Challenge
A large Pharmacy Benefits Management (PBM) was unable to keep up with the rapidly evolving regulatory and compliance requirements in Medicare, Medicaid, and Consumer Driven Healthcare due to systemic issues which resulted in substantial audit risk, member impact and client frustration.
Solution
We led the assessment & roadmap to streamline the regulatory project delivery & portfolio management. Established key metrics & dedicated teams with more agility and flexibility to deliver compliance needs. The streamlining of the entire compliance delivery life cycle eliminated delays and low-value steps, as well as creating a more repeatable cadence to keep up the regulatory market changes.
Results
This transformation eliminated systemic regulatory issues, supported business growth, increased visibility, and improved client satisfaction and responsiveness for the Government Programs portfolio. The client was able to double the speed of project delivery throughput while throughput increased 400%
