Our health plan client had been outsourcing their Medicaid analytics and risk stratification for a particular state. Because they were not leveraging predictive analytics in healthcare, there were concerns regarding the viability of produced results in facilitating effective care management practices.
One of the nation’s largest health plans and integrated delivery systems launched a platform to test early-stage, FDA-approved innovations, which became a commercialized service offered to other payers.
Their innovation platform identifies best-in-class solutions, connects health care innovators to facilitate product testing, generating evidence and propelling new health solutions into the marketplace.
The test-and-learn platform needed to scale to meet the needs of their health insurance clients. They, also, needed to streamline operational efficiency to keep up with the operational enhancements and the backlog of software requests.
SDLC Partners helped this healthcare client expand their software development capacity and ability to scale their platform to meet market need. We did this by empowering the client with a transparent and clear view of their current state, as well as guiding them to create an effective strategy and action plan that would allow them to maximize value in light of the volume of development requests.
This payer was relying on outsourced analytics and risk stratification to fuel population health and care management outreach to a particular state’s Medicaid members.
Further, the deterministic nature of the outsourced risk stratification process – which was based primarily on claims-driven diagnosis codes – was found wanting in terms of an ability to predict adverse events like unanticipated death investigation alerts or effectively curb opioid / substance abuse.
The client needed a way to develop prescriptive paradigms for care management, which embodied predictive abilities that went beyond rule-based stratification of member-specific risks. The goal of such a prescriptive risk stratification paradigm is to target member outreach, as well as offer timely and effective care management to high-risk members. Some specific cohorts of interest, concerning prescriptive care management, included substance abuse, maternity, neonatal ICU care, and sudden death investigation alerts.
However, the resulting insights were not robust enough to accomplish optimal managed care or predict deaths amongst members that were at risk of substance abuse. This health plan wanted to prescribe care management practices in a manner that anticipated, and therefore averted, otherwise unanticipated deaths amongst members, especially owing to opioid abuse.
The innovation platform for payers couldn’t expand in the marketplace with the current approach. They were unable to scale fast enough to accommodate more health plan clients and struggling to keep up with their backlog of demand for operational enhancements and software customization requests.
The SDLC Partners team was charged with producing the design and implementation roadmap for our client’s innovation platform, spanning processes, tools, and measures, as well as any needed adjustments to team composition and accountabilities with three goals:
- Address known and to-be-discovered process bottlenecks and prioritize pain points
- Design a “pull system” to improve processes, simplify tools and de-duplicate to further improve ‘stickiness”
- Align the measurement system to goals and provide an easily-accessible, single source of truth to track and predict throughput and value for the market
- Additionally, the client asked us to help them execute on their product’s value chain, expand development capacity, and bring standardization to their software development processes.
Our interdisciplinary team brought proprietary methodologies, proven approaches, and industry best practices to bear on the project, incorporating all of the following and more.
- Lean Thinking
- Process Improvement via SIPOC (suppliers, inputs, process, outputs, and customers)
- RACI Framework (responsible, accountable, consulted, informed)
- Skill Mapping with SFIA
- Demand/Capacity Modeling
- Human-Centered Design approaches like ethnographic Interviewing and observing
- Knowledge transfer mentoring and training sessions
Through effective collaboration and established, proprietary approaches, SDLC Partners helped this health plan client increase platform use, address a backlog of 100+ requests, and garner national attention for their innovation platform.
Now, this commercialized innovation platform for payers can meet market demand and empower healthcare organizations to test their innovative creations, producing evidence for commercially available products. The sky is the limit now that this client has the capacity to meet software enhancement demand and scale as their customers’ needs grow.
If your backlog is preventing your innovation from reaching their market potential, we can help. Contact Us to discuss how we can help your team launch product features faster and amaze current and potential customers.