Tricast Snags $3.3M to Expand Push Into Pharmacy Benefits Software

Xconomy Wisconsin — 

Tricast, a Milwaukee-area healthcare insurance consulting business that started selling analytics software last year, has raised nearly $3.3 million from investors to grow its software business, president and CEO Greg Rucinski says.

Rucinski founded Tricast in 1997, which has primarily conducted health insurance audits and provided other consulting services for customers such as public employee health plans, school districts, labor unions, commercial health insurers, and companies. Tricast had developed software that it used in-house to monitor the processing of patients’ health benefits, such as Medicare Part D drug plans. Eventually, the company decided to start selling such a product to its customers so they could do their own tracking and analysis of pharmacy claims data.

The Web-based software product, Reveal, hit the market last year—a big move for a traditional consulting company into a healthcare IT sector that has exploded nationally over the past few years. Rucinski declined to talk sales numbers or disclose who is using Reveal, but he is bullish on the prospects for a product that he sees as an “enormous” business opportunity.

“We’ve done pilots where we’ve shown the value of the software,” Rucinski says. “The challenge is to get that message out and build an infrastructure that allows us to support software as a service.”

Healthcare IT is a growing sector in Wisconsin, although most of the companies are concentrated in and around the state capital of Madison. There’s a smaller cluster in the Milwaukee area, and new healthcare IT companies have launched here in the past few years, including Mpirik, Intellivisit, ConsortiEX, and iDAvatars.

The influx of capital for Tricast marks the first time it has raised money from outside investors. Rucinski declined to name its new backers, but a filing with the SEC includes two members of the team at Brook Venture Partners, based outside of Boston.

The money will be used in part to hire software developers and other new staff members, Rucinski says. The company has around 35 full-time employees right now, mainly located at its headquarters near the Medical College of Wisconsin in Wauwatosa. “We foresee doubling that over the next year and a half,” Rucinski says of the employee count.

The basic idea behind Reveal is to enable the automated processing of prescription drug benefits in real time, so that customers can quickly find and fix problems, while also helping to predict future complications. It could prove useful in battling fraud and waste in the healthcare system, Rucinski says. “Within our software, they can actually track their work flow, track oversight, to prove to everybody that they are doing what they’ve been contracted to do,” he says.

The software is capable of pulling data from multiple sources, including medical claims. Say, for example, a patient tries to purchase a drug that wasn’t covered by his or her insurance and wasn’t prescribed by the doctor. The software could detect that pharmacy claim and report the problem, Rucinski says. Or, perhaps a claim was rejected at the pharmacy; the software can report that to the health plan to check if the patient was supposed to receive the medicine.

Another way the software could be useful is in identifying “gaps in care,” such as patients who aren’t complying with their treatment plan. For example, it can spot if a patient who received an organ transplant isn’t getting the prescribed pharmaceuticals, which are important for trying to ensure the organ isn’t rejected by the body. Properly following the treatment plan can be crucial to avoiding unnecessary follow-up procedures and incurring additional costs, Rucinski says.

“It’s really cost prevention,” he says. “But it’s good clinical oversight.”

Ultimately, Reveal could help health plans improve their ratings with the Centers for Medicare & Medicaid Services, Rucinski says. “That allows them to be reimbursed at a higher rate from the federal government,” he says.