DS approach uses analytics to predict, monitor, identify, and ultimately work to effectuate change relating to potential F/W/A practices.
Most systems only analyze paid claims while TPG-DS examines a total situational view of all claims that led up to a paid claim searching for critical patterns. Our tool can be custom-tailored to meet your business priorities – whether monitoring prescribers, pharmacies, or member activities – reviewing all claims generated by the nexus of the member, provider, and pharmacy.
Utilizing our automated tool takes the hassle out of the time consuming practice to monitor F/W/A while identifying and communicating how to proactively change behavior to bend the cost curve.
We work closely with payors and employers with the goal of avoiding waste and calling out fraud and abuse with actionable and direct communications to the potential prescriber, pharmacy, or member in a timely manner.
Financial Auditing and Analytics
TPG-DS conducts a comprehensive analysis of claims data to quickly examine contract compliance, while identifying past financial claims errors to save you money.
Assess brand and drug pricing, rebate program adherence, prior authorization validation, and many other claims data points all at the touch of a button. Powered by the TPG-DS Claims Invoice Snapshot Tool, our clients:
- Reduce the complexity and time behind sifting thru volumes of data
- Deliver actionable advice to assist C-level suite decision-making
- Report automatically based on needs, yielding cost reduction opportunities
- Benefit from drug pricing expertise from TPG-DS financial and clinical performance experts
Don’t miss the chance to integrate a turnkey technology solution without the hassle of investing in additional IT resources.
The project was very successful; our per member per month (PMPM) costs declined 7% or $12 PMPM throughout the program, annual savings were $6.0 million yielding a return on investment in excess of 20 times.
OptumRx analysts see more pharmacy fraud activity amid COVID-19
There was a significant increase in pharmacy fraud and abuse under the pandemic, analysts at OptumRx say. The pharmacy benefit manager giant recovered $300 million in
Dr. John Vazquez is a Physician Consultant with TPG International Health Academy (TPG-IHA). TPG-IHA has hosted educational programs for senior healthcare executives for 25+ years, holding week-long Educational Summits in over 30 countries across the globe. The Academy is powered by three pillars: education, networking, and cultural immersion.
Michelle is a Senior Consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Sue is a senior consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Gayle is a Senior Consultant with TPG Data Services (TPG-DS). TPG-DS and our team of senior healthcare and clinical consultants are transforming the way providers and payors monitor healthcare information to control costs and enhance efficiencies.
Nancy is a Senior Vice President with The Pharmacy Group, responsible for all financial aspects of the TPG Family of Companies, as well as operational matters. She joined The Pharmacy Group in March 2012, in addition to performing the overall financial management she evaluates project profitability and pricing, manages cash flow, analyzes financial performance, and makes financial recommendations. Additionally, she handles HR functions, and frequently is involved in client contracting.
Jeff joined The Pharmacy Group (TPG) in August 2008 to support its administrative functions. Over the years he has taken on additional responsibilities including marketing initiatives, client communications, and general web support. As a vice president Jeff is primarily responsible for attendee recruitment for all TPG activities, from the planning and strategy of recruitment to the execution and oversight of those initiatives.
Mr. Brook has over 30 years in health care industry management and consulting. He has managed medical and health economic educational programs, convention activities, and promotional product support as both an employee and a consultant. He has worked on market access programs with the National Payor Roundtable since the organization formed in 2005, (as the National Managed Care Roundtable). He managed the daily operation of a pharmacy benefit manager’s formulary programs and was instrumental in the development and implementation of over 20 custom formularies. Mr. Brook has worked with state and federal agencies in refining the diagnosis-related-group system, in developing the resource-utilization-group system—part of the U.S. Federal Long-Term-Care Minimum Data Set, and in developing a mental health classification and reimbursement system. Mr. Brook has taken an active role in the developing and reporting the results of the National Payor Roundtable advisor survey. He reviews for several journals including the American Journal of Managed Care and Current Medical Research and Opinion. He has a variety of therapeutic experience with marketed and developmental products and holds several degrees from Rensselaer Polytechnic Institute, including an M.S. in operations research and statistics, an M.B.A. in health systems finance, and a B.S. in management information systems.
Dr. Sax is co-founder and President of The Pharmacy Group LLC in Glastonbury, Connecticut where he provides marketing services to healthcare service providers; pharmaceutical, biotech, and medical device clients; and information technology and companies to grow revenue and improve the financial performance of their products and services.
Rich Balest has served as a health industry consultant utilizing over 25 years of experience in data mining, data modeling, data warehousing, and information delivery. Rich has comprehensive experience analyzing detailed claims and eligibility from CMS, insurance companies, and managed care organizations including prescription benefit managers (PBM), and account and medical record detailed patient data from hospital patient accounting systems, clinical ancillary systems, and professional and institutional billing systems.
Sarah is a Vice President of Business Development for The Pharmacy Group (TPG). Her primary responsibility is coordinating business growth across the various LLCs in the TPG Family of Companies. She joined The Pharmacy Group in February 2015— initially to augment the organization’s business development and administrative activities. In the years since she has worked on marketing initiatives, client communications, general web support, and program development.
Marjorie Pestel Zimmerman, MS, BS Pharm, is a registered pharmacist with diverse experience in the healthcare industry. During her practice in a large tertiary care center, she held numerous positions, including decentralized clinical pharmacist and Assistant Director of Operations within the pharmacy department. As a consultant for a psychiatric hospital, she performed medical staff drug usage evaluations and led patient medication groups.
In August 2015, Leon Edelsack became the President of TPG Healthcare Consulting (TPG-HC) and also serves as the president of TPG-HC’s sister company, TPG Data Services (TPG-DS), a position he has held since 2009.