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Case Study
Core Administrative Processing System Replacement
Our consultants have worked in a variety of management, operational, and technical positions within both payer and provider organizations. They average more than 15 years of experience in the healthcare industry. We have first-hand knowledge of your challenges, and understand how to overcome competitive pressures, organizational obstacles, and limited resources.
Case Overview
A northeastern regional health plan chose to migrate its legacy claims processing system to a more modern platform. The health plan engaged Change Healthcare Consulting to lead its system migration and modernization initiative, which encompassed far more than a simple system replacement. This project launched a full-scale digital transformation that included an enterprise architecture redesign, departmental restructuring, and the reimagining of roles, responsibilities, and workflows.
From a technical perspective, the project was a mammoth effort. The new core administration system, Trizetto QNXT, leveraged modern technologies that were unfamiliar to the health plan’s staff. To meet the plan’s business objectives, years of customized report development, hundreds of wraparound applications, and thousands of reports and integrations would need to be rearchitected. The health plan also chose to replace its existing data warehouse with one based on a system-agnostic, data-driven design built to leverage data and turn it into business intelligence.
The Change Healthcare Consulting team collaborated with the health plan’s senior leadership to lead the overall program and guide many of the technical and business tracks, including enrollment and billing, customer service, referral management, claim processing, interface and report development, and system and integration testing.
Challenges
The health plan’s most overarching challenge was its workforce’s strong propensity to return to the status quo. Many staff members had worked at the organization for decades and only knew one successful way of working, completing familiar processes within the same system they had used their entire careers. Helping staff understand the need for change and get on board with reimagined workflows would require a significant effort, especially when many assumed greater efficiencies would lead to job losses.
Change Healthcare Consulting worked with the health plan’s leaders to develop a comprehensive staff communication strategy. We also helped the plan build an incentive program to reward personnel for their contributions. Once the project began in earnest, staff rallied to support the initiative and took pride in doing their part to reshape the future of the organization.
Another significant challenge was the company’s technology debt. The health plan had relied on its legacy platform for decades, deploying patches and temporary work-arounds to meet changing industry requirements the system couldn’t accommodate. For several requirements, however, the health plan had been unable to implement stopgap measures. As a result, the scope of the project was significantly larger than a typical system replacement.
Change Healthcare worked collaboratively with the client to gather and prioritize its requirements. Our consultants helped develop and share the implementation road map, which included going live with the core system before all requirements could be satisfied. The road map extended for a year past go-live to allow the organization to take advantage of the new technology while it devised new solutions to age-old challenges.
Lastly, the health plan did not have a formal program-management methodology, nor did it have a standard change-management process. As each of these processes are essential for large enterprises, the consultants provided a base framework and collaborated with the health plan’s staff to customize, document, and refine the new methodologies.
Solutions
Change Healthcare Consulting worked side by side with the health plan’s leaders to develop and implement a program and change-management methodology. Together, we were able to facilitate staff buy-in and ignite enthusiasm to reimagine what was possible by focusing on the staff members’ cumulative knowledge and expertise.
Results
Change Healthcare Consulting helped implement the health plan’s new core administration system as part of an enterprise architecture that leveraged industry standards and aligned with the company’s business objectives. Ultimately, we successfully migrated the client to its new enterprise system while also transforming the organization’s processes and practices. The health plan is now well positioned to be more agile and responsive to market forces and changing requirements.
