Contact Center Modernization for Top Pharmacy Benefit Manager
Overview.
Our client is the 5th largest Pharmacy Benefit Manager in the US, owned by 19 separate health plans. Over the last four years, they have launched several initiatives to improve cost structure, modernize its technology and enhance its competitiveness for growth. Growth has been largely organic, but a recent acquisition is quickly changing and transforming the business landscape within their walls.
Consumers, regulations, and other market factors are reshaping PBMs. For PBM’s to survive, they must:
Find a better way to reach and serve patients by leveraging modern technology and their constituent channels.
Streamline Prior Authorizations
Provide greater transparency in their role of negotiating drug prices.
Reshape their operations and reduce internal costs.
Solution
The client has partnered with Coforge to deliver modernized end-to-end experiences and drive operational cost reduction:
A modern contact center solution leveraging AWS Connect and Pega for a seamless digital experience.
A suite of Pega solutions within clinical operations to drive increased auto authorizations and physician clinical reviews.
End-to-end Pega workflows that manage all aspects of drug list management, network operations, and claims exceptions.
Integrated Pega framework to reduce IT delivery costs.
The Impact
30%
cost reduction in service operations
35%
decrease IT delivery by 2025
The client has been able to eliminate brick-and-mortar contact centers and automate core operational processes. processes.
Transformed the Clinical and Call Centers from traditional to virtual, global, integrated, & digitized
Coforge enabled the client to achieve greater than 30% cost reduction in service operations.
Empowered client to have fully automated Prior Authorizations by 2025 leveraging the Pega framework; Authorizations and claim exception handling have reduced touchpoints.
The client is on track to decrease IT delivery costs 35% by 2025 by expanding the integrated Pega framework to all areas and reducing the IT footprint.
