TriCast Inc.
10400 W. Innovation Drive, Suite 310, Wauwatosa
Innovation: AccuCast risk management and fraud detection software
Employees: 30
The costs of health care, particularly in prescription medications, continue to rapidly rise. More senior citizens are opting into the Medicare Part D plan, and the demands for cost cutting, validation, oversight and quality control are becoming more important for all parties involved in the pharmaceutical drug business.
Wauwatosa-based TriCast Inc. recently launched the newest version of its AccuCast software solution to help with those demands.
“Everything we do is data-based,” said Greg Rucinski, president and chief executive officer of TriCast Inc. “The company is essentially a three-legged stool with all aspects of health care data at the core.”
In addition to doing business on a consultative practice and producing analytics and reports for health plans and state entities, TriCast has a team of in-house developers that have built AccuCast and other management tools to help pharmacy chains, heath plans and prescription drug companies control and predict costs, comply with regulations, and even uncover fraud, Rucinski said.
Rucinski previously worked as a pharmacist and managing partner in a Wisconsin-based pharmacy chain. He later served as president and chief executive officer of a third party pharmacy benefit management company.
According to Rucinski, pharmacy costs now make up nearly 25 percent of all health care spending, up from 10 percent a few years ago.
Traditionally, according to Rucinski, the way anyone would predict costs in the pharmaceutical arena was to utilize actuarial tables to produce the information.
“The reason that didn’t work long term, especially in regards to pharmaceutical costs, was because costs were rising so rapidly,” he said.
Actuarial assumptions were often not as accurate as they should be because treatment costs would change rapidly. The AccuCast software utilizes predictive modeling that reflects that ever-changing environment, Rucinski said.
“Our software can take into account every facet of the cost and incorporate them into a client’s data and pricing as if it’s happening next year,” he said. “We are constantly looking at, and importing, benchmark pricing data and compliance regulation requirements to make the traditional process that much faster.”
In addition to being able to predict potential cost expenditures for its clients, the software also has the capability to test and validate every order that comes through, Rucinski said.
“With the increasing number of senior citizens entering into the Medicare Part D program, the Centers for Medicare and Medicaid Services are demanding more oversight and quality control through that process than ever,” Rucinski said.
The software can cross validate a patient’s medical records with an insurance plan and other data to determine if an individual receiving the treatment is getting what they need and at what cost.
“The quality aspect and validation the software can provide is really crucial,” Rucinski said.
The software can also automatically generate reports both for internal purposes as well as reports required by organizations like the Centers for Medicare and Medicaid services (CMS), Rucinski said.
“What we’ve really done with this software is speed up the process of pricing and validation,” he said. “Historically most companies would be months behind where they needed to be in terms of utilizing data. The software makes it almost real time. That’s the real difference.”
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According to Rucinski, pharmacy chains are utilizing the AccuCast software to help underwrite the risk of providing treatments to patients, i.e., making sure patients get what they need and pay the correct amount for it.
In addition to pharmacy chains, AccuCast is being used by health plan providers, pharmacy benefit management companies, actuarial companies, and pharmaceutical manufacturers that need to comply with CMS Part D product requirements, Rucinski said.
The software is custom implemented in each facility and comes as a stand alone product or as a hosted solution. TriCast makes updates to the benchmark pricing data in the software nearly every month, Rucinski said.
Those updates are passed on regularly to software users.
“The ultimate goal is to improve patient care and the general health status of a patient,” Rucinski said. “The software can quickly identify prescription errors and even inappropriate use. Both will ultimately benefit the patient, but secondarily it will also help control waste and abuse within the program, which will then in-turn help with cost cutting measures pertaining to pharmaceutical drugs.”
