Case Study: Non Profit Midwestern Health Plan
A non-profit midwestern health plan faced a unique challenge in moving its million-plus members to a single care management platform.
Implementing a care management platform presents multiple challenges, particularly for large health plans with diverse populations and complex clinical and claims systems. This case study explores the successful implementation of HealthEdge’s GuidingCare® platform by a non-profit Midwestern health plan, which managed to transition over one million members to a unified care management system.
The Challenge
The health plan faced the daunting task of consolidating two distinct clinical systems linked to four separate claims systems, one set for an upgrade and the other being phased out. A unified model was essential for managing various risk levels effectively.
The Solution
The implementation strategy was executed in three distinct waves to ensure a seamless transition:
- Wave 1 focused on a small, simple commercial population, allowing the team to learn and apply insights to more complex groups.
- Wave 2 expanded to a larger, more intricate member population, including Medicare and Medicaid, requiring additional planning and configuration.
- Wave 3 addressed the most complex phase, incorporating individual family businesses and new Medicare expansions.
Despite the onset of the COVID-19 pandemic, which forced the team to shift to remote work, the careful planning and collaboration with HealthEdge ensured that the GuidingCare implementation was completed efficiently within approximately six months.
Key Lessons Learned
- Prioritize Critical Tasks: Focus on essential activities to maintain project momentum.
- Solid Team Assembly: Appoint an experienced project manager and ensure strong executive support.
- Phased Implementation: Conduct the rollout in waves, learning from each step and applying those lessons to subsequent phases.
- Celebrate Milestones: Recognize and celebrate key achievements to maintain team morale.
- Prepare for the Unexpected: Expect and plan for unforeseen challenges.
By leveraging these best practices, the health plan was able to demonstrate how to effectively manage a large-scale, complex platform implementation even during uncertain times, ensuring minimal disruption and maintaining high standards of care management.
Learn more about overcoming care management implementation challenges and how HealthEdge’s GuidingCare® can help your organization achieve a smooth transition. Contact us today to get started!
