Streamlining PBM Compliance Portfolio

Streamlining PBM Compliance Portfolio

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...
Agile Transformation & Business Agility

Agile Transformation & Business Agility

Challenge Health-care insurer had various levels of maturity in their agility journey, but was experiencing challenges scaling agile to deliver large multi-million dollar business solutions across the release trains in the enterprise. Solution Established Scaled Agile...
Implemented New PBM Member Experience Capabilities

Implemented New PBM Member Experience Capabilities

Challenges For both contractual and strategic reasons, a healthcare insurance company needed to jointly build out a new Pharmacy Benefit Manager (PBM). The company was looking for integrated medical and pharmacy benefits for members including billions of dollars of...
Consolidated Enterprise Healthcare Systems

Consolidated Enterprise Healthcare Systems

Challenge Coordinate the consolidation of six claims systems, middleware architecture, and customer facing system portfolios and ensure seamless transitions for millions of members as they move from legacy claims & customer facing systems to strategic platforms...
Improving Network Patient Outcome Accountability

Improving Network Patient Outcome Accountability

Challenge  Our healthcare system under-emphasizes the pharmacists role in driving patient adherence and outcomes. This presented our client with an opportunity to develop a market leading product to help improve treatment results and reduce cost of care. Solution...