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Pharmacy Benefits Management Strategic Roadmap

The Pharmacy Benefit Management (PBM) client offers a complete suite of programs, including clinical services, mail, specialty, formulary management, rebate contracting, worksite centers, and claims processing.  In addition, they are a leading processor of Medicare Part-D prescriptions.  The client provides tailored pharmacy benefit management solutions to help clients with their cost containment strategies while providing members the access to the medications they need to ensure their health.  

Overview

The client was having difficulty developing systems and capabilities to satisfy their rapidly evolving business needs.  Their legacy business applications were outdated and difficult to maintain.  Enhancements and changes to business processes made it impossible for them to meet their objectives or client service level agreements.  Additionally, the client was trying to expand customer service offerings to improve its market share in the PBM space.  

The Challenge

The aim of the project was to:

  • Assess current business and IT environment
  • Collect re-engineering requirements, define gaps and prioritize opportunities
  • Determine complexity and dependencies
  • Create an application service architecture
  • Create a data architecture
  • Recommend implementation options
  • Develop a strategic roadmap

Strategy and Goals

The roadmap provided the client with a valuable communication vehicle to ensure that both the business and IT organizations had a shared vision. The roadmap also provided a common understanding of the next projects that the client should undertake. 

The data architecture blueprint defined the data restructuring necessary to support the re-engineering of current systems. The service blueprint defined the common service components to develop including Workflow, Rules Engine, Notifications, and Application Framework.

The Final Results

RCG developed a Strategic Roadmap to define a strategy, establish technology architectures and to re-engineer their key customer service offerings.  The Roadmap guided the client to becoming operationally efficient by stabilizing their systems environments, streamlining their business and IT processes, and realigning their organization with their service offerings in a single strategy.

The Conclusion

Following the delivery of the roadmap, RCG assisted the client in following the roadmap to enable them to provide new offerings at a higher level of service in a cost-effective way.

Industry
Healthcare

RCG Service Offering
Strategy & Roadmap

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