Jul 21, 2023 | 4 Min Read
Challenge
Our client, a full-service Third-Party Administrator (TPA), serving a significant number of lives across multiple employer groups, faced a series of operational and technological challenges. Their growth strategy, involving the acquisition of multiple TPAs, led to a decentralized and siloed IT landscape, resulting in increased operational costs and complex data management. Their outdated legacy web portal for population health management was inefficient, leading to missed performance benchmarks in clinical case management and quality outcomes.
Moreover, the disparate systems and data structures across TPAs resulted in scalability issues, lengthy data load times, and relied heavily on manual processes. This resulted in non-uniform models and structures, thereby affecting data quality and trust.
Solution
To solve these challenges, we partnered with the client to undertake a series of transformative initiatives aimed at improving operational efficiency and service delivery.
Unified Data Platform (UDP)
Recognizing the difficulties posed by data management across multiple TPAs, we embarked on a project to create a unified data platform. The goal was to consolidate, rationalize and standardize data assets, effectively creating a single, comprehensive source of truth for business intelligence and analytics. The process involved careful planning, design and development, ensuring that the new platform could seamlessly integrate data from the various systems and formats previously in use.
Population Preventive Care (PPC)
To improve the efficiency and effectiveness of the client’s disease management processes, we developed a new product offering named PPC. This initiative was based on the existing Disease Management (DM) care gaps addressal process but aimed to provide a more robust and comprehensive solution. A critical part of this project was the development of a new multi-tenant clinical portal. Built using Design Led Engineering, this portal integrated all necessary member data in a single, user-friendly interface, greatly enhancing the efficiency of case managers and nurses.
Online Portal 2.0
Alongside these specific projects, we also recognized the need for a comprehensive, unified platform for various client services. We worked closely with the client to understand their specific needs and goals, leading to the development of a new portal integrated with the UDP. This platform, dubbed “Online Portal 2.0”, was designed to be highly intuitive and user-friendly, providing a seamless experience for both the client and their customers.
Payment Gateway Integration
Recognizing the importance of a seamless payment process, we integrated the client’s online platform with a payment processing solution. This project required careful coordination with various stakeholders and thorough testing to ensure secure, reliable operation. The result was a significantly improved user experience, empowering patients and members to make payments easily and securely.
Throughout these initiatives, we provided staffing services and implemented Agile project management methodologies. This approach ensured efficient project planning, tracking and reporting, and it allowed us to adapt and respond to any challenges or changes that arose during the projects.
Outcomes
The partnership led to significant positive outcomes. The creation of the Unified Data Platform resulted in a single, trustworthy source of data for all TPAs. This improved scalability and significantly reduced data load times, thereby overcoming one of the major challenges the client was facing. The new PPC product offering and the development of a clinical portal increased the productivity of case managers and nurses. By providing comprehensive member data in a single location, it became easier to identify care gaps, conduct screenings and provide preventative care.
The user experience was also enhanced by integrating the payment gateway, which facilitated easier and more streamlined payment processes. The engagement showed steady growth, starting with a small team and expanding to a large team with a high retention rate. This growth was accompanied by multiple successful releases, including the rollout of the new online portal, improved messaging and other feature enhancements.
This engagement exemplifies a comprehensive digital transformation journey, highlighting the immense value that strategic partnerships can deliver in overcoming complex operational and technological challenges.