Newly Formed Gainwell Technologies Named PBM for Ohio’s Medicaid Program

The Ohio Department of Medicaid (ODM) recently announced Gainwell Technologies (Gainwell) was selected to be the agency’s single pharmacy benefits manager (PBM). The award moves Ohio closer to realizing greater transparency and accountability in Medicaid’s $3 billion pharmacy program.

Ohio’s Medicaid MCOs previously contracted with large national PBMs, including Cigna Corp.’s Express Scripts and CVS Caremark, on an individual basis.

DXC Technology recently sold its U.S. State and Local Health and Human Services business to Veritas Capital, a leading investor in government and healthcare technology businesses, to form Gainwell Technologies. Gainwell operates as a standalone company with over 7,500 employees who support clients across 42 U.S. states and territories.

Since 2010, Gainwell has achieved 16 Centers for Medicare and Medicaid Services (CMS) certifications — more than all other vendors within the same time period. It provides services for 29 state Medicaid programs, processes more than 195 million pharmacy claims a year, and answers 6.6 million provider and recipient phone calls annually on behalf of state health care customers.

HMS, an industry-leading technology, analytics and engagement solutions provider helping organizations reduce costs and improve health outcomes, and Veritas Capital-backed Gainwell have entered into a definitive agreement whereby Gainwell will acquire HMS.

Veritas will look to optimize the HMS solution set across Gainwell and Veritas-backed Cotiviti, Inc., a leading provider of data-driven healthcare solutions. Gainwell will acquire the HMS capabilities focused on the Medicaid market, including solutions delivered to states and managed care organizations, and Cotiviti will acquire the HMS capabilities focused on the commercial, Medicare, and federal markets.

The addition of the HMS business lines will further expand Gainwell’s and Cotiviti’s capabilities with unique, data-driven technology and service solutions expected to drive greater impact in the healthcare market.

Clients will be offered a broad range of complementary, scalable and flexible solutions that improve outcomes and quality as well as reduce waste and inefficiencies through technological innovation, service excellence and unparalleled industry expertise.

Takeaway: Gainwell’s offerings including Medicaid Management Information Systems (MMIS), fiscal agent services, program integrity, care management, immunization registry and eligibility services