Building the Knowledge Foundation for Managed Care Operations.

About the Client

The Managed Care Division served as the company’s primary interface with health plans and pharmacy benefit managers, coordinating account management, sales, brand management, contracting, and competitive intelligence to support the commercial success of Company C’s product portfolio.

Industry Context

By the early 2000s, pharmacy benefit managers and health plans had become powerful, increasingly consolidated gatekeepers between pharmaceutical manufacturers and patients, controlling formulary access through complex rebate contracts and utilization management programs. Winning and defending favorable formulary positions required pharmaceutical companies to coordinate account management, contracting, brand strategy, and competitive intelligence far more tightly than a single sales relationship ever had. For a diversified manufacturer like Company C, that meant the functions supporting managed care needed to operate as a coordinated intelligence capability rather than a set of independent teams working from separate spreadsheets and inboxes.

Current Situation

The Division’s six functions shared information almost exclusively through telephone calls and email, with no central repository for managed care knowledge. The Division’s new President was shocked by the lack of software tools and infrastructure supporting decision-making and asked the Director of the Managed Care Intelligence group to address the problem, with a scope that included understanding and documenting complex decisions, cataloging knowledge sources, mapping processes and knowledge flows, and developing a performance management system. The Director sought a consulting firm with strong knowledge management capabilities and deep pharmaceutical and managed care experience, and selected Iknow for the assignment.

• Fragmented information sharing across the Division. Six distinct internal functions shared managed care knowledge almost exclusively through phone calls and email, with no central repository.
• No systematic understanding of how the business actually ran. No documented view existed of the complex decisions, processes, or knowledge flows underlying the Division’s managed care business.
• No performance visibility into major accounts. The Division had no performance measurement system providing visibility into its largest, highest-value managed care accounts.
• Rising external complexity outpacing internal infrastructure. A consolidating, increasingly sophisticated managed care and pharmacy benefit management industry demanded far more internal coordination than the Division’s tools could support.

• Understand and document the complex decisions made across the Managed Care Division.
• Catalog the knowledge sources used by each of the Division’s six functions.
• Map current business processes and knowledge flows, including future-state business requirements.
• Develop a performance management system providing visibility into major accounts and Division operations.

How Iknow Structured the Work

Iknow structured the engagement around three parallel workstreams — Process, Content, and Scorecard and Technology Architecture — reflecting Iknow’s knowledge audit and mapping methodology for building a knowledge foundation grounded in how a business actually makes decisions, not just where its documents happen to sit.

Key Activities & Decisions

• Process workstream: current-state documentation. Iknow conducted more than 50 interviews across the Division’s six functions, building a thorough understanding of managed-care related tasks and activities, the decisions the Division makes, the sources and uses of its data, and future-state business requirements.
• Content workstream: source analysis and cataloging. Iknow conducted a Content Source Analysis to identify the types and sources of information used by each group, then built a database cataloging all of the Division’s managed care content.
• Scorecard workstream: performance framework. Iknow designed a measurement tool providing visibility into major accounts and the Division’s internal operations, developing a performance management framework and defining the relevant performance metrics.
• Technology architecture documentation. Iknow documented the company’s technical standards and identified the data sources required to power the scorecard application, giving the Division a technology architecture grounded in what it could realistically build and maintain.

Stakeholders & Collaboration

Iknow worked directly with the Director of the Managed Care Intelligence group and staff across the Division’s six functions during the current-state interviews and content analysis.

Understanding a Decentralized Business in a Compressed Timeline

With six distinct functions, each holding its own piece of the managed care picture, and only a few months to work with, a shallow assessment risked producing a knowledge foundation that overlooked how decisions were actually made. Iknow addressed this by conducting more than 50 structured interviews across every function, building a genuinely comprehensive picture of tasks, decisions, and data flows rather than relying on a handful of leadership conversations.

Turning Informal, Phone-and-Email Knowledge Sharing Into a Documented System

Because so much of the Division’s knowledge sharing had always happened informally, there was no existing inventory of content or sources to build from, and no established performance baseline to design a scorecard against. Iknow addressed this by running the Content and Scorecard workstreams in parallel with the Process workstream rather than sequentially, using the same interviews to surface content sources and performance requirements while it documented workflows. Iknow also grounded the resulting technology architecture in the company’s existing technical standards so the scorecard would be realistic to build and maintain.

Quantitative Outcomes

• Stakeholder engagement: More than 50 interviews conducted across the Division’s six internal functions.
• Content repository: A new database cataloging all of the Division’s managed care content and knowledge sources.
• Performance framework delivered: A performance management framework with defined metrics providing visibility into major accounts.
• Engagement duration: Four-month assignment.

Qualitative Outcomes

The Division implemented many of Iknow’s recommendations, and over time achieved more effective contract negotiations, better monitoring of contract performance, improved quality of the business intelligence outputs it produced, and faster, higher-quality development of customized managed care programs. The Division’s managed care and product launch plans also became more tightly integrated, evidence that the new knowledge foundation didn’t just document how the business worked but actively improved how its six functions coordinated with one another.

Timeline to Impact

Iknow delivered its process documentation, content database, and performance scorecard framework within the four-month engagement; the Division’s efficiency and quality gains in contract negotiation, business intelligence, and program development followed over the months after implementation began.

Core Skills

• Knowledge audit & mapping
• KM framework design & implementation
• Performance management & scorecard design
• Cross-functional process documentation

Methods & Frameworks

• Current-state to future-state gap analysis
• Content source analysis
• Structured multi-function stakeholder interviews

Technologies & Tools

• Performance scorecard and technology architecture documentation