The Client Challenge

A regional health plan sought to improve the efficiency and accuracy of its provider network functions and committed to implementing a new provider data management (PDM) platform. The health plan wanted to maximize the value of this investment and knew that existing manual and nonstandardized practices and structures would need to change alongside the technology. The health plan was unsure where to start or how to enable success moving forward. 

  • Low user adoption of the new platform
  • A PDM platform built around poor, unoptimized practices
  • Persisting inefficiencies in people, process, and technology
  • Inability to meet the technology investment business case
  • Lost opportunity to improve provider and member experience

Navigating to Next: The Solution

The health plan was already working with the technology vendor on initial configuration, which relied solely on the staff’s accounts of their existing manual, siloed, and nonstandardized processes. This risked transposing these broken processes into the new technology and missed business process optimization opportunities and business readiness planning.

The health plan partnered with Chartis to conduct a rapid assessment to identify opportunities for business optimization and provide insights across people, process, and technology. For example, an inventory of staff responsibilities found that provider relations staff held competing responsibilities across functions, including recruitment, contracting, credentialing, and PDM. Work was reactive and not proactive, resulting in all-hands-on-deck firefighting and lack of bandwidth for quality assurance.

Chartis created a roadmap of needed organizational changes, process improvements, change management priorities, and recommendations for implementation phases. Through analysis of turnaround times, Chartis also helped establish baselines and KPIs for post go-live monitoring.

Navigating to Next: Key Components

establish foundation

Establish Foundation

Confirm business goals and impacted provider network management (PNM) functions


Analyze Current PNM Operations

Identify current-state processes, roles and responsibilities, hand-offs, and pain points


Inventory PNM Enhancements

Determine process improvement opportunities, organizational structure changes, and technology implementation priorities

path forward

Chart the Path Forward

Define and validate the roadmap with prioritized opportunities and next steps

Client Impact

By closely examining its provider lifecycle functions, the health plan was able to better understand its current state—including underlying reasons why ongoing processes were so reactive, nonstandardized, and time-consuming. With Chartis’ support, the health plan could use its newfound understanding to pinpoint opportunities for overall process improvement and to optimize implementation for the new technology platform. The health plan was also equipped with an 8-month roadmap and change management plan that would foster ongoing implementation work alongside business optimization efforts. The health plan was able to use the roadmap with the technology vendor for the next phase of requirement gathering. 

By closely examining its provider network functions, the health plan was able to identify key areas for optimization.


business functions assessed


improvement opportunities identified


success criteria identified for post go-live monitoring

How We Are Making Healthcare Better

Advancing to a more mature provider network operations model that supports a positive provider experience and meets member needs requires not only investment in technology but also in the supporting organizational structure and processes.

—Bethany Richmond, Director, Chartis

Next Intelligence

When it comes to implementing new provider lifecycle platforms, health plans can consider:
  • Functional workflow development:
    Redesign workflows based on new technology and industry best practices
  • Short- and long-term technology strategies:
    Sequence technology priorities around business needs and position provider data as an asset to support growth, innovative payment models, and other goals. 
  • Change enablement strategy: 
    Drive buy-in and adoption of new processes and technology.

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