Implementation of Facets: A Health Insurance Core Claim Processing System

Case Study:

Implementation of Facets: A Health Insurance Core Claim Processing System

Project Mission and Background

A program’s success hinges on the ability to understand a complex technical environment and effectively manage the integration points between systems and projects. When the program impacts every business group in the organization, success or failure extends beyond the work at hand to the entire future of the corporation. Technical project management expertise and leadership are vital to drive complex work around a tight schedule, with hundreds of integrated working parts, in order to fulfill the strategic advantage such a program achieves.

 

A large insurance payer (33,000 employees; $19.1 Billion in 2008 revenue) was in the process of replacing their core system with a more advanced product that would dramatically increase scalability and versatility. The existing systems were inefficient due to outdated technology and had been a constraint to acquiring new business. Manual efforts caused by system inflexibility cost the company an estimated $35M in the year prior to the project kickoff. Administrative costs were 50% higher than the competition. In addition, the company’s growth plans hinged upon a successful rollout of the new system. The system would need to integrate with a plethora of existing systems while crossing through virtually every business organization. To be successful, the new system would need to be rolled out in an expeditious, but thorough fashion.

 

Challenges

Experience in managing complex technical programs was lacking throughout the organization. In addition, the vendor chosen to provide the system had the technical working knowledge of their own system, but was ineffective in managing the business and technical integration into the current network of systems and functions. Existing program leaders were having difficulty determining a feasible scope and timeframe for the effort. At the same time, the company’s project management organization was interested in rolling out a new software development lifecycle process that was still in early development stages.

Our Approach

Lewis Fowler stepped in to provide leadership in the Program Office and in key project management positions in the early stages of the project, after the client realized that external assistance was needed. As the program progressed, our team utilized their technical project management skills, and leaned on their significant experience to provide a framework for delivery, a realistic expectation of results and the precise management of complex interrelationships that were essential in successfully delivering the program.

Direct Benefits

Establish

Activate

Outcome

Building or providing existing project management templates and tools to supplement the new software development lifecycle process

-Streamlined processes and tools to facilitate project progress

-Tighter scope control which in turn helped keep project costs in line

-Expedited project phases due to stronger tool set helped teams meet critical dates.

Driving detailed requirements by working collaboratively with the business organizations

-Full project scope identified

-Business engaged in the process

-Reduction of costly scope changes on the project.

-Decrease in unidentified business requirements which lead to virtual elimination of expensive and time consuming re-work.

Mapping the technical dependencies and integration points on the critical path

-Full understanding of critical path to delivery

-Accounting of dependent systems

 

-Identification of additional process and system improvements

-Focus on activities driving critical path.

Providing a realistic assessment of what was achievable in the timeframe, given the technology, staffing, budget and number of integration points.

-Continued business engagement and buy-in throughout the project

-Confidence of the technical team in the dates

-Ability to communicate delivery dates to customers to enhance customer relationships

Documenting a gap analysis of what the new product could and couldn’t do, working with the business to fill the gaps with existing tools.

-Fewer process or functional gaps in the new operating environment

-Identification of effective business work-around processes

-Leveraging of existing business tools.

-Cost avoidance of having to fill gaps with new technical solutions.

-Assurance of functional operations during and after the implementation.

Continuously planning the effort throughout the lifecycle of the program.

-Ability to make quick adjustments to ever-changing information

-Drove fact-based decision making

-Continuously planning the effort throughout the lifecycle of the program

-Better decisions led to a stronger final product

Incorporating architectural guidance necessary for a consolidated solution

-Elimination of redundant back-end solutions or technical changes

-Avoidance of causing new issues while solving existing problems

-Avoidance of funding additional projects to address newly created technical issues

-Reduction of support costs post go-live for a stronger architectural solution.

 

Summary

In the end, thanks to the leadership of the Lewis Fowler team, the large implementation program was a success. The client was able to sell new business and drive additional revenue on the back of the new core processing system. In addition to revenue growth, significant cost savings were achieved by moving away from the less flexible, technologically-outdated, legacy systems. The success of the implementation also attracted the interest of the major players in the health insurance industry, as they sought to benefit from the flexibility the new system offered. The best compliment we received from the client was being hired to run the critical components of the next major program undertaken by the organization.

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