Insights

A Managed Medicare and Medicaid Plan Defines its Systems Strategy

T2C assesses the application portfolio of a managed Medicare and Medicaid plan to define its Systems Strategy.

Background:

A leading not-for-profit Medicare Advantage and Managed Medicaid health plan was experiencing rapid growth. Over a span of four years, membership had more than doubled to 400,000 members. This growth had resulted in many technology and operational challenges.

Ongoing system configuration, integration, and maintenance costs were higher than desired and above industry peers. Additionally, upgrades to their claims platform had become significant undertakings that required several million dollars to implement new releases, took staff away from higher value projects, and required significant outside resources. This combination of factors lessened the plan’s ongoing ability to improve organizational and operational efficiency.
Management decided to evaluate whether its application portfolio could meet their current and future needs. In 2014, T2C was engaged to develop a technology and application roadmap to address its current challenges and support its future needs.

Challenges:

Over many years, the plan had implemented several different vendor solutions across sales, marketing, enrollment, billing, contract management, provider credentialing, care management, claims and customer service. To varying degrees, operational owners had selected and implemented solutions that were optimized for their functional areas.

However, poor integration, configuration, and system standardization had resulted in disjointed governance, systems management, and testing processes. End-to-end business processes were highly fragmented with tasks being inefficiently routed and tracked across departments. The plan was also struggling to keep systems configured to meet the increasing number of requirements from CMS and state regulators. Operational and technology leaders were searching for improved systems and operational performance.

Solution:

In less than three months, T2C developed a technology roadmap with organizational and process recommendations to transform the application portfolio and improve organizational performance. T2C developed a framework for evaluating roadmaps that addressed “point” versus “enterprise” solutions, implementation sequencing, and the ROI to support the necessary investments. T2C developed and evaluated six different scenarios, conducted financial analysis for each, and recommended the roadmap to guide transformation of the systems portfolio.
Accompanying the application strategy were recommendations to improve processes supporting systems configuration, portfolio management, governance, and testing. Finally, T2C recommended additions and changes to IS roles that would improve management and operations of the systems portfolio.

Value:

T2C has extensive knowledge of the vendor landscape across CRM, care management, claims administration, and workflow platforms. We work routinely to evaluate and implement the leading vendors in these areas. Our experience, vendor knowledge, and consensus enabled us to build a thoughtful and pragmatic roadmap. In addition, we know that technology strategies must also address organization, process and governance to be successful. Combined with our deep health plans experience, we delivered this plan a pragmatic and achievable path for their application portfolio.