PerformRx, one of the nation’s 10 largest PBMs, had a long tradition of innovation. 80% of the company’s staff are pharmacists or pharmacy technicians, so its bold approach has been particularly notable in clinical care.
Then, the company decided to reimagine the technical infrastructure that it used for claims processing and other PBM functions. Like many PBMs in the industry, PerformRx was using a system that had served its clients for years but lacked efficiency and adaptability. The leadership team grew concerned that, over time, the legacy technology could slow its ability to adapt to regulatory changes and limit the kinds of differentiated services it could bring to the market. PerformRx wanted an advanced platform that would provide next-generation clinical and drug management tools and easily integrate with other best-in-class solutions.
PerformRx wasn’t alone in this challenge. Many companies in the space operate with legacy systems that haven’t been replaced or upgraded because companies would rather settle for a minimally adequate, but proven platform, than risk a complex overhaul or upgrade.
BUILD OR BUY?
PerformRx was in the process of carefully considering the risks, costs, and time involved in building their own platform versus partnering with another vendor when the company’s leadership met Abarca.
Abarca had built a PBM platform in-house, from the ground up. The company has been able to do this because of its experienced, tech-savvy team that includes PharmDs, engineers, and team members with a deep understanding of pharmacy benefit management. And, because it was founded just over a decade ago, Abarca wasn’t working with a Cobol-language, mainframe-based legacy system.
The result was Darwin, a modern, mobile-ready, and user-friendly platform, unlike any other in the industry. Darwin integrates all PBM functions – claims processing, formulary management, clinical programs, rebates, financial, and government programs – into a single browser-native interface.
PerformRx evaluated the alternatives available in the market and, after extensive study, realized that there was only one option that was both game-changing and proven. Once PerformRx had put Darwin through the paces in an extensive due diligence and testing exercise, the build versus buy question had a straightforward answer. The next question the company faced wasn’t as easy: How do we transition our core underlying technology without disrupting our business?
THE APPROACH
In any big project of this kind, collaboration is key. In this case, it came naturally. Abarca has an intensely people-first culture that integrated readily with the PerformRx team. Abarca created an account team dedicated exclusively to providing uninterrupted support for PerformRx staff. The two organizations created a joint task force that worked closely to develop a detailed, comprehensive implementation plan that prioritized vital change management initiatives, including:
- Educating stakeholders and subject matter experts across PerformRx in a way that was organized, methodic, and efficient
- Proactively managing potential challenges that could be caused by the transition, minimizing their impact or interruption to members’ prior benefits
- Integrating capabilities PerformRx had previously developed across multiple vendors into Darwin’s single interface
- Improving the experience of the PBM staff through access to real-time data and advanced analytics
- Maintaining ongoing communication with PerformRx’s key departments, including operations, technology, clinical services, account management, compliance, and finance
THE RESULTS
The implementation of the first 11 health plans, which included Medicaid, Medicare, and MMP, representing close to 2 million lives was completed in three carefully planned waves over 18 months. The implementation was accomplished with a high degree of accuracy, ensuring client and PBM satisfaction. Any operational or data issues that came up were resolved quickly and in close collaboration with PerformRx.
Users were delighted by the visually appealing, intuitive interface that put advanced technology and new business functionality at their fingertips. Clients were impressed that despite the massive complexity involved in the transition, they did not experience disruptions to member access, client financials, or compliance.
Now, PerformRx has the tools, technology, and flexibility they need to continue to grow their business, innovate for their clients, and deliver PBM happiness to their key stakeholders.