Products & Services

Health Care and Benefit Related Data Aggregation

Health plans, consultants, and self-insured employers need a comprehensive set of benefits data in order to monitor usage, track costs and make strategic decisions. Having and using this data is invaluable. Often information is difficult to obtain, unorganized or scattered in different formats and sources. The challenge lies in aggregating data into a common, relational database that can transform the data into actionable information that uncovers inefficiencies and areas for intervention and improvement. The Data Aggregation component of the MAHCP Data and Reporting Program allows members to overcome this challenge by aggregating multiple sources and types of data into a single source database.  This service is important to those health plans, consultants, and self-insured employers that use a variety of vendors for its benefit programs. MAHCP provides an opportunity to manage data through a single, member owned data source.

Health Care Data Analytics and Reporting

The DataSmart Analytics and Reporting package assimilates MAHCP aggregated health and financial data sources into one powerful and central resource to facilitate informed and strategic decision making. It is a secure and HIPAA compliant set of tools that mines plan data in order to help managers learn from the past data, understand current plan performance, and manage future change.   The MAHCP analytics and reporting package provides access to proprietary predictive modeling algorithms used widely by health plans, employers, and consultants operating regionally, nationally, and internationally.  Reports are available in multiple areas of plan management, including risk identification, risk modeling, plan performance, and program efficiencies.

Case, Disease and Wellness Management System

MAHCP has developed and supported a Care Management System that assimilates health data and powerful analytics into an intuitive workflow management tool.  The system provides care managers access to patients’ eligibility, clinical, and cost information. Using the system, care managers can obtain and track additional information from supplementary data sources otherwise unavailable from claims, such as biometrics, lab results, health risk assessments, and over-the-counter and herbal medications, diet, exercise and allergies.  From early detection of “high-risk” members with complex care needs, to supporting Wellness and Disease Management programs, the Care Management System provides ongoing support to manage the entire spectrum of care management programs.

PBM Contract Participation

A coalition negotiated contract that provides traditional pharmacy benefit management (PBM) services to MAHCP Members. The PBM program also leverages the knowledge and size of our coalition in contracting, in assisting with the management, and auditing components of the PBM program.

Products & Services

URX Pharmacy Benefit Program

The URx Pharmacy Program is a unique and innovative Pharmacy Benefit Program that emphasizes multiple pharmacy vendor contracts and targets cost savings through a combination of important formulary, value added benefit and pricing strategies that effectively target pharmacy benefit cost reduction.  The URx program includes but is not limited to: mail order pharmacy, specialty pharmacy, PTAC, formulary expertise from the outside vendor, and infusion services.

Ask A Pharmacist (AAP) Clinical Pharmacy Program

The AAP Program is unique in that it emphasizes a focus on clinical pharmacy resources for member and physician questions. This program compliments the URx Pharmacy Benefit Program by integrating medical and pharmacy benefits through a combination of formulary education, clinical applications and benefit adjustments.