August 18, 2018

Pharmacies and PBMs face a myriad of changes that are driving reinvention of business operating models—regulatory and demographic changes, consumerism, technological advances, shrinking margins in core revenue streams and commoditization of services. The best way to deal with these changes is by being able to rapidly build distinctive capabilities and optimize existing operations.
Team should help retail, specialty and mail order pharmacies and PBMs understand the impact from fast-paced industry developments and rapidly respond to changing market dynamics.


 Regulatory Compliance

Team should help healthcare organizations evaluate the impact of regulatory requirements and implement supporting solutions to help ensure compliance.

  • ICD-10
  • Medicare Part D compliance
  • NCPDP D.0 compliance
  • Controlled substance dispensing
  • Patient compliance

 Health Intelligence and Analytics

The ability to access and leverage data is changing the way business decisions are made, with rich insights enabling evidence-based decision-making and proactive planning. Team should provides expertise on the data that should be collected across a wide range of attributes affecting pharmacy and PBM businesses, helping customer make well‑informed decisions.

  • Analytics strategy
  • Process innovations

 Investigative Services

Enabling organizations to identify and resolve intentional and unintentional errors or verify the absence of both is critical. With significant dollars being lost to fraud and abuse each year, investigation and recovery efforts are critical to an organization’s overall financial health.

 Operational Improvement

Team should help healthcare organizations drive cost reduction and revenue enhancement through improved efficiency and effectiveness and process transformation.

  • Best-in-class series (Claims, Enrollment, Medical Management)
  • Requirements
  • Product evaluation and selection
  • Operational readiness (BPS)


New consumer-focused operating models in healthcare demand a shift in thinking, requiring many companies to go from a B2B to B2C focus. Team should help healthcare organizations understand the requirements for health benefit exchanges, manage the patient and member experience with solutions that drive engagement and help build effective strategies for member identification and retention. Services span these areas:

  • Customer engagement
  • Customer experience
  • Customer retention

 Implementation Services

Complete project and IT implementation and support services, including:

  • systems modernization
  • Administrative, claims management, clinical and electronic health record implementations
  • Custom development and maintenance
  • Systems integration and program management
  • ERP and CRM systems
  • Data warehouses
  • E-health, self-service applications and portal development

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