A leading pharmacy benefit manager (PBM) sought to enhance its member experience by extending white-glove support through its member care advocates. The PBM faced multiple challenges, including encouraging healthy behaviours among members, ensuring adherence to prescribed therapies, resolving prior authorisation denials efficiently, and capturing member sentiment alongside clinical insights.
Addressing these issues was crucial not only for improving member satisfaction but also for reducing costs related to non-adherence and therapy delays.
To tackle these challenges, the PBM partnered with Ushur to deploy multi-channel outreach campaigns aimed at promoting healthy behaviour and protecting costs.
By leveraging SMS texts containing secure links to Ushur’s Invisible App—a user-friendly and HIPAA-compliant digital channel for information exchange and two-way communication—the PBM was able to guide members towards better outcomes efficiently.
Key initiatives included:
Member check-in: Automated monthly outreach enabled members to easily call or schedule time with their assigned advocate, ensuring consistent engagement.
Medication adherence: Intelligent identification of treatment gaps allowed members to call, schedule an appointment, or indicate that they were no longer taking a prescription, helping to mitigate non-adherence risks.
Prior authorisation denial notifications: Members received proactive alerts for prescription denials caused by missing paperwork, providing immediate pathways to resolve issues and avoid therapy delays.
Member surveys: A digital feedback loop captured member perspectives on advocate performance, with the option to leave a Google review, promoting transparency and continuous service improvement.
The impact of these AI-powered workflows was significant. The PBM successfully scaled personalised, white-glove engagement without increasing administrative workload. Measurable results included:
Higher engagement through white-glove service: Completion rates across multiple journeys reached 25–30%, engaging nearly one-third of members via automated digital channels—far exceeding the slow, low-yield results of traditional cold-calling.
Member satisfaction: Automated monthly check-ins fostered trust, offered 24×7 support, resolved queries proactively, and enabled seamless live agent escalation.
Improved adherence: Early identification of non-adherence through automated outreach reduced the risk of costly care escalations.
Faster resolution of prior authorisation denials: Proactive communication lessened member frustration and therapy delays.
Actionable feedback: Surveys and public review options created a feedback-rich environment, driving continuous improvements in member care services.
This approach highlights how AI and automated workflows can transform PBM member engagement, boosting both satisfaction and operational efficiency.
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