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Abstract:
Reimagining Medical Cost Reporting Across All National Health Plan’s Projects

The Medical Cost Initiative team at a large national health plan tracks over 400 innovation and improvement initiatives that require regular performance reporting. The monthly process to collect data and provide performance reporting was ad hoc, chaotic, and relied on one individual to carry out the entire process. The resulting reporting data required frequent quality checks, and the team would have to rely on heroics of individuals for timely report creation.

SDLC Partners quickly brought order to chaos by reimagining their workflow into an iterative, agile data collection and reporting process built upon documented standards and training a broader team.

Now, the client has a repeatable and reliable process that has rebuilt trust in their ability to report timely and accurately. They can create reporting, quickly, based on data that is, at most, a week old. They have multiple, trained staff to carry out the new, standardized process and modern, reliable tools to make data collection and reporting a point of confidence and pride rather than frustration and chaos.

Agile Performance Process Reporting
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Challenge:
Managing 400+ Medical Cost Innovation and Improvement Initiatives

The health plan’s Medical Cost Initiative is responsible for metrics management and reporting for over 400 innovation and improvement initiatives. The client wanted to gain clarity on the scope of the problem and receive recommendations on how best to resolve their many pain points, most importantly, regain trust in their reporting and ensure that the project metrics were timely and reliable.

SDLC Partners conducted process mapping and carried out interviews with stakeholders to uncover all the pain points, including:

  • The data and reporting request intake process was ad hoc
  • Data collection and reporting request traceability was manual
  • Few instructions were standardized or documented
  • The ad hoc process was exceedingly complex and required much rework
  • An inordinate amount of time was needed to “check the checkers” because of lack of trust in the data
  • All data validation and quality control were manual
  • There was no documented process for version control
  • Data updates were not on a fixed schedule
  • Only one person was able to carry out the entire process because of complexity and lack of standards or instructions

What the Client Thinks…

“Working with SDLC Partners, we were able to realize all the technology possibilities we had available to us. Not only did they help us gain clarity on our current- and desired-state quickly, but they helped us stabilize current processes in the real-world while we worked side-by-side to bring the new process to reality.

We were very pleased with their ability to dive in with our team and work deeply, productively, and quickly.”

Stephanie Madia Mobley
Vice President, Medical Cost Initiatives
Highmark, Inc.

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Solution:
Creating an Agile, Iterative, Standardized Process that Builds Data Confidence

A cross-functional team from SDLC Partners included experts in enterprise agility, business process transformation, digital enablement and digital architecture. Together, they faced a very tight timeline and a client request to bring stability to their real-time process while providing recommendations for sustainable and repeatable solutions.

Process Mapping Uncovers Pain Points & Priorities

Our process mapping (Figure 1) revealed 27 major pain points, of which two were most deleterious – too much time needed to be spent “checking the checkers” and the entire process depended on the knowledge and ability of one staff member.

Process Mapping
Fig 1: Process mapping metrics reveal current workflow areas for improvement and innovation.

Creating Agile Process Solutions Based on Priorities

Our current-state decomposition (Figure 2) looked at how much value could be gained by improving each area when compared to how much the business relies on that area.

Current State Decomposition Chart
Fig 2: Current-state decomposition helps prioritize pain points and create a solution plan of action.

Based on our analysis, we got to work addressing the ad hoc and unreliable nature of the current data collection and reporting process with the priority to ensure comparable, timely, and reliable data output.

We recommended taking an agile approach by separating data collection into a weekly, iterative process and data reporting into a standardized, monthly workflow (Figure 3).

This simplified approach could eliminate guesswork and “reinventing the wheel” each month and enable a repeatable, documented workflow that many staff could be trained to execute.

Fig3-Weekly Report Process
Fig 3: Agile approach by separating data collection into a weekly, iterative process and data reporting.
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Results:
Agile Performance Reporting Creates Confidence in Data Decisions

Most critically, we were able to reimagine the client’s entire data collection and reporting process, enabling a larger team to carry out a reliable, standardized, and repeatable workflow and providing a new level of data reporting quality and confidence.

Together, we were able to bring stability to their performance reporting in real-time, as well as provide recommendations for innovating and improving the metrics management program overall.

Creating an agile performance reporting process immediately addressed 16 out of the 27 pain points and gave the client a path towards rebuilding trust in their data reporting. Now, they can create reporting for their 400-plus innovation and improvement initiatives, quickly, based on data that is, at most, a week old. They have multiple, trained staff to carry out the new, standardized process and modern, reliable tools to make data collection and reporting a point of confidence and pride rather than frustration and chaos.

Reimagine Your Metrics Management Process and Build Trust in Your Data Again

If your performance data collection and reporting process is costing you precious time, money, and employee satisfaction (as well as executive confidence), we can help. Our enterprise agility approach to business process improvement and data analysis and reporting can transform how you make confident strategic and operational decisions based on data you trust.

We can help you Achieve Real Results

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