2019 Welcome Season

Improved Service, Greater Client and Plan Member Satisfaction

Call center operator with headset
February 19, 2019
Vice President, Client Service Operations, CVS Caremark

It’s the start of a new year and that often means a time for change. For payors and plan members, that may mean switching to a different benefit provider or making changes to their plan design.

Our focus, for new and existing CVS Caremark pharmacy benefit management (PBM) clients, is on service excellence to ensure we provide a seamless transition that keeps members on track with their health while supporting unique payor goals.

This year, we achieved service improvements across all critical areas leading to more accurate benefit setups, quicker issue resolution, and as a result, the most successful welcome season for us to date, and a smooth transition or onboarding for clients and members. Of 222 new clients, accounting for 3.2 million new lives, and 1,357 existing clients with plan benefit changes, 99.89 percent of members had a seamless experience with no issues. In all, we processed 249.5 million transactions in January — 2.3 percent more transactions than last year.

99.89 percent of members had a seamless experience with no issues.

Of the relatively few issues reported, 98 percent were resolved on the first call. That’s not by accident or luck. Providing a seamless member and client experience means rigorous planning and preparation, which begins almost the minute the previous year’s welcome season ends.

Assess and Learn Prepare Execute Deliver
Q1 2018 Q2 2018 Q3-Q4 2018 January 2019
  • Assess performance and opportunities from 2018 welcome season
  • Create formal lessons learned summary
  • Key business areas define plans, coordinate and communicate with stakeholders
  • Kick-off 2019 welcome season planning process
  • Weekly status reviews with PBM Executive Committee
  • Plan and enhancements confirmed
  • Execution exercises for risk management
  • Resolution Center established
  • Virtual command centers organized to monitor, identify, triage, and resolve issues in real time

Assess and Learn
Q1 2018
Assess performance and opportunities from 2018 welcome seasonCreate formal lessons learned summary

Q2 2018
Key business areas define plans, coordinate and communicate with stakeholdersKick-off 2019 welcome season planning process.

Q3-Q4 2018
Weekly status reviews with PBM Executive CommitteePlan and enhancements confirmedExecution exercises for risk management.

January 2019
Resolution Center establishedVirtual command centers organized to monitor, identify, triage, and resolve issues in real time.

Harnessing the Power of Technology

Significant investments in automation, system upgrades and artificial intelligence have helped us streamline the implementation process, increase productivity and improve quality.

A series of rule-based, machine-learning algorithms helped internal teams detect potential issues with benefit or plan set ups in real time during claims adjudication. Nearly 90 percent of all issues — 4.3 percent more than last year — were identified internally. Once an issue was identified, Account teams took immediate action to help mitigate member disruption. As a result, mean time to resolve issues was down 31.6 percent from 2018.

System response time improved by 37.6 percent — from 0.24 seconds to 0.16 seconds.

Tailored Engagement to Support each Unique Member’s Journey

Effectively addressing each member’s unique needs and potential challenges requires a tiered communication strategy — not a one-size-fits-all approach. Typically, all members receive a notification 45 days in advance of implementation. Then, using predictive modeling, we identify members who may need additional support, or may be at risk of falling off therapy or experiencing a reject at the pharmacy. We tailor our approach to the member’s need. Those who need to take additional action, such as moving their prescription to a new pharmacy, receive a more detailed letter 30 days prior to implementation outlining the steps they need to take. We also offer a high-touch outreach program for members who might need greater transition support.*

Our member communication approach — and availability of even more convenient self-service tools on Caremark.com — helped reduce calls to Customer Care by 4.8 percent and reduced calls to the Pharmacy Help Desk by 31.4 percent from 2018.**

Want to learn more about how we use the latest technology to ensure a seamless transition and onboarding experience? Ask Us
February 19, 2019
Vice President, Client Service Operations, CVS Caremark

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Helping members get a smooth start with their new PBM can improve satisfaction and results.

*For clients who have implemented Maintenance Choice. Exclude controlled substance, antibiotic and specialty drugs. All Exclusive Specialty members receive call from CVS Specialty. Mail pricing at CVS retail for ERISA governed plans. The Maintenance Choice program is available to self-funded employer clients that are subject to ERISA. Non-ERISA plans such as insured health plans, plans for city, state or government employees, and church plans need CVS Caremark Legal’s approval prior to offering the Maintenance Choice program. Prices may vary between mail service and CVS Pharmacy due to dispensing factors, such as applicable local or use taxes.

**4.8 percent decrease in calls to Customer Care and 31.6 percent decrease in calls to Pharmacy Help Desk are each per 10,000 members. Year over year total call volume decline to Customer Care was 1.6 percent (3.61M for 2019 vs. 3.66M for 2018).

Source: CVS Health book of business data, 2019.

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Image source: Licensed from Getty Images, 2019