Case Study 5.9.2019

Merging PBM Business Processes and Systems

Trexin helped a leading pharmacy benefit manager integrate a large acquisition targeting $1B+ in synergies.

Business Driver

One of the largest national pharmacy benefit managers (PBM) had recently finalized its acquisition of another large PBM. Planning over $1B in cost-reduction synergies within 14 months, the newly combined company quickly set about integrating its organizations, processes, and information technology, including facility-, system-, and personnel consolidation. To mitigate delivery risk by introducing additional post-merger integration leadership and expertise, one of the company’s Vice Presidents of Technology asked Trexin to lead one of the most important workstreams, focused on claims processing consolidation.

Approach

A key goal of the claims processing consolidation workstream was to maintain client service throughout the 14-month effort, effectively completing the transition of thousands of clients and 45M lives to the target platform without disrupting client operations. To meet this challenge, a claims integration project management office (PMO) was established, and Trexin played a key role in developing, implementing, and operating that PMO. Once in place, the Trexin team was itself responsible for managing a $15M portfolio of IT integration projects to integrate claims processing and to ensure claims applications could scale to post-merger volumes.

Results

All clients were successfully transitioned to the consolidated platform within the 14-month target window, enabling legacy system retirement and data center consolidation. As a direct result of Trexin’s successful performance on claims processing consolidation, the Vice President of IT then asked Trexin to lead another program, a $5M initiative to build a custom platform for processing member-submitted manual claims. This new system replaced an outsourced vendor solution, bringing the capability in-house. Again, Trexin led the successful completion of that effort, on-time and on-budget. In addition, the previously outsourced vendor relationship was retired within one fiscal quarter after starting the transition to the new platform for manually submitted claims.

Tagged in: Growth & Acceleration, Healthcare, Program Execution
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