Follow the Quality Assurance journey taken by CoverMyMeds as it transitioned from a start-up to a growth company. Founded in 2008 with a mission to help patients get the medication they need to be healthy, CoverMyMeds has doubled its staff and revenue every year since inception. As the company expands, quality processes have become paramount in protecting Patient Health Information (PHI) and mitigating risk. Implementing Juran’s concept of Big Q, CoverMyMeds has begun its journey in creating its own quality center of excellence.
4. What We Do
Patient Pharma
Prior authorization requests are a permission slip from health plans for their patient to begin taking a medication, ensuring the right therapy for
the condition and cost-effectiveness. Before CoverMyMeds, the PA process was paper-based and accomplished through multiple faxes and
phone calls between providers, pharmacists and health plans.
Today, CoverMyMeds works with electronic health record systems (EHRs), health plans, pharmacy systems and providers to initiate, transmit
and track the status of PA requests within the clinical workflow.
6. Challenges:
CMM moved from startup to quickly growing company—new set of risks
• From “Just Do It”, get a foothold to sustaining growth and rapidly increasing complexity
Data privacy for rapidly growing database of Protected Health Information
Organizational growth requires more process & communication than before
• Many new managers & individual contributors
• Not familiar with processes, systems & the organization
Complexity of systems, customer hierarchy & regulations requires strategic planning
• Can’t rely on series of tactical steps & “you’re smart/you’ll figure it out” like startup phase
Initial applications not meant to handle current rate of growth (scaling/technical debt vs. new business)
Quality was primarily associated with testing activities
10. Getting Buy-In for Big Q Strategy
• Talking to Leadership
• Outlined Benefits (What’s In It forYou?)
• Targeted their goals: Promoted expense/waste reduction as an enabler for revenue
enhancement
• Included them so they felt vested in the outcome
• Sold the “Why?” to leadership, mid-level managers, and individual contributors
• Reduction in risk
• Improve customer relationships
• Avoid the “Company Killer”
• Best Practice