Designed as a lifeline for low-income and underserved patients, the US 340B offers healthcare providers discounts of up to 50% on prescription and outpatient medicines, with the intent that these savings would be reinvested to provide care services to those who need it most.
However, for the largest participating hospital in New England, this well-meaning initiative was fast becoming an operational bottleneck.
Managing the 340B program at scale requires constant reconciliation of vast amounts of prescription and claims data across fragmented systems and multiple stakeholders. The hospital must meticulously prevent duplicate discounts and drug diversion, which requires tight controls, audits and exception handling for every eligible prescription.
What should have been a cost-saving measure is now straining the hospital’s ability to focus on patient care, while causing missed savings opportunities, reporting errors and exposure to regulatory penalties.
Growing Administrative Complexity
Administering the program manually via Excel sheets was proving to be an operational bottleneck, especially when data had to be sourced from three disparate databases (Epic, Sentry and QS1). This led to:
- Data Inconsistencies: Inaccurate or duplicate patient, prescription, and pharmacy data led to conflicting records and unreliable reporting, making it hard to verify drug eligibility and submit claims correctly.
- Financial Impact: Inconsistent data reporting led the TPA to wrongly label eligible 340B claims as ineligible, causing lost discounts and reimbursements. This directly reduced client revenue and limited its ability to reinvest in services for underserved patients, weakening financial stability.
- Compliance Risk: Manual processes caused errors and ineligible 340B prescription claims, resulting in unintentional 340B violations, triggering audits, financial penalties and potentially jeopardizing the client’s continued participation in the 340B program.
The client needed a new system for efficient administration of the 340B program. It turned to Persistent as its strategic IT partner.
Re(AI)magining Accessible Healthcare with Cloud-Native Platform
Persistent dove in, taking the time to understand the pain points and the operational burdens holding the client back. Recognizing the need of the hour, Persistent designed an AWS-hosted cloud platform, tailored to the unique needs of 340B administration, to ease the client’s operational burden. Leveraging SASVATM, our AI-powered engineering accelerator, to drive the platform development, we were able to roll this out 40% faster than expected.
By consolidating all patient, prescription and pharmacy data into a unified Snowflake data warehouse, Persistent created a reliable “single source of truth.” To ensure speed and efficiency, Persistent replaced legacy, error-prone workflows with automated, cloud-native ETL pipelines built in Python, drastically reducing errors and improving data trustworthiness.
Integration became seamless. We connected clinical and administrative systems, including EMR and TPA platforms, via secure APIs to ensure bidirectional, real-time data flow. This improved care coordination and made compliance far more manageable, while meeting strict HIPAA and healthcare security requirements.
For the first time, the client’s teams could use embedded business intelligence tools like Tableau and Qlik to monitor compliance, maintain audit readiness and make evidence-based decisions with intuitive dashboards. The operational burden lifted—allowing both the administrative staff and care providers to work more effectively.
Persistent continues to support and refine the client’s cloud environment, ensuring the platform remains compliant, scalable and insight-rich. What was once a daunting operational challenge is now an industry-leading system—one that the client plans to share with other healthcare providers.
From Administrative Blocks to Blueprint
With Persistent’s reimagined cloud-based platform, the client now efficiently manages administration of the 340B program for its patients and partners, consistently meeting compliance requirements and realizing savings aligned with the patients served under the plan.
The scalable, compliant platform has become an industry blueprint that the client plans to commercialize over time. Accelerated delivery—from concept to implementation—combined with AI-driven productivity gains, enabled the cloud-based platform to go live 40% faster.
Recognizing Persistent’s demonstrable engineering expertise, the client continues to rely on us to manage its new administrative platform and has committed to a joint go-to-market venture to launch this solution as a commercial product.
