The 2013 Implementation Awards

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Customer: Express Scripts
Vendor: Verint Systems
Product: Impact 360 Speech Analytics

As U.S. healthcare providers are being forced to squeeze costs out of the system, pharmacies find themselves under increasing government and consumer pressure to achieve the seemingly contradictory goals of creating greater efficiency and better protecting Americans from the rising costs of prescription drugs while improving health outcomes.

Express Scripts, a provider of integrated pharmacy benefit management services, has taken an aggressive approach to cutting costs by reducing the number of local supply overrides (LSOs) it issues to customers. Each LSO, which typically occurs when a prescription is delayed and the customer has to scramble to get a small emergency supply of a medicine from a pharmacy outside of the Express Scripts network, costs the company more than $47 on average.

Using speech analytics, the publicly traded company, based in St. Louis, was able to cut $3.3 million in LSO costs last year alone. It manages more than a billion prescriptions a year for tens of millions of people across the United States on behalf of thousands of employers, health plans, unions, and government health programs.

Express Scripts was founded in 1986 as a result of a joint venture between the Medicare Glaser retail chain of more than 79 pharmacies and Sanus Corp. Health Systems. It expanded its client base and product lines through several acquisitions, and currently employs more than 30,000 people nationwide.

A major part of the program the company put in place to address the LSO problem was Verint Systems' Impact 360 speech analytics. It first started rolling out the solution in late 2011 and launched an entirely new program in mid-2012.

Though Express Scripts' policy authorizes customer reimbursements for LSOs only when the delay is caused by an Express Scripts processing or shipping error, agents were getting into the habit of offering them to anyone who called in with an issue getting their prescription refills on time, whether it was due to an Express Scripts error or not. Customers got so used to receiving LSOs without a hassle that they demanded them month after month regardless of the circumstances.

With speech analytics, Express Scripts was able to determine how many of its LSO orders were caused by customers repeatedly requesting their refills late or forgetting to renew their prescriptions altogether. That cut the number of invalid LSOs from 22 percent to just 2 percent, which resulted in an immediate savings of more than $3.3 million. Year over year, Express Scripts cut the total cost of LSOs by 13 percent.

Additionally, LSOs are only supposed to cover a three-day supply of medicine, and from day four on, the customer is expected to pay for it out of his own pocket. Express Scripts was getting billed for many orders that extended well beyond the three-day limit because customers alleged that Express Scripts' agents never told them about the three-day cut-off. Without a system to replay the conversation, the company had no way to verify what the agents did or did not tell customers, so Express Scripts was often stuck picking up the tab.

Express Scripts also cut follow-up calls to customers from 39 percent of the total call volume to 21 percent. "We were able to leverage the speech analytics technology and direct coaching to improve our service to members, in particular reducing the need for member callbacks," explains Renee Rowles, the company's manager of speech analytics.

Verint's Impact 360 mines customer interaction data and generates actionable intelligence data that has driven other significant business benefits as well. "We have reduced handle time through coaching and training and call volume through a systemic change for some of our outbound calling campaigns," Rowles says. Another benefit has been "improved internal compliance with coaching and communication to the field," she adds.

"Our ultimate goal is to continually improve the members' experience, and utilizing speech allows us to do exactly that," Rowles points out.

The implementation of Impact 360 also led Express Scripts to receive a Verint Innovator of the Year award, presented in June at Verint's 2013 Driving Innovation user conference in Baltimore.

"Verint's speech analytics technology has allowed us to mine millions of calls to obtain actionable intelligence, creating new opportunities for us to improve our service," Rowles says.

The results

  • Cut the number of invalid local supply overrides (LSOs) from 22 percent to 2 percent, leading to $3.3 million in savings
  • Lowered the total cost of LSOs by 13 percent
  • Reduced follow-up calls from 39 percent to 21 percent
  • Decreased call handling time and call volume

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