CVS Safety, Quality, & Monitoring
How might we provide Clinical Pharmacists with a quicker and more efficient way to review prescription claims in order to meet their large, daily quotas because legacy systems are slow, cluttered, and outdated?
Backstory
Every time a benefits plan member uses their health benefits to fill a prescription, pharmacists off-site and behind the scenes analyze the claim and the member's claim history to ensure that there are no potential, dangerous, drug interactions or that the member isn't "doctor-shopping" for addictive, narcotic pharmaceuticals. For decades, CVS pharmacists have used two old, clunky, legacy applications to complete their analyses. ​My team and I were tasked with creating a brand-new app to replace the legacy systems in order to increase efficiency and productivity and to save CVS a whopping $40m dollars in annual maintenance costs.
An Uphill Battle
Our user base consisted of 16 pharmacists and managers across a couple of different specialties. For example, there were certain teams of pharmacists that reviewed claims made by Medicaid members, members covered by their employer plans, etc. All of the pharmacists used the same two legacy systems in their daily work, Retro, and CSS.
Retro
CSS
Poor System Performance
The old systems had frequent performance issues creating an unreliable and frustrating user experience. Crashes would occur throughout the day, but many times would occur first thing in the morning and after lunch. These failures would negatively impact job performance.
Too Many Clicks
Pharmacists felt there were too many clicks required to complete their daily tasks. They would queue up cases to review based on certain criteria. However, sometimes a certain queue wouldn't have many cases, requiring them to return to the home screen and create another queue, and so on.
Missed Daily Targets
Pharmacists had daily, claim review quotas of about 100. This amount was a lot because some cases took several minutes to review. Many times poor system performance would cause our users to struggle to hit quotas consistently.
Information Overload
In order to decide on cases, pharmacists relied on tables displaying members' claim histories. However, these tables displayed too much information, and it became difficult for users to scan for the information they needed, thereby slowing their task times.
Emotional Repercussions
Productivity hits were causing morale to dip. Pharmacists found it challenging to keep their enthusiasm high. Ultimately, this could negatively impact members should they miss a red flag on a claim. Their job duties were monotonous already, so additional blockers could be exponentially demotivating.
Also, users were feeling unfulfilled in their roles and with their tools, because they had to look outside of the current apps to find the necessary info. The tables in Retro were just too dense and busy to find what they needed quickly.
Setting Pharmacists Up For Success
We were lucky to have high access to users because we were able to gain a strong understanding of their problems, what limitations we had, and what goals they were trying to achieve. I ran a design studio with 16 pharmacists in addition to numerous individual sessions. Those conversations led to the designs you see here.
Automated Queues
During our conversations, we had an idea that it would be great if users didn't have to create their own queues at all but instead they would have preloaded lists of queues that they could pick from and begin working right away. The "My Carrier Queues" and "Opportunity Queues" sections you see below are just that. Two different types of preloaded queues that would save users time and mental energy.
Multiple Queues
Although most of the queue creation would become automated, some users still needed to create queues manually. To save these users the time and effort of having to go back and forth to create new queues once one was completed, we allowed them to select multiple queues at once. Now, once they've reviewed the last case in a queue, a new queue would begin in their feed automatically.
Claims at a Glance
The claims table was a key tool in deciding whether or not to intervene on a claim. However, the previous table had a large amount of useless information and required the user to side scroll quite a bit to find necessary information.
Although we couldn't abandon the side scroll completely, we significantly reduced the number of columns on the table by eliminating unnecessary information and only keeping the important data. Also, we added value by adding a number pill on rows displaying trigger claims to help tell a more accurate story of the member's claim activity.
Quota Tracking Made Easier
Before SQM, users had to track their progress towards daily quotas by running manual reports in Retro. This process involved several clicks and about 15-20 minutes of wait time. Also, running reports slowed the system down. Our redesign solved these problems by having a persistent counter in the header. This feature brought a lot of peace of mind.
Outcomes
SQM has made a significant impact on the fulfillment of our pharmacist users and also on the business. Average case time went down, performance went up, and savings came back to CVS. Working on this product was fun and successful.
35% Improvement in Case Review Time
One of the metrics that pharmacists were assessed on was average case review time. Within the first 6 months, average case review time decreased from 4.3 minutes to 2.8 minutes. User feedback attributed this improvement to better claims tables and other visual cues.
4% Increase in Quota Achievement
Quota achievement always hovered around the 91% mark, fluctuating each month by just a few points. By the third month after SQM was adopted, overall goal achievement had increased by 4% up to around 95%. Management attributed this success to preloaded queues. The feature helped to reduce pharmacist downtime because there was more transparency around who needed cases to work and it allowed managers
to distribute them more effeciently.
Projected $40M Savings in Maintenance Costs
Maintenance costs on Retro and CSS were projected to exceed $40M per year over the next 3 years. The new, state-of-the-art SQM application would cost a fraction of that. Users were happy because it was easier to hit their goals, and the business was happy because we finally fixed
a nagging money-pit of a problem.
