Situation:

A large payer was undergoing leadership changes while formalizing a cost-of-care management approach and needed support validating savings opportunities related to drug costs and pharmacy operations. The payer desired a review of operational functions, organizational structure, vendors, and market competitiveness.

Approach:

AArete performed an assessment of various utilization management initiatives, including prior authorization, as well as a review of the overall organizational structure and vendors to identify gaps and opportunities across pharmacy and medical benefit drug management. Leveraging market intelligence and operations expertise, strategies for market competitiveness and best practices were established.

Results:

AArete identified $10M in savings opportunities and provided analysis, competitive fee recommendations, and key points of leverage for negotiations related to vendors.

Recommendations were provided for an organizational structure that aligned with the payer’s business accountability structure to improve their ability to reach cost-of-care savings targets