Compare Agilum vs. CareCost Estimate

We facilitate the transition to value-based healthcare by evaluating various treatments, medications, processes, and costs, which aids hospitals, life sciences firms, and payers in pinpointing the most effective treatment strategies for optimal patient results. Our CRCA™ P&T platform equips Pharmacy and Therapeutics committees to implement data-driven enhancements in key quality indicators, including metrics like average length of stay (ALOS) and 30-day readmissions. The innovative POP-BUILDER Rx™ solution offers comparative evaluations among chosen cohorts against CRCA’s extensive real-world data index, which encompasses over 140 million longitudinal patient records. Additionally, our drug remittance dashboard provides an in-depth analysis and reporting of drug remittance information across different payer categories, focusing on high-cost medications at the National Drug Code (NDC) level. Furthermore, we assist hospital finance teams in effectively tracking and enhancing service line costs and profitability, productivity, and revenue cycle performance through our insightful analytics, detailed reporting, and the expertise of our Agilum Healthcare Intelligence team. This comprehensive approach ensures that healthcare providers can make informed decisions that positively impact both operational efficiency and patient care.

CareCost Estimate provides a solution for infusion centers and specialized medical practices to address a common patient query: what will the treatment cost? By selecting the medication, dosage, and insurance details, staff can utilize CareCost to swiftly determine the patient's out-of-pocket expense, typically within a 90-second timeframe. This calculation considers various factors such as Medicare Part B coinsurance, any applicable secondary insurance, Medigap, weight-based dosing, and potential vial waste (JW/JZ). Furthermore, it incorporates any manufacturer copay assistance programs and foundation grants the patient may be eligible for, ensuring that the figure presented reflects the actual financial responsibility of the patient. In addition to cost estimates, the platform provides insights into the prerequisites set by payers, including necessary prior authorizations, step therapy protocols, and site-of-care stipulations, all directly sourced from the payer's policy along with relevant links for reference. The pricing information is derived from the CMS Average Sales Price files, which are refreshed quarterly, and since the estimates are processed directly in the browser, patient data remains secure and does not get transmitted to external servers. Moreover, CareCost also offers complimentary resources related to billing and coding, including infusion CPT codes, J-codes, and modifiers, along with a quarterly Infusion Reimbursement Index to assist healthcare providers further.