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CLIENT CASE STUDIES

Delivering Value Through Integrity, Passion, And Strong Client Relationships

Accountable Care Organizations

The Need

Multiple client ACOs needed to align IT plans with overall strategies and CMS requirements, improve core business processes, set IT priorities, select clinical solutions, and secure stakeholder buy-in.

What We Did

Worked with stakeholders to develop IT ‘roadmaps’, establish Board-level IT governance models, optimize key processes, drive vendor selection efforts, and manage implementations.

The Result

These organizations transformed ambiguity into certainty, establishing clear IT priorities and effective linkages to critical stakeholder groups. They engaged vendors with clearly-defined requirements.
Consumer Oriented & Operated Health Plan

The Need

Start-up health plan needed comprehensive IT management services, from planning, to CMS relationship management, database design, TPA integration, vendor evaluation, portal design, and physical site buildout.

What We Did

Assembled a cross-functional team of health IT ‘A players’, including strategists, project managers, database professionals, and analysts, and executed a large-scale, 18-month implementation effort..

The Result

The health plan went from ‘Day 1’ startup to full IT capabilities, including enrollment, claims adjudication, portal ‘go-live’, and successful achievement of every CMS-mandated milestone.
Healthcare organization affiliated with a major university hospital system

The Need

This large physicians organization was about to undertake the largest project in its history, a private Health Information Exchange (HIE) implementation linking several affiliated clinical entities to drive coordination of care and analytics.

What We Did

Developed a Program Charter and schedule, and executed a formal program kickoff. Leveraging best-practice PM methodologies, we managed multiple EHR integrations, while ensuring effective stakeholder communication.

The Result

Our efforts instilled structure and accountability, drove on-time execution, and ensured vendor performance. The organization’s executive management team used our successful engagement as the impetus to establish a PMO, with our help.
State Medicaid Agency

The Need

Our client needed a consultancy to develop, and obtain subsequent Federal approval for, its State Medicaid HIT Plan and associated multi-year implementation budgets. This approval would result in Federal funding for major EHR adoption incentives.

What We Did

Engaged stakeholders, developed a comprehensive plan, and overcame lengthy Federal review cycles by developing full plan drafts within two months of engagement start-up. We created provider outreach plans and managed technology vendors.

The Result

Our approach resulted in early momentum and transformed uncertainty and risk into success. The client secured conditional Federal approval for its Medicaid HIT Plan far earlier than most other states and progressed decisively with provider outreach.
World class, Boston area hospital interested in piloting real-time locating system (RFID/RTLS) technologies in its inpatient clinical settings.

The Need

Our client had been unable to mobilize to plan and execute the pilot. Stakeholders were diffused throughout the hospital and were not engaged. Vendors were anxious to participate, but a lack of organizational focus was creating inertia.

What We Did

  • Assessed current state; validated scope
  • Established program governance
  • Identified critical success factors
  • Developed requirements and initiated vendor management
  • Developed a comprehensive plan.

The Result

After two years of inertia, our client made dramatic progress during the first three months of our engagement. During our eight month engagement, our client successfully engaged four vendors, initiated testing, and formulated a house-wide RTLS strategy.
Large Commercial Health Plan

The Need

The Health plan needed to migrate to a new PBM, integrate eligibility, claims and plan profiles, and establish real-time accumulator updates with the PBM. Participating vendors were behind schedule.

What We Did

  • Implemented, planned, and staged go-live
  • Established business and technical team stand-ups to accelerate development
  • Defined user acceptance criteria
  • Developed real-time update processes
  • Prepared test beds in advance.

The Result

After two years of inertia, our client made dramatic progress during the first three months of our engagement. During our eight month engagement, our client successfully engaged four vendors, initiated testing, and formulated a house-wide RTLS strategy.
Large Commercial Health Plan

The Need

Configuration and software testing within the client organization was managed primarily at the project level. Project teams within the organization were not able to consolidate their testing resource requirements, resulting in over-allocation of temp resources.

What We Did

Developed well-defined testing methodologies and processes , including process roadmaps, estimation models, staffing models, status reporting etc. The engagement model included Testing Lead participation throughout the project lifecycle to ensure a seamless testing and release process.

The Result

Through the implementation of our methodology, the client was able to support Enterprise Projects, Services Requests and Production support work simultaneously, with proper resource planning. This resulted in reduced internal resource and external consultant needs.
Large Commercial Health Plan

The Need

The complex plan configuration for each customer base drastically increased the number of plan/product/benefit configurations, as well as testing requirements during open enrollment. The client faced challenges around retention of key testing resources due to fluctuations in resource needs throughout the year.

What We Did

Developed process to streamline plan/product configuration and testing activities. Created the concept of a ‘core team’ for key areas and the creation of a knowledgebase that remains constant throughout the year.

The Result

We relieved the client’s experienced resources from training and mentoring new testers, enabling greater availability for more critical tasks. Enhancements to key processes eliminated configuration and testing inaccuracies and expedited the overall benefit configuration timeline.
Large Commercial Carrier

The Need

Needed a new Broker Compensation Program that aligned with the Corporate strategy.

What We Did

Created entirely new commission and bonus plans aligning distribution compensation with the goals of the organization while maintaining overall competitiveness in the market.

The Result

Increased membership penetration in specific market sizes, products and target regions; increased net profit margins by nearly 50%. Effectively aligned broker distribution costs with desirable new business production.
Mid Size Commercial Carrier

The Need

Needed to reorganize entire sales division

What We Did

Recruited talent and trained staff. Created sales, distribution, product and network strategies, and introduced new products to the market. Developed value proposition, introduced new compensation plans for internal staff and the distribution channel, and implemented sales automation tools.

The Result

Increased new business production in carrier’s core area by over 100% and supported successful expansion into 8 additional regions. Increased broker engagement from 327 to over 1,700 in three years.
Start-up Commercial Carrier

The Need

Needed to set up sales and marketing process for health insurance product offerings and distribution channels for sales.

What We Did

Recruited sales, retention and sales operations staff, created organizational strategies and marketing plan (TV, Radio & Print). Developed processes linking sales to other functional areas; created new products to align with appropriate market risks, and compensation plans for internal staff and the distribution channels.

The Result

Gained over 27,000 commercial members in 3 years of operations and increased broker engagement from 32 to over 1,300.