The vision

A provider-sponsored health plan (PSHP) sought a new, integrated provider network management (PNM) technology platform to enable future growth and scalability, streamline and automate core operational processes, and enforce a single source of provider data. 

The PSHP wanted to ensure the new capabilities added value and avoided disruptions for staff, operations, and infrastructure. To do that, the PNM platform transformation required deliberate pre-implementation activities.

Investing in planning prior to a PNM transformation helps:
  • Define the strategic design of the future state
  • Identify critical success factors for process optimization
  • Reduce risk of unforeseen implementation challenges and disruption to operations
  • Maximize ability to achieve the initiative’s business case

Co-creating the solution

The PSHP partnered with Chartis to perform an analysis and due diligence, defining the full impact of change prior to investing in and implementing a new PNM platform. Stakeholders across provider data management, contracting, credentialing, network management, and reporting functional areas collaborated to define 10 enhanced workflows that support over 80% of PNM day-to-day activities and will inform future platform customization needs. The team also defined a data migration strategy, which included establishing a source of truth for provider data and defining data quality efforts. This would set up the new PNM platform with robust, clean provider data. 

The team also defined the minimum viable product (MVP), which specified capabilities required to maintain and enhance existing automation and support core PNM processes. PSHP leaders and Chartis collaborated further to develop a business case with expected efficiency gains and staffing impacts to ensure the transformation project was prioritized and granted the essential resources for success.

Transformation in action

  • Assess impact
    Determine implementation impacts across people, process, and technology

  • Design for efficiency
    Design future-state workflows based on anticipated PNM needs
  • Strategize data
    Identify data migration and quality improvement plan

  • Socialize benefits
    Define a business case to support business prioritization

  • Prepare for change
    Identify needs for communication, training, and organizational readiness

Believe in better

By investing early in a long-term transformation effort, the PSHP defined an ideal future state to guide PNM system customization and development. This proactive approach allowed the PSHP to strategically design core PNM processes that would optimize efficiency and improve data stability. An implementation roadmap and a pre-defined MVP now serve as decision-making anchors in upcoming discussions with the PNM vendor, helping to navigate system customization decision points and potential scope changes. 

By applying a business readiness framework to the roadmap, the PSHP can continue the momentum in implementation planning and proactively develop mitigation strategies. This is safeguarding a successful implementation and enabling future growth with enhanced capabilities.


Meaningful outcomes 

The ideal future state was designed to best utilize the capabilities offered by a new PNM platform. 
80 %

of PNM activities optimized through 10 enhanced workflows

~$1.1 M

estimated cost savings within 3-5 years via staffing efficiencies alone


estimated reduction in manual provider data activities

Health plans must invest in analysis prior to a PNM implementation to identify the critical enhancements and platform customization needs that will drive improved provider and member experiences.

—Bethany Richmond, Senior Partner, Chartis

Building to better

Health plans can optimize the implementation of a new PNM platform by:
  • Identifying impact at staffing, operations, and integration points to promote robust planning.

  • Collaborating across all teams that touch provider data, enabling input into future-state design.

  • Designing strategically with existing and future PNM needs informing the optimized future-state design. 

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