Abstract

In support of a Pay-for-Performance (P4P) initiative, a large health insurer required significant changes to a series of clinical quality measures that populated its web-based physician scorecards. The P4P program offers primary care physicians an opportunity to earn additional reimbursement for providing efficient, high-quality care. The scorecard grades each physician and determines the level of additional reimbursement, if any. With a fixed deadline, mounting frustration and no light at the end of the tunnel, the Business Intelligence and Data Integration Practice of SDLC Partners was asked to help mitigate the situation.

The Challenge

Charged with ensuring success on an initiative already behind schedule, SDLC’s leadership team quickly organized a strategy session where it uncovered additional hurdles that threatened the project’s advancement, including:

  • Migration of existing clinical quality processes from one platform to another
  • An ineffective data model
  • Excessive system processing time
  • No, limited, or insufficiently-designed documentation
  • Inefficient communication between business and IT
  • Lack of confidence in data
  • Less than optimal level of expertise within the IT team to support the initiative

The Solution

Given the urgency of the situation, the traditional assessment and requirements gathering process was impractical. Rather, a “triage and treat” approach was undertaken to establish development and implementation priorities for a limited group of resources, under severe time constraints. Using this model, concurrent design, development, and testing takes place across a team of highly experienced developers and testers. The project management team focuses its energy on driving rapid, high-confidence decisions that are both practical and in alignment with future state considerations. In the end, SDLC Partners leveraged existing best-in-class technology and information assets to deliver this clinical quality component of the dashboard on budget and on time.

The Results

Due to the “failure is not an option” attitude, as well as the highly-skilled expertise of SDLC Partners’ BI Practice, the enhanced scorecards were released. Not only did the client realize a significant increase in data confidence levels, the scorecard enhancements also exceeded expectations. Both SDLC partners and the client team were challenged with what seemed like an insurmountable task, but rallied to establish a workable contingency plan making the initiative a success.

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