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Advancing our technology roadmap

Our commitment to providing industry-leading, digital-first experiences

 

From the Editors

Briefing

In 2022, CVS Health served 115M plan members, processed 3.5B claims and 14M prior authorizations, and filled 63M mail order and specialty prescriptions. Our commitment to technology and innovation allows us to meet the needs of clients, members, and providers on a large scale.

Presenting on our technology roadmap at 2023 Forum, Callie Baumann, Vice President of IT Operations and Client Delivery at CVS Health, highlighted our top priorities as a pharmacy benefit manager: investing in our core capabilities and providing seamless digital experiences.

 

Callie Baumann explains CVS Health's technology investments at 2023 Forum.

 

In 2022, we served 115 million plan members, processed 3.5 billion claims transactions, filled 63 million mail order and specialty scripts, and processed over 14 million prior authorizations.

The foundation upon which all of that sits is our solid and resilient technology foundation.

We're focused on both maintaining the reliability of our core systems, but also future proofing the PBM ecosystem. Our goal in focusing on the provider experience is to reduce the administrative burden and to streamline the end-to-end process while balancing the needs of our clients to control spend.

We're providing plan benefit and cost transparency via our real-time benefit solution.

This is a solution that allows members and providers to know if a drug is covered, what the out-of-pocket costs are, and to see clinically appropriate alternatives and understand any prior auth and UM requirements.  

For prior authorizations we know that it's a friction point for providers and patients, and we know that we need to continue to invest and are continuing to invest in streamlining the end-to-end prior authorization process.

One of the ways we're doing that is by leveraging intelligent automation.

An example is how we're leveraging data extraction in vision cognitive services to pre-populate notes created during the verification process.

That reduces the average time to initiate prior authorization for providers by 24 to 48 hours. We know that every interaction with consumers is an opportunity to build trust.

It's an opportunity to have a meaningful experience.

And as such, we've been investing in technology to transform our contact centers. We're implementing conversational AI self-service experiences that’ll result in faster, shorter interactions.

Enabled by understanding member intent via real time insights that are generated. My PBM will be the single platform for capturing and maintaining client requirements across products, services, platforms, and capabilities.

It has self-service, guided, intuitive workflows to help you make informed decisions, to provide visibility into the CVS delivery process, to enable perspective analytics, and to allow for more consultative interactions.

Bottom line, with my PBM you're going to be able to access, review, and update your plan in one easy-to-use digital platform.

 

To maintain the reliability of our core systems, we test and deploy industry-leading technology to each of our platforms. CVS Health continues to invest in our claims adjudication platform, find ways to streamline our specialty platform, and introduce AI-powered technology to alleviate friction associated with prior authorizations.

Stakeholder satisfaction is our North Star, and we know satisfaction looks different for clients, members, and providers. We want our clients to rely on us their trusted pharmacy benefit manager. Solutions like MyPBM, a cloud-based, self-service platform, drive efficiency, transparency, and value for our clients, offering the ability to access, review, and update plans from a single platform.

For members, we know that every interaction is an opportunity to build trust, which is why we are investing in enhanced solutions such as online chat, improving our mobile experience, and reimagining digital onboarding.

We are also committed to reducing administrative burden for our provider partners. From tools that support benefit and cost transparency to our enhanced EHR connectivity, we enable providers to provide a better, more seamless clinical experience.

CVS Health’s industry-leading technology paired with our overall reach enables us to provide this level of service and allows us to push the needle on what is possible.

 

 

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