From wherever the program is, to where it should be.

Before recommending anything we establish what the program is actually doing — across all four disciplines, not just the compliance one. What it captures, what it leaves behind, where it is exposed, and how each of those interacts with the others.

The output is a prioritized picture rather than a score. Most assessments produce a list of findings ranked by severity. That is not the same as knowing what to do first, and it is the ranking that determines whether anything actually changes.

The work most reviews never get to. Eligibility breadth across departments and child sites, contract pharmacy performance, purchasing split across 340B, GPO and WAC, and the accumulation that quietly never happened because two systems never agreed on a join key.

None of this appears as a finding. Nobody is out of compliance for failing to capture savings they were entitled to. It simply does not happen, year after year, until somebody goes looking.

Turning policy into something that runs at the bench. Split billing and accumulator design, purchasing and wholesaler account structure, inventory and automated dispensing, contract pharmacy administration, and the ownership and escalation paths that decide whether any of it survives a staffing change.

A policy nobody can execute at two in the morning is not a policy. This is the difference between a program that is defensible on paper and one that works.

Formulary and therapeutic interchange, biosimilar conversion, site of care and drug selection — and the physician engagement that every one of those depends on.

This is the discipline most 340B advisors have no standing in, and it is where the largest decisions are actually made. A conversion that finance loves and the medical staff will not accept produces nothing. Clinical failure precedes financial failure every time.

Patient and encounter eligibility, inpatient versus outpatient status determination, the GPO prohibition for covered entity types subject to it, Medicaid carve-in versus carve-out and how that interacts with your state's billing rules.

Also the unglamorous half: keeping OPAIS registrations, child site listings and the Medicaid Exclusion File consistent with what the organization actually does today rather than what it did when someone last updated them.

Self-audit, HRSA audit response, corrective action plans, and documentation that traces every conclusion back to an underlying record. We work the way an auditor works: sample, follow the record end to end, see whether the trail holds.

And remediation is not only a cost. The work that closes a finding — reconstructing eligibility, reconciling accumulation, checking purchases against what qualified — is the same work that surfaces volume you were entitled to and never captured. Properly run, it recovers considerably more than the exposure that prompted it.