Organizational Turnaround

IndustryManaged Care/ PBM
ProblemThe PBM's prior authorization process needed to be rebuilt due to the increased volume of requests. The existing process was inefficient, causing delays that resulted in service issues with their clients. The organization requested an operational assessment to streamline the processes allowing the business to handle future growth and complexity of prior authorization decision criteria while minimizing the addition of new staff.
PHSI SolutionThe PBM’s prior authorization process required an operational turn around. PHSI investigated the root cause of the operational problems focusing on people, process and technology areas. PHSI used cost accounting techniques to benchmark operational processes and identify true cost of processing prior authorization requests. PHSI recommended an organizational restructuring, process improvements, and technology enhancements that increased operational capacity and throughput. Management controls were established to manage workflow, focus efforts on lowering costs and improving quality.
ResultsThe clients operations were stabilized and improved results were achieved as new management was hired to manage the prior authorization process. The implemented changes improved the work flow and enabled the PBM to operate more efficiently.