Leadership Problem
Desired company values set forth by management is in-congruent to actual work directives. On one hand, management asks us to do what is best for our Members. On the other hand, they ask us to do what is best for our Clients. Then there's the need to generate revenue for the company.
If you know anything about insurance industry, this is fundamentally conflicting mandates that cannot be reconciled. Between Clients, Members, and Express Scripts, only 2 out of 3 parties can be happy at any given point.
Despite the management mantra, our current business model disincentivizes us from doing what is best for our members and clients because disproportionate amount of the company profit is tied to script volume. The more sick our members are, higher the script volume, and more money Express Scripts make. We are a one-trick pony.
Wall Street-consumption-ready sound bite about our diversified revenue streams is largely a farce. It doesn't matter if the revenue sources are evenly split between specialty drugs, mail order, service fees, and rebates if the size of the overall pie is completely dependent on the script volume. This is not true diversification.
For true diversification and script-agnostic growth strategy, the company needs think outside the box it is trapped in, and invest in innovative strategies and people. On the surface the company has been trying to be position itself as all-in-one, benefits management company, pharmacy, healthcare provider, and research institution. But it is failing in all of them.
Take the Big Data opportunity as an example. As a PBM, we are sitting on mountains of empirical data about members, providers, treatment, and outcome. We are not using them to drive growth in meaningful ways, because we are willfully ignoring data points that can improve member outcome and lower costs, but that can potentially reduce script volume.
Instead, the big data is being used mostly for client marketing purpose (a.k.a Express Scripts Lab) and cut operating expenses, rather than meaningfully growing top-line.
Pay problem.
The current HR compensation structure and performance management system are designed to attract and retain mediocrity. Many good people have already left and we are left with smart, but sour staff who've been chronically underpaid, and now even more sour than ever.
Paying market rate salary is not going to work with Express Scripts. In order to attract and retain good talent, the company needs to be paying above market rate. When you have a problem that can easily be solved by literally throwing more money at it, you say "thank you" and start throwing cash.
After the merger, management significantly reduced options and RSUs for middle managers and top talents to the point of insult. Long term incentive is a key strategy in retaining top talents.
IT-pocalypse
The company suffers from weak IT leadership, particularly at Sr. Director level and above. We are in a sore need to recruit highly competent, bold, leaders from a proven technology company to clean up the disastrous IT foundations that are root of cause of many project failures and hindrance to new initiatives.
The current leadership positions are all occupied by 50 something year old males or (30-40 year old females) with dubious technical skills who think going 'agile' is as easy as saying abracadabra and its utterance alone provides magical 30% productivity boost.
News Flash: Express Scripts is not set up for agile, and to its fairness, most large companies are not either.
What the company needs is a new IT visionary and his/her lieutenants that will stand up to the senior management and call spade a spade, but smart enough to recognize when the lower level staff is serving turd sandwiches with PB&J.
Organizational culture and structure problem.
There is culture of business-worship that results in gross mis-allocation of resources. There are literally hundreds of directors on the business side with no direct reports while other department directors have to manage staff of half a dozen to hundreds. And the ugly truth is, we have some of the weakest and woefully under-qualified business and product owners I have seen in my career.
And in order to 'serve' business needs better, management inserted liaison roles between business and IT called them "BAT" or "BIAC"; roles that were traditionally performed by business analysts and project managers. In theory, this specialization of roles sounds like a good idea from resource management perspective. In practice, it results in IT project managers who are effectively clueless about the details of the projects they are managing, business analysts whose roles have been marginalized, and across the board staff bloat.
