Successfully completed PBM transition of Commercial, Medicaid, Medicare Part D and Health Exchanges for a large Health Plan

Client: Major Benefit Provider

Award-winning Fortune 50 provider of healthcare services for tens of millions of consumers through thousands of employer, government and union health plans.

Challenges

• Benefit Provider needed to transition all prescription drug plans in one benefit year and needed resources (clinical and non-clinical) to lead the effort

• Scope of services included the review, identification, documentation of all clinical rules (Utilization Management, Step Therapy, Prior Authorization, QA support and ongoing operational maintenance) for all Lines of Business
• Client management wanted this client’s first experience with the new PBM to be a positive one
• The timeframe was tight, with the project overseen at the highest executive level

RMK Solution

• RMK planned, set up and administered a near-site and off-shore delivery solution
• Scheduled and directed shifts seven days a week to support three implementation waves (May, June and October)
• Devised and implemented automation which assisted in the migration
• Coordinated with other departments within the PBM and the Health Plan client
• Ensured ongoing transparency through overall project management and tracking

Results

• Delivery was completed on time, under budget with lower than expected errors reported after the go-live date allowing the Command Center to be dismantled earlier than planned
• The seamless, “invisible” solution led to increased business for the client
• The quality of the project was recognized at the highest levels within the PBM as well as the client