A Self-Servicing Option
1.0 Executive Summary
Argus Health Systems, Inc. is a pharmacy benefit management company (PBM) that provides information management services to healthcare organizations, specifically, managed care organizations, and pharmacy benefit management companies, alike. Headquartered in downtown Kansas City, Missouri, Argus was founded in 1983. The key executives are President and CEO Jonathan J. Boehm, Senior Vice President Candy Yakimo, Vice President and Controller Elizabeth Toohill, Senior Vice President of Strategic Alliances Roderick McKinney, and Director of Marketing Stu Goldstein. In addition to their roles, they are excited about the enhancement tool that Argus ...view middle of the document...
These healthcare organizations are located throughout the United States, where many of them compete with each other, according to the geographic regions they are licensed to serve. Argus will provide a self-servicing option through value innovation. The price will be in line with the industry price point for a la carte services, offered under contract. So that Argus can remain competitively priced for enhancement tools in the PBM market. Volume will be based on the number of registered users, per customer. The financial objective is primarily to capture a higher gross profit margin by the end of fourth quarter, 2017.
2.0 Situation Analysis
Managed care organizations that contract with federal government agencies are known in the industry as plan sponsors. Plan sponsors must comply with all federal program regulations and guidelines, per written contract. Failing to comply runs the risk of substantial penalties and fines. Therefore, it is crucial that all administers of prescription drug benefits ensure that any customer request to implement, or edit a federal program initiative is provided for in the customers’ contracted service level agreement (SLA). Thus, if the work to implement a federal program is late, incomplete, or completed incorrectly, CMS could fine the customer. Consequently, the customer would bill Argus for the full amount of the fine.
Argus Client Services is comprised of five instrumental teams:
1. Account Management (AM),
2. Benefits/Pharmacy Benefits Analysts (PBA)
4. CMS Programming (CPO)
Each department has a unique role in satisfying customer expectations. Each role is critical to maintaining regulatory standards, performance guarantees, SLAs, and are instrumental in completing quality deliverables on time. The logging, tracking, and monitoring of deliverables is a critical step towards ensuring that plan sponsors remain in compliance with the federal government. There should be nothing arbitrary about recording and retrieving information. Simply tracking requests is a waste of time and effort, if there is no reliable customer tracking system. If a PBM is not using a good reliable tracking system, then, most likely, the organization is doomed to fail.
According to James Evans and William Lindsay (2011), “Meeting customer expectations (that is, providing satisfiers) is often considered the minimum required to stay in business” (p. 200). That said, sufficiently managing customer requests is a huge challenge in the PBM industry. Otherwise, Argus risks losing its reputation for seeking to provide a higher level of quality service, as well as, losing customer loyalty, revenue, and profits.
2.1 Market Summary
According to IBISWorld (2013), due to healthcare reform, there has been an increase in insurance coverage, people are living longer, and the US population is steadily rising (IBISWorld, Prescription strength, 2013). Additionally, The IMS Institute (2014) claims, “Utilization...