LexisNexis® Risk Solutions: Bringing Intelligence to Pharmacy Management

LexisNexis® Risk Solutions: Bringing Intelligence to Pharmacy Management

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Craig Ford, VP of Sales, Pharmacy Markets, LexisNexis® Risk SolutionsCraig Ford, VP of Sales, Pharmacy Markets, LexisNexis® Risk Solutions
The evolution of pharmacy has seen a multitude of renditions over its 4,000-year-old history. The long journey of the institution from papyrus scrolls in 400 BC to modern day electronic prescriptions was an arduous one. Even today, pharmacies continue to evolve from being entities that merely dispense medication to playing a critical role as providers of care. This transition is leading the pharmaceutical sector to realize the need for the integration of workflow data and analytics to enhance the efficiency at the point of sale and improve the ability of pharmacies to engage with patients. However, due to the impacts of the growing regulatory complexities, pharmacies are being forced to move into the clinical area of healthcare in search of newer sources of revenue. This transition of pharmacies into healthcare destinations is increasing the inefficiencies in patient engagement due to disorganized workflows and difficulties in the integration of patient information.

Georgia-based LexisNexis® Risk Solutions offers products that support pharmacies to tackle the effect of regulatory changes on workflows and ensure proper linking of medical records to improve patient outreach. “LexisNexis helps pharmacies remain compliant and offers a robust patient engagement data analytics offering to enable them to better understand patients,” says Craig Ford, VP of sales, pharmacy markets at LexisNexis. Initially, LexisNexis offered services to help pharmacies integrate prescriber demographic and licensure data into their workflow. Today, the company offers solutions that leverage patient insights and analytics to aid clients in reducing risks while enhancing compliance and adherence.

The company has developed solution suites—Provider Intelligence Suite, Fraud Waste Abuse suite, and Patient Identity Intelligence Suite—to resolve the core challenges in the Pharmacy and Pharmacy Benefits Management (PBM) market. The Provider Intelligence Suite offers prescriber data and real-time prescription validation to assist pharmacies in staying compliant with state and federal prescriptive authority requirements. This suite offers three solutions—Provider Data MasterFile, Provider Data Enhancements, and VerifyRx—to assist pharmacies in operating efficiently through the growing regulatory complexities.

Provider MasterFile is a golden-record that is consolidated from hundreds of prescriber sources delivered to the clients through API, batch file delivery, and a web-based user interface. Meanwhile, Provider Data Enhancements is a robust data augmentation and management solution that enables customers to report on data requests that clients want to validate with LexisNexis’ extensive and well-defined auditing processes. Finally, VerifyRx allows pharmacies to validate prescribers in real-time, support internal and external audits, and configure checks to reject claims, send warning messages, and capture requests for reporting. “VerifyRx is a real-time compliance solution that performs over 65 state and federal level checks to enable pharmacies to strike the optimum balance between compliance and relevant workflow requirements,” explains Ford.

Together, these solutions offer prescriber compliance by enabling best-of-breed provider insights.

LexisNexis helps pharmacies remain compliant and offers a robust patient engagement data analytics offering to enable them to better understand patients

With the LexisNexis fraud, waste and abuse suite, the company helps clients accurately identify the individuals and businesses involved in fraud schemes. The main offering, LexisNexis® Relationship Mapping, connects the dots among individuals, providers and businesses to help mitigate rising fraud schemes like opioid abuse.

Additionally, their Patient Identity Intelligence Suite helps stem identity theft related fraud by corroborating the identities of individuals that customers interact with. Products such as LexID®, TrueID®, and Instant Authenticate® Q&A anchor their identity authentication and patient record matching applicability. “LexID provides current demographic data for each individual and identifies where customer databases may have duplicate records of the same individual,” adds Ford. Moreover, the TrueID and Instant Authenticate Q&A solutions offer clients the ability to validate the legitimacy of a person logging into a customer system or presenting IDs in person. By utilizing these products, pharmacies can minimize the impact of fraudulent activities, ensure patient records are matched correctly and protect access points to personal information.”

Lastly, LexisNexis provides a collection of scores and attributes hinged on the company’s social determinants of health data to strengthen statistical models in client organizations and assist them in identifying social influencers impacting health outcomes. Categorized into four categories—social isolation, address stability, education, and financial health—these insights are based on hundreds of attributes that were created from extensive data sources that have been statistically and clinically validated to predict health outcomes. Within LexisNexis’ social determinants of health suite, the company offers a hospital readmission score and total healthcare cost score as well.

At the heart of LexisNexis Risk Solutions’ unique position in the PBM market is the customizability of their product portfolio, particularly the company’s VerifyRx solution that allows customers to personalize real-time checks based on third-party partnerships and store locations. In addition, the ability of LexisNexis’ solutions to tap into vast data sources and provide analytics that can be integrated into the workflow in real-time is key in the delivery of their solutions.

In the coming months, LexisNexis plans to add a medication adherence score to their social determinants of health suite to not only identify why patients need assistance with adhering to medication, but also indicate the drivers of such behavior to offer personalized services. In terms of organizational objectives, the company will continue to remain laser-focused on expanding their clientele and growing alliance engagements. “Our customers trust and believe in our commitment to deliver data-driven insights and solutions that can solve their greatest challenges,” concludes Ford. LexisNexis is passionate about developing and delivering solutions that will help customers continually innovate, and overcome organizational and regulatory challenges with a vision to shape the future of the pharmaceutical industry for the better.

LexisNexis® Risk Solutions News

LexisNexis Risk Solutions True Cost of Fraud Study Finds Fraud Costs Increased 7.3% for U.S. Retailers Year over Year



Kimberly Sutherland, Vice President of Fraud and Identity Strategy

ATLANTA - LexisNexis® Risk Solutions has released its 11th annual LexisNexis Risk Solutions 2020 True Cost of Fraud„¢ Study: e-Commerce/Retail Edition. The study that surveyed risk and fraud executives at e-commerce and retail companies in the U.S. and Canada reveals that fraud continues to increase and most acutely affects mid to large-sized e-commerce and retailers. Retailers experienced increased online and e-commerce fraud volumes and monetary losses correlating to a mass shift to online and mobile transactions during the COVID-19 pandemic.

The result of increased fraud volumes translates into a 7.3% increase in the cost of fraud year-over-year for U.S. e-commerce and retail merchants. The LexisNexis Fraud Multiplier„ “ the total amount of costs related to fees, interest, merchandise replacement and redistribution per dollar of fraud for which the merchant is held liable “ shows fraud now costs companies $3.36 for every dollar lost to fraud compared to $3.13 in 2019 and $2.40 in 2016. This is an increase of $0.96 over five years. U.S. costs are significantly higher than the cost that Canadian retailers face per $1 lost to fraud at $2.87.

The True Cost of Fraud Study is a comprehensive survey that compares fraud rates, impacts and challenges related to fraud detection and prevention year-over-year and during COVID-19.

Key Findings and Trends from the Study

Successful Fraud Attacks Increase: The average volume of monthly fraud attacks increased 9% for U.S. retailers year-over-year while the average number of successful monthly fraud attempts increased 43% - 48% for mid to large retailers and 27% for smaller retailers. Attack volumes were already trending upward prior to the shutdown as mobile and online channels traditionally have higher fraud rates. Some of this growth is due to increased transaction volume due to the temporary closing of brick-and-mortar retailers during the pandemic.

Shutdown Spurs Increase in Fraud Costs: A comparative analysis of those surveyed showed that average monthly fraud attack volumes were significantly higher for specific retail segments who responded to the survey during the shutdown. Mid to large general merchandise retailers selling physical and digital goods had on average 70% more fraud attempts per month than those surveyed prior to the shutdown in March 2020. Businesses that continued operations during the pandemic who had higher mobile purchase transactions with in-store pick up experienced more fraud volume and coinciding higher fraud costs since these retailers had to rely on store employees for identity authentication rather than solutions designed to detect mobile fraud.

Retailers Struggle to Keep Pace with Fraudsters: Retailers are finding it difficult to distinguish legitimate customers from malicious bots while balancing fraud prevention with risk-appropriate customer friction. This becomes even more complicated when purchases involve third-party, non-bank payment providers where transaction speed and volume are high and transparency into complex payment chains and end-customer profiles is low. Mid to large retailers selling digital goods are more challenged detecting and preventing fraud within these payment types. Fifty-eight percent of retailers selling digital goods say differentiating synthetic identities is a top verification challenge. Businesses new to mobile commerce contend with these issues more than businesses with more established fraud and risk mitigation solutions.

"Retailers and e-commerce merchants should be prepared for increased fraud attacks and costs for the foreseeable future," said Kimberly Sutherland, vice president, fraud and identity management strategy, LexisNexis Risk Solutions. "It is unclear how the COVID-19 pandemic will shape the purchasing landscape over the next few years, although we do know that fraudsters will continue to shift tactics quickly in response. The most effective way for businesses to fight fraud and protect their consumers is by performing a more complete assessment, combining physical and digital identity data of those making purchases.

"High fraud costs impact e-commerce merchants and retailers as sophisticated threats increase," Sutherland continued. "A multi-layered strategy can protect retailers and e-commerce merchants throughout each buyer experience. Every transaction channel and type carry unique risks. Using different solutions to support fraud detection at various points in the consumer journey will strengthen overall defense."

LexisNexis Risk Solutions 2020 True Cost of Fraud Study: e-Commerce/Retail Edition Methodology

This is the 11th annual comprehensive research study on U.S. merchant fraud and the first year surveying Canadian merchants. This year's study surveyed 801 risk and fraud decision makers from late February through late April 2020. Respondents represented a wide spectrum of retail merchants: retailers offering e-commerce, retailers receiving a majority of their income though online or mobile channels and retailers offering mobile commerce. The margin of sampling error for findings reported at an overall level is +/-3.5 at the 95% confidence interval. Data reflects the U.S. and Canadian merchant population based on weighting to U.S. Economic Census.