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.
