About TPG Healthcare Consulting

TPG Healthcare Consulting (TPG-HC) provides consulting services to payors focused on management of the pharmacy benefit and improvement in the utilization of pharmaceuticals. TPG-HC is powered by a team of seasoned industry healthcare professionals well versed in all facets of managed pharmacy programs, pharmacy program evaluation, and laboratory benefit management services. We work with you to manage costs and ensure better outcomes.

Our consultants, on average, have 20+ years of experience in the healthcare industry and provide clients with effective cost containment strategies for payors to improve their economic, clinical, and operational performance. TPG-HC also offers consulting specific to specialty pharmacy benefits, including strategic planning, program evaluation, and organizational support.

TPG-HC has successfully worked with a variety of payor clients, including Blue Cross and Blue Shield organizations, regional health plans, employers, and unions.

Pharmacy Benefit Management Services

TPG-HC brings a seasoned team of professionals, with over 20 years average experience, to help you evaluate partnerships with current or potential PBMs. We are an unbiased third party whose skilled team is up to date on the latest developments, trends and markets.

Through TPG-HC’s objective proprietary process, we identify key elements to help achieve savings and to ensure compliance to get prepared for the future.

RFPs

With a deep understanding of the current PBM market and strengths of various PBMs, we provide technical experience to develop an RFP to ensure a fair and consistent evaluation of different vendors. We don’t take a “one-size-fits-all” approach – conducting market research tailored to identify PBMs that would be a good fit for your plan and then help you craft a contract that ensures delivery of exactly what your plan wants. Whether your goal is cost savings, modernization or growth, we are the business partner who can guide you there.

Contract Negotiation

TPG-HC brings a flexible mindset and years of negotiation experience. If our performance analysis shows the terms of the contract are not being met, we’re there for you. We’ll work with your PBM partner to ensure both quality and satisfaction, and adjust the contract terms to satisfy your need for savings and performance. Contract assessment by our experts is critical to ensure that your PBM is set-up to serve you best.  Without the right financial and clinical guarantees, as well as contract definitions, the risk management of the contract can increase dramatically, leaving you vulnerable to potential losses.

Contract Analysis

If you’re looking to renegotiate with your current PBM or conduct a performance assessment, TPG-HC can help. Paired with our market knowledge, the detailed and objective review process will accurately assess PBM compliance performance and provide detailed recommendations for performance improvement and cost efficiency. We can leverage our extensive market research to make sure your pricing is competitive with the marketplace.

Benchmarking

Benefit from TPG-HC’s comprehensive database incorporating the most recent market information on pricing for a variety of PBMs – whether you are comparing small, medium, or large plans – we benchmark comparatively to help you drive negotiations with your current vendor to secure the best deal.

Pharmacy Program Evaluation

With years of experience, TPG-HC is the perfect partner to track and manage your pharmacy program performance.  Our team can readily assess performance metrics, operational process and staffing structure to provide recommendations to benefit you and your members.

We recognize that each organization is different.  TPG-HC takes a multi-disciplinary approach enabling us to work with teams of all sizes and skills, including clinical, IT, and contracting professionals. 

Performance

Looking to improve both efficiency and quality? Our experts assess and monitor your pharmacy program to identify any areas of improvement and then analyze claims to determine whether contract terms are met.  Our audits ensure that the implementation of the contract is meeting your business objectives.  When contracts are not meeting expected results, TPG-HC is armed with market intelligence to provide recommendations for improvements with cost saving strategies without compromising quality.

Operations

Our team doesn’t just review contract adherence, but also determines whether benefits have been administered correctly. Member eligibility issues, services to non-members, prior authorizations, dispensing of drugs on formulary, assignment of correct co-pays, and adherence to discounts are just a few of the areas where we’ve helped clients in the past.

Organizational Strategy

Is the organizational structure of your pharmacy program built in the most efficient way? TPG-HC evaluates the impact of staffing changes, re-organizations and management processes to ensure that your staffing approach best meets your needs.  Our team delivers actionable recommendations to yield measurable improvements.

Specialty Pharmacy Strategic Planning

Specialty drug management is one of the fastest growing and most complicated areas. TPG-HC’s wealth of talent and knowledge in this niche area enables us to work with clients to create a best in class, cost effective strategic plan to directly address these challenges.  Using our lessons learned via our vast specialty network, we deliver insightful advice that makes a difference when managing a variety of specialty point of care issues.  Let our experts recommend ways to navigate an ever-changing pricing environment to manage costs and deliver quality services in this complex market.

RFPs

Leveraging our extensive specialty pharmacy experience, we conduct a thorough market analysis, evaluating real-time data to provide an objective approach to specialty RFP evaluation with a focus on identifying the most cost-effective relationships.

Specialty Drug Administration Evaluation

Our team works with clients to map out the most cost effective process for specialty drug administration.  TPG-HC benchmarks your current practices to industry standards ensuring you have the right business process in place to manage the delivery of specialty drugs.  We also review formulary design and provide recommendations on how specialty drugs are sourced.  

Vendor Management

With the potential for multiple payors and complicated data management issues, how do you know you’re receiving the services and reimbursements called for in your contract?  TPG-HC audits your current specialty contract to ensure its being fulfilled to the letter of your agreement.

Laboratory Benefit Management Services

Over the past several years, it has become clear payors need to address laboratory testing. The growth of precision medicine (the right drug, to the right patient, at the right time) has engendered the growth of thousands of new diagnostic tests. TPG-HC leveraging its experience in managed care, has put together a team of experts in the area of diagnostic (molecular) tests. Our expertise can help payors (health plans and employers), and laboratory test companies navigate this emerging area. Our seasoned team of professionals can help navigate the complex landscape.of payor requirements whether they be commercial, or government-supported as well as state/regional difference.

Through TPG-HC’s proprietary process, we identify key milestones as part of a complete reimbursement model:

  • Diligence is the first step to address reimbursement requirements and add value to ALL stakeholders
  • Commercial Strategy employs a targeted approach to achieve growth
  • Market Adoption Strategy ensures steady growth with predictable revenue and margins
  • Billing Compliance provides risk mitigation with compliant policy and processes to avoid violations
  • Enterprise Outcome provides a sustainable growth model to increase valuation