How KAIP partnered with the Department of Health Care Services (DHCS) to close pharmacy benefits reporting gaps for faster leadership decision-making
The Challenge: New Policies, Old Reporting
In 2025, new pharmacy benefits policies began to take effect at the California Department of Health Care Services (DHCS). As a result, the DHCS team faced an immediate problem that cut straight to oversight and decision-making: the reporting it depended on would not last.
The original reporting solution was not designed to support dynamic policy updates. The Pharmacy Benefits Division needed a consistent way to track whether policy changes were truly changing utilization, controlling costs, or creating new risks. What remained was a patchwork of ad hoc reporting at the very moment leadership needed clearer answers.
The continued rise of pharmacy benefit costs, along with additional policy changes set to begin in a few months, meant that DHCS needed fast, accurate numbers to maintain control in a rapidly evolving situation.
And with budget planning for the next two fiscal years on the horizon, the DHCS leadership needed timely, credible insight. As well as the internal reporting capability built to provide that intelligence.
Aligning Reporting to DHCS Goals
KAIP started by getting clear on the critical decision points and the reporting gaps standing in the way. The team met with policy owners and leadership, reviewed DHCS’s existing data structures and warehouse environment, and assessed Prime’s reporting outputs. Requirements were gathered to ensure key performance indicators aligned to policy intent, not just available data.
That real issue quickly surfaced. Current reporting, on its own, would not fully enable DHCS decision-makers to achieve the level of insight and oversight needed manage their risks. They needed to own their own reporting capabilities. And the DHCS team needed a new reporting system they could govern, scale, and use independently after vendor reporting ended.
With an expanded understanding of the client's multiple goals, KAIP shaped the engagement around the dual outcomes. We combined data analytics, business analysis, program management, and project management to build a solution that was:
practical for staff to maintain
useful to leadership to make decisions, and
strong enough to sustain broader program monitoring over time.
Turning Insight into Action
Developing a Sustainable Reporting Structure
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Defined Standardized KPIs Aligned to Policy Intent
Identified the KPIs needed to monitor policy performance in a way that reflected leadership priorities and policy intent.
Identified Reporting Failure Points
Reviewed DHCS data structures, the warehouse environment, and Prime’s reporting outputs to:
vulnerability points due to dependency on vendor-controlled reporting
Surface internal monitoring weaknesses
Replaced Static Reporting with Dynamic Dashboards
Developed dashboards to increase visibility of utilization, cost, and policy performance over time. These dashboards enabled the department to rapidly:
Identify the effectiveness of the policy that removed CDL GLP-1 drugs from the list of those indicated for weight-loss.
Identify trends of increased utilization for GLP-1 drugs indicated for diabetes.
What Changed and Why It Mattered
Within 90 days, KAIP delivered an internally governed reporting framework that gave the division stronger visibility into policy performance.
More importantly, the Pharmacy Benefits Division built a new internal capability for building usable, scalable reporting independently of Prime’s reporting platform. This capacity reduced reliance on temporary external outputs and gave leadership a more durable way to monitor performance over time.
The work also helped ease the manual reporting burden on program and analytics staff while giving leaders more reliable dashboards and KPIs to support decision-making.
Enhanced Internal Control
Extended monitoring of policy performance
Identification of additional dashboard needs from the Pharmacy Benefits Division leadership.
Team Capability Building
Decreased manual reporting burden on program and analytics teams
Shortened turnaround time in reporting request from Division leadership
Expanded stakeholder representation in policy and data discussions with vendors
Improved Policy-to-Outcome Alignment
KPI and internally governed dashboards better support leadership decision-making.
Evidence generated to show how policy enhancements help meet fiscal budget projections.
The Road Ahead
As the new fiscal year approaches, DHCS is now monitoring policy performance with an internally governed system.
Looking to the future, their team is also prepared to build out a comprehensive, internally-managed Program Monitoring framework that includes dashboarding and reporting for even more functional areas at DHCS.
Let’s Talk About What’s Next for You
If you’re ready to bring clarity to complexity and build infrastructure that supports your people as much as your programs, let’s start the conversation.
