Over 75 Years Experience in Managed Care

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Agadia is dedicated to

Improving the quality of care and expediting the delivery of health care services by advancing and automating utilization management processes.

Healthcare Utilization Management Solutions for Health Plans & PBMs.

Discover Why the Nation’s Leading Health Plans & PBMs Choose Our Solutions To Streamline Their Utilization Management Processes

All Lines of Business

Agadia’s solutions are used across all lines of business (commercial, Medicare, Medicaid, etc.

All Channels

Our Prior Authorization solution, PAHub is available across all channels (phone, fax, ePA, e-prescribing, etc.

All Healthcare Services

Our solutions are applicable to all healthcare services, all benefit types (pharmacy, medical), lines of business, and channels.

At Agadia, we value our team’s wide range of talents and skills, and we are continuously seeking new opportunities to grow our capabilities. We take pride in our entrepreneurial and innovative environment and focus on empowering our team to grow and do meaningful work.

We welcome experienced professionals or recent college graduates who foster strong customer service, internal operations support, or outside sales experience, preferably in the healthcare industry.

Delivering Electronic Prior Authorization Efficiency & Compliance

As Prior Authorization volumes continue to rise, and as specialty drugs create additional clinical complexities, Health Plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs) are challenged to adapt while maintaining or improving operational and clinical efficiencies. PAHub is a HITRUST-certified solution that puts the tools at your fingertips to streamline and control all clinical, compliance, and administrative aspects of Prior Authorization at the point of care to improve compliance, and reduce turn-around times and costs.

By leveraging the latest technologies for data mining, data analytics, content management, and advanced decision support trees, PAHub, enables customers to automate the end-to-end prior authorization process.

A Fully-Configurable Software Leveraged to Automate Your MTM Process

With evolving CMS requirement complexities around Medication Therapy Management Programs (MTMP), Health Plans and PBMs are challenged to incorporate a comprehensive approach into their benefit infrastructure. Under 423.153(d), a Part D sponsor must provide an MTM program that:

  • “Ensures optimum therapeutic outcomes for targeted beneficiaries through improved medication use
  • Reduces the risk of adverse events
  • Is developed in cooperation with licensed and practicing pharmacists and physicians
  • Describes the resources and time required to implement the program if using outside personnel and establish the fees for pharmacists or others
  • May be furnished by pharmacists or other qualified providers
  • May distinguish between services in ambulatory and institutional settings
  • Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP)”

RxMTM+ gives Health Plans and PBMs the tools to efficiently manage and implement medication therapy management programs to meet these CMS requirements and address the needs of all lines of business. The solution provides flexibility to configure and define MTM program rules and enables staff to seamlessly process MTM cases for any disease state.

RxMTM+ is leveraged to streamline workflow and clinical modules, increase staff productivity, consult patients in a quick and efficient way, and improve the quality of care.

Furthermore, Health Plans & PBMs are able to ensure proper patient therapy, save valuable time and money, meet CMS requirements for CMRs & TMRs, and prepare for audits with accessible reporting archives.

Medicare Part D Quality Star Ratings: Manage the Clinical Needs of Your Patients

The Managed Care Market is increasingly challenged by unnecessary medical spending as a result of gaps in medication adherence. Furthermore, growing patient care barriers add pressure to improve quality measures through innovation.

Agadia’s patient safety and pharmacy quality improvement solution, RxSentinel+, is enabling Health Plans, Pharmacy Benefit Managers, and Third Party Administrators (TPAs) to configure and manage patient safety and medication adherence programs to achieve higher Clinical and Formulary medication compliance. RxSentinel+ leverages cutting-edge technology, enabling clients to configure custom clinical programs concurrently that monitor patient groups by disease state, identify dangerous drug-drug interactions, manage the formulary interchange, and more.

Evolving Complexities Require Innovation

As requirements around formularies rapidly grow in complexity, traditional formulary management strategies must evolve. Without innovations in technology to match the speed at which the market responds to new and changing drugs, Health Plans and PBMs are challenged by time-consuming tasks of administering and managing those formularies, as well as communicating formulary changes to relevant parties. Furthermore, growing complexities around state and CMS regulatory requirements for formulary creation and publishing drive the need for a streamlined and efficient process.