On-site and Offshore Support and Administration Increase Productivity and Lower Costs [hidden]

by admin on November 21, 2012

Client: Pharmacy Benefit Manager

A leading pharmacy benefit manager (PBM) with one of the nation’s largest mail-order pharmacy operations assisting its customers with moderating the cost and enhancing the quality of prescription drug benefits to millions of members through an extensive network of retail pharmacies.


  • The client’s goal was to increase productivity and manage seasonal volumes without increasing costs for its Plan File Administration operations—with the following challenges:
    • Workflow and automation. Workflow was highly paper-intensive and required numerous verification steps to ensure a high-quality end product, resulting in a labor-demanding process prone to errors.
    • Backlog. A large volume of plan maintenance requests, especially during open enrollment periods and at year end, combined with a lack of flexibility to ramp up staff to meet temporary volume increases, resulted in an excessive backlog.
    • Staff. Overqualified resources such as licensed pharmacists were required to perform many mundane operational tasks resulting in low morale and high turnover.
    • Quality issues, such as unverified plan modifications being introduced into production, and misprocessed claims, were leading to excessive processing costs and rework.

RMK Solution

  • Improved the staff, process and technology aspects of a high-performing organization.
  • Leveraged both on-site and offshore resources and introduced 24/5 processing, extending the workday and improving throughput.
  • Redesigned and streamlined the workflow and developed automated analytical tools to support that effort.
  • Developed a repeatable and scalable process that significantly reduced redundancy, was SAS 70 compliant and reduced the need for licensed pharmacists to perform many of the operational tasks.


  • This holistic approach enabled the client to increase productivity and lower overall costs. Significant benefits included:
    • Reduction in the backlog from over six weeks to less than a day
    • 50% cost reduction over previous in-house QA function
    • Vastly improved workflow tracking and monitoring to support management reporting, trend analysis and budgetary exercises
    • Significantly improved employee morale and reduction in turnover through leveraging in-house clinical expertise and sending data entry and verification tasks offshore

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