Case Study 6.19.2018

Supporting the Extended Growth of a PBM

Trexin helped a large pharmacy benefit manager prepare for the replacement of its claims adjudication system.

Business Driver

Our Client recognized that they had an aging claims processing platform that was increasingly incapable of supporting their expanding number of customers and membership due to three primary factors: 1) scaling limitations, 2) aging technology risks, and 3) capability uplift constraints. To meet their 5-year growth trajectory, they decided to launch a strategic initiative to modernize their claims adjudication system to ensure their growth strategy was fully supported by their core claims ecosystem. Because they had never run a transformational program of this size or scale from a financial or impacted-scope perspective, the VP of Application Development asked Trexin to provide advisory services to begin implementation vendor selection and design a deployment strategy that would replace the entire claims system within a 3.5-year timeframe.

Approach

Conducted under the auspices of a 12-week assessment, strategy, and roadmap project structured as a traditional 3-phase gap analysis, the effort focused on:

  • The completion of the business case for Board-level funding
  • The market scan and preliminary evaluation of qualified system development/implementation vendors
  • The drafting of an RFP that could later be used in a formal vendor solution selection process
  • The creation of a 3.5-year program roadmap
  • The development of an integration governance methodology for current projects

Trexin’s approach was highly collaborative, first working with the business owners to enumerate their top business objectives, and then working with IT to map those needs to future-state capabilities, identify gaps from the current-state, and prescribe a roadmap for capability improvement. Trexin also conducted workshops to collectively brainstorm with IT and business units, gather future-state requirements, and develop a governance methodology to execute the program.

Results

Trexin successfully completed all project objectives, culminating in an executable program roadmap for modernizing our Client’s claims system within a 3.5-year timeframe with projected costs within range of the Board-approved budget. A governance methodology to operate in synchronization with current business operations projects was also adopted. Trexin’s engagement was subsequently extended to collaborate on the development of a project lifecycle, to provide strategic advisory services on best practices, and to continue as an advisory partner through the implementation phases.

Tagged in: Aligned Enterprise, Growth & Acceleration, Healthcare, Program Execution
Social Media Accounts