From commodity to strategic asset: How a regional Blues plan strategically positioned its provider data to support enterprise initiatives

The Client Challenge

A regional Blues plan had to sunset its more than 15-year-old provider data management system. Recent federal policy changes, acquisitions, and enterprise strategy needs further complicated this major transition. The client faced challenges in developing its strategy: What data should it migrate? How should the data reside in a new system? How could it leverage the data to support enterprise goals for the provider and member experience?

CHALLENGES WITH PLANNING FOR A PROVIDER DATA SYSTEM MIGRATION CAN INCLUDE

Understanding and meeting varying requirements that span multiple teams
Identifying a single standardized structure for a provider record
Accounting for the time and resources required to cleanse data prior to migration
Mitigating the impacts associated with excluding or including certain data segments
Maintaining an enterprise perspective when making critical decisions

Navigating to Next: The Solution

The health plan wanted to take advantage of its new provider data system capabilities to turn its provider data into a strategic asset, not simply as a repository of information for processing claims and populating its provider directory. Client leadership recognized that provider data can impact enterprise initiatives and the member and provider experience as well. The client partnered with Chartis to develop a data migration strategy.

The planning approach was based on 3 essential elements: (1) an in-depth analysis of legacy data; (2) a technical examination of the data model and the migration process; and (3) a holistic investigation into how the data would impact other areas of the enterprise. Chartis facilitated workshops with stakeholders across the organization to align on key decisions that incorporated broader enterprise perspectives. The team discovered that most provider group records did not require migration, and, of the data to migrate, many records required cleanup. Chartis helped define and prioritize business cleanup rules, size the level of effort, and establish a resolution strategy. Chartis also helped define a long-term data enrichment and accuracy improvement plan to support ongoing and future enterprise needs.

Client Impact

With Chartis’ support, the payer was able to plan and prioritize the data migration activities within 3 months. The team decided to exclude over 69% of its provider group records that were out of network and had no claims activity in the past 3 years. They also developed 27 data cleanup rules, accounting for additional data quality and enrichment needs that should occur after go-live. With a defined migration strategy, the health plan could shift focus to execution details, such as data mapping, with sufficient time to test and implement the migration. This approach gave the health plan a clean foundation at go-live, instead of migrating data with existing quality challenges.