health-plans

Health Plans
Case Studies

Care Management Selection

Summary

Our team worked with a health plan to evaluate the landscape for a third party care management solution vendor, and our efforts culminated in the plan selecting a vendor in less time, that was the right fit for their company.

 

Challenge

  • A medium sized health plan sought external resources to evaluate the landscape for a potential third party care management solution
  • This health plan was struggling to meet the demands of the ever-changing healthcare environment by using a solution developed in- house, which was limited in scope and functionality
  • The health plan set an aggressive timeline to develop operational requirements, select a vendor and implement a new solution

Approach

  • On-site meetings were scheduled with each department to document operational and regulatory requirements
  • We created a global requirements document with general market directions accompanied by a high-level operational workflow future state blueprint
  • We developed an RFP based on the requirements and served as the primary contact for all vendor questions and follow-ups
  • We helped the health plan schedule vendor demonstrations, evaluate vendors using a scoring matrix, evaluate other in house solutions and develop a TCO model

Results

  •  We reduced the time for selection by focusing on our previous knowledge of the vendor space and eliminating vendors not suited for the client
  • Our client selected a vendor that was not known to them previously but was the ideal solution for their business
  • We used previously established CM/DM/UM requirements to shorten the requirements development cycle, which enabled an earlier deployment of the ultimate solution