What Happens After Go-Live? How Health Plans Successfully Leverage Technologies Long Term

Long term technology success hinges on the last step of HealthEdge’s Transform Methodology, Execution

Transform Methodology’s Last Step: Execution

Traditionally technology implementations involved simply building on a firm’s operational competencies and short term needs by adding a product.

Instead, transform methodology is the insurance industry’s long term approach to change management. It requires working together with vendor’s expertise and software to align and achieve long term goals while transforming businesses from the inside out.

Transform methodology was developed leveraging HealthEdge’s extensive experience successfully implementing their suite of solutions with health plans of all types, sizes, and lines of business.

HealthEdge has outlined 3 phases of successful technology implementation: 1. Evaluation 2. Envision 3. Execution. Because Transform Methodology is focused on long term success, the last phase of technology implementation is ongoing and the most intensive to explain. This article goes over in detail how to successfully execute technology implementation over many years.

To learn about the previous two phases read 3 Steps to Effective Technology Implementation for Health Plans.

Phase 3: Execution

Key Steps

PART 1- Implement

• Build: Configure and Integrate products
• Migrate data
• Execute test phases
• Plan operational readiness and training
• Plan cutover and go-live

PART 2- Promote

• Execute final end-to-end validation and assure operational readiness
• Execute cutover
• Go live
• Begin monitoring user adoption and outcomes

PART 3- Transition

• Stabilize customer business in production
• Conduct handoff from project to operations
• Initiate next phase and optimization opportunities

Planning for the Go-Live

Planning for a technology’s Go-Live involves outlining the design, delivery tools and best practices which will be leveraged.

Design

There are 3 aspects of design to keep in mind to ensure long term technology impact:

1. Operational Efficiency and Scalability: Consider any needed maintenance. Are there any processes to outline which would promote sustainability and accuracy? As well, make sure the designs are scalable to meet throughput and performance needs.
2. Modular Framework: It’s important to work in tandem with existing editors to enable additional editing opportunities and efficiencies.
3. Security: Make sure to leverage secure cloud-based architectures with SaaS delivery.

Delivery Tools

When deciding which delivery tools are important for your go-live consider including tools that:

• Ensure Operational Readiness: Tools that adapt to change such as those that correct language, edits and pricing
• Leverage Agile Principles: Tools that enhance collaboration across teams to deliver iterative batches of work with well defined acceptance criteria
• Promote Future Functionality: Tools that will allow your health plan to become better as your vendor’s solution becomes better

Best Practices

Best practices your health plan uses when executing a software deployment should encourage process optimization. This includes leveraging training materials like:

• User Guides: Guides that provide organizations knowledge and recommendations on how to leverage features and functionalities
• Training Suites: Trainings which empower your team to drive organizational change and implement operational efficiencies.

Vendors should also offer separate product support by customer type like Blues and Non-Blues. Upgrade cycles should also be separated by customer type.

“One Team” Principal

All execution efforts should promote a “one team” approach to software launches. This means integrating activities of all internal departments and vendor supports. In this way, deployment should be seamless and have a precise focus.

Most importantly, be sure to have unified:

• Goals
• Governance Practices including the governance team’s mastery of advanced operations
• Collaboration Mindsets where work is encourages across business teams
• Operational Model
• Communications including agreed upon cadence and promotion of knowledge-sharing across teams
• Decision-making structures
• Focus on value driven work like reuse, scalability and flexibility
• Capacity to accept changes quickly.

With the “one team” approach, vendors can be better partners to your health plan, helping you with implementation and setting your organization up for long term success.

Moving Beyond the Go-Live

It’s important that health plans think beyond the go-live date to ensure long term success of any implementation. This planning should include:

• Maintenance of a strong release management process
• Coordination of at least 1 upgrade annually
• Implementation of an annual Health Check to analyze workflows and new features
• Optimization of processes as new items are released

Other considerations involve adopting a continuous improvement approach when moving from an MVP (minimum viable product) to optimal functioning, removing manual interventions, as well as improving processing times and key metrics.

As new features and functionalities are released your health plan can take advantage of better optimized workflows and configurations. For example, with Source, new content and policy updates help health plans keep pace with business and growth.

When implementing new features ask yourself:

• Are there new ecosystem partners we need to integrate with?
• What does this change impact? (ex. input/output, technical, business, claims, manual processes?)
• Who deploys the changes?
• Which configurations or pricers need updates or changes?
• Are updates required for automated or manual workflows?
• How will testing take place for the changes? (pre-production testing for expectived results, go-live decision testing, export or import testing to update production environment?)
• What training or communication should be send out regarding the change?

Health Edge Case Study: Results and Returns

Using these principles, HealthEdge has enabled savings for its clients through long-term partnerships.

• Medicare Advantage payment integrity
• Multi-state Medicaid implementations
• Dual-eligible implementations
• Automated claims pricing for LOB

Their Source solution consistently monitors and updates regulatory policies, rates, fee schedules resulting in effective contract configuration which:

• Reduces repeatable processes
• Reduces number of contracts
• Minimizes needed maintenance
• Optimizes existing processes.

The Source solution also applies claims pricing seamlessly with your health plan’s existing editors. To learn more about HealthEdge and their suite of solutions for health plans click here.