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Averaging more than 15 years of experience in the healthcare industry, our consultants have worked in a variety of management positions within commercial and government payer organizations, so we understand first-hand your challenges—including competitive pressures, organizational obstacles, and limited resources.

 

Case Overview

A West Coast-based, not-for-profit health plan had been underutilizing a current software, Compliance 360 (C360), to its fullest capabilities. Although the technology had been in place for years, better processes and optimization opportunities existed. The health plan sought out Change Healthcare Consulting services to help re-implement C360 with several goals in mind: to help streamline compliance-related work processes, identify compliance gaps and risks, eliminate duplicate efforts, ensure accurate reporting, enable timely responses to regulatory compliance requirements, and easily maintain compliance records. They sought out the Consulting Team’s Project Management expertise during the first phase of the project and planned to carry forward the second phase of the project independently.

Challenges

  • Due to the underutilization and lack of experience, there was a significant knowledge gap about functionalities within the C360 application and compliance-related workflows and processes within the organization
  • Lack of initial-launch staff; none of the same staff had been around for the first implementation
  • Inefficient compliance-related workflows and processes
  • Resistance to change from departmental staff members

Results

  • Despite the large resistance, staffing limitation, and delays that occurred during configuration reviews and testing, Phase 1 of the C360 Reimplementation Project went live by the scheduled Go-Live date
  • Completed detailed Business Requirements Document (BRD) with Functional Specifications supporting desired future-state compliance-related workflows
  • Phase 2 of the C360 Reimplementation Project was initiated by the scheduled kick-off date
  • Client was provided with project materials and documentation to move the second phase of the project independently

Solutions

  • Helped the project team and end-users understand how new compliance-related workflows integrated with the C360 modules
  • Applied strategies supporting a change-management approach to combat staff resistance to change
  • Assisted with drafting and finalizing business requirements and functional specifications
  • Aided in creating a collaborative team environment with the Project Team to identify, address, and work on the reimplementation project
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