The Client Challenge

A large national Medicaid health plan covering more than 5 million lives sought to improve its heavily manual, non-standardized, and lengthy provider onboarding process. It was also in the process of implementing a new provider lifecycle management platform and wanted to take full advantage of the new technology’s capabilities to stand up provider networks quickly and strengthen the provider enrollment experience.

  • Serves as a strategic differentiator during provider network recruitment
  • Reduces provider enrollment processing time
  • Lays the foundation for complete and accurate provider data to inform downstream system needs, such as the provider directory
  • Allows members to access preferred providers quickly

Navigating to Next: The Solution

Based on a strategic roadmap developed with Chartis for the end-to-end provider lifecycle experience, the health plan sought to increase automation and improve efficiencies in the provider enrollment and onboarding processes. As part of the strategy, a key recommendation was implementing an enterprise-wide, standardized, best-in-class onboarding process in conjunction with a new provider lifecycle management platform. Along with fully leveraging the new technology’s capabilities, the health plan’s leaders wanted to align multiple stakeholders across numerous markets with varying priorities on a standardized enterprise approach. But doing so would be challenging.

The health plan partnered with Chartis to design the end-to-end provider onboarding process. Multiple workgroups were formed to engage key stakeholders across the organization and with the vendor to align on a future-state vision and ensure the technology would be configured to achieve business objectives. Performance indicators and goals were identified to gauge success and allow for continuous improvement. Four of the health plan’s markets were identified to serve as pilots prior to implementation of the larger enterprise rollout.

Navigating to Next: Key Components

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Discovery & Analysis

Define current-state challenges and opportunities with the provider onboarding experience.

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Facilitate multistakeholder workshops to develop the desired future-state processes

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Broker alignment with health plan markets and corporate teams

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Equip the health plan with a clear path toward implementation

Client Impact

Through multistakeholder collaboration, the team developed a future-state business process architecture that aligned with strategic business objectives and requirements. This included more than 10 standardized workflows for provider onboarding, credentialing, and hand-offs across various provider use cases. The workflows focused on incorporating the new technology capabilities to leverage automation, reduce turn-around times, and increase data quality. Key performance indicators were established to measure ongoing performance and outcomes post-implementation. As a result, the health plan achieved critical stakeholder buy-in on a defined future-state solution within 3 months.

Embarking on this transformation journey allowed the health plan to lay the foundation for achieving enterprise goals. This foundation included:
10 +

enterprise-wide onboarding workflows to drive customization of the provider lifecycle management platform

30 +

stakeholders across multiple markets aligned on the foundational design and supportive of the next phase of implementation

20 +

net-new KPIs to monitor the new provider onboarding processes

How We Are Making Healthcare Better

Health plans must continue to invest in and enhance their provider onboarding and enrollment processes so that members can access care as efficiently as possible.

Mohammed Nomani, Associate Principal, Chartis

Next Intelligence

Planning for a next-gen provider onboarding experience requires:
  • Collaboration and engagement: Representation from the right internal and external stakeholders.
  • Technology: An integrated platform that combines the multiple pieces of the provider onboarding lifecycle to improve collaboration and efficiency.
  • Transparency: Clear expectations for stakeholders to drive toward alignment and desired outcomes.

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