2018 Plan Year: Delivering Service and Operational Excellence

Call center operator with headset
February 8, 2018
Vice President, Client Service Operations, CVS Caremark

For many payors, and their plan members, the beginning of a new year means a new pharmacy benefit provider or changes to their pharmacy benefit plan. When executed effectively, it can ensure a positive member experience and avoid disruption or inconvenience.

At CVS Health, the 2018 benefit year was our biggest ever, with 232 new payors becoming new pharmacy benefit management clients, accounting for 4.1 million net new members. In addition, existing clients implemented benefit changes for their members. We know that for each payor — whether a new or existing client of our pharmacy benefit manager (PBM) CVS Caremark — what matters most is ensuring a smooth transition for their own members. Our record of exceptional implementation continued with this welcome season. Client satisfaction continued to improve across all areas, with service levels reaching record performance.

Proof in the Numbers

With strategic investment in personnel, processes and technology, we were able to successfully handle 244 million transactions during the first 31 days of this year, while reducing system response time by almost 17 percent — to just 0.24 seconds. In all, we processed an average of 91 transactions per second. In every recent benefit year, we have improved on the performance of the prior year. Of members new to CVS Caremark or those undergoing plan benefit changes, 99.82 percent did not experience any issues. Of the issues reported, 97 percent were resolved on the first call. 

In 2018 we handled 244M transactions in the first 31 days.

Planning Early, Harnessing Technology

The secret to success? Ongoing planning that begins early. Preparations for a new benefit year begin January 31 of the prior year — the day onboarding and transition activities for the current year end. The first step is estimating where and what additional investments are needed. For the 2018 plan year, we invested $50 million in infrastructure and $13.8 million to automate workflows and help boost efficiency and accuracy. We also tracked ongoing progress and performance across 39 different functional areas in the readiness program. We harnessed the latest in technological advances — predictive modeling and artificial intelligence — to help us:

  • More rapidly identify and resolve transactions processing issues
  • Identify members with a higher risk for future medical expenses and intensify outreach to reduce any potential issues with access to care
  • Conduct proactive outreach to members who may be at higher risk of adverse outcomes from benefit or network changes and provide extra support to help them make the transition

Ongoing Operational Improvements

Each year, we take stock of “lessons learned” and develop a game plan for the next year. For 2018, we took a number of steps to further improve our processes for a seamless client and member experience, including:

Checkmark Creating a vendor management approach to facilitate key data exchanges required by clients’ third-party vendors
Checkmark Expanding our comprehensive program management capability to ensure alignment with client expectations on timing and quality of operational deliverables
Checkmark Increasing flexibility in Customer Care staffing to maintain high levels of service, especially during peak periods

A new plan benefit brings changes for clients and their members. Whether big — like a new PBM — or small, each change is an opportunity to ensure and enhance member satisfaction, or a chance for something to go wrong. Our focus is on always delivering the kind of service and operational excellence that ensures a great member experience and a seamless start to the new benefit year — and build upon that success the following year.

Want to learn more about how we use the latest technology to ensure a seamless transition and onboarding experience? Ask Us
February 8, 2018
Vice President, Client Service Operations, CVS Caremark

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Member Engagement

Our success in helping people on the path to better health depends on how well we engage members and encourage them to take the right steps.

Benefit Plan Changes

Intelligent targeting and tailored communications about formulary or pharmacy network changes can ease the transition for affected members.


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

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