Client
The client is a top pharmacy benefit manager in the US. They optimize the complete pharmacy care experience by offering services, including pharmacy benefit management, prescription savings programs, mail order and specialty pharmacies, as well as group and individual Medicare Part D plans.
Challenge
Amidst the fast-evolving healthcare sector, this prominent US Pharmacy Benefit Manager (PBM) found itself facing a multitude of daunting challenges:
- Low Member Engagement: The client was struggling with low member engagement across multiple channels.
- Low STAR Rating: The client’s STAR rating was suboptimal, affecting their reputation and market position.
- Infrastructure Scalability: Existing infrastructure was not scalable to accommodate the increasing volume of calls, leading to high operational costs.
- Regulatory Needs and Consumerism Trends: Rapidly changing healthcare and pharmaceutical regulations and consumerism trends demanded a more flexible approach.
To overcome these challenges and adapt to evolving industry dynamics, the client launched a digital transformation roadmap, which included the following initiatives:
- Core Business Process Transformation: The transformation aimed to revamp the core business processes and enhance consumer-facing engagement portals.
- Portal Redesign: The existing portals needed to be redesigned with improved functionalities, such as enhanced pharmacy search and member portals that streamlined operations for members, clients, and brokers.
- End-to-End Digitalization: The initiative involved the digitalization of functions like enrollment and claims administration.
- SaaS Application Development: SaaS applications were aimed at attracting new clients and enhancing business operations.
To deliver on these important digital transformation initiatives, this top pharmacy benefit manager partnered with Hexaware.
Solution
As the trusted digital transformation partner, Hexaware played a pivotal role in helping the client achieve their goals. Here’s how:
Developed a Pharmacy Benefits Management (PBM) Platform: This platform could also be offered as a SaaS service to smaller and medium-sized PBMs, providing an additional avenue for revenue growth.
Enhanced User Experience: Hexaware transformed the Medicare user experience, utilizing a powerful set of data-driven technology platforms. Integration with various digital touchpoints like smartphones, smartwatches, tablets, Amazon Alexa, and chatbots enabled seamless omnichannel access from anywhere and at any time.
Drove Value Through Digitalization and Modernization: Hexaware completely redesigned the portal, incorporating design thinking principles and digital technologies, resulting in a superior user experience. The application was designed with a microservices architecture, ensuring future integration capabilities. Various functions like enrolment, policy administration, claims submissions, and claims adjudication were digitalized. The modernization of the portal helped in boosting the customer’s star ratings.
Designed Multi-tenant Architecture: The new solution was designed on a multi-tenant architecture, guaranteeing modularity, scalability, availability, and maintainability. HIPAA security measures were implemented to secure data encryption, Single Sign-On (SSO) enablement, and user authentication.
Adopted Distributed Agile Approach: The project was executed using a distributed agile transformation approach, leveraging Hexaware’s RapidX™ for Dashboarding. This approach laid a strong foundation for continuous improvement and insights into the client’s operations and performance.
Benefits
The digital transformation had a profound impact on the client’s operations and business outcomes:
- 65% improved business processes with reduced human intervention and errors
- 84% improved response time for checking eligibility criteria
- 60% reduced call center volume, resulting in substantial cost savings
- 83% increased member engagement, positively impacting customer satisfaction and loyalty
Summary
A US Pharmacy Benefit Manager faced low member engagement, a low STAR rating, inadequate infrastructure scalability, and high operational costs. To address these issues and adapt to healthcare trends, they launched a digital transformation initiative with Hexaware. This led to an exceptional customer experience through data-driven technology, seamless omnichannel integration, and significant cost reductions, ultimately enhancing customer engagement and value delivery.
