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White Paper
The Four Pillars of Success:
Establishing a Framework for Effective Core System-Implementation
Summary
As the transformation of healthcare continues to accelerate, the limitations of many legacy core systems are increasingly apparent when it comes to meeting the demands of today’s value-based environment.
Faced with the need to support higher levels of provider-payer collaboration, stronger member engagement, and the design and execution of complex reimbursement models, a growing number of payers are seeking systems that are more flexible, scalable, and data-driven.
At Change Healthcare Consulting Services, we understand the complexities surrounding core system replacement and the many steps required to successfully advance a project from inception to fruition. Having worked with dozens of clients to assist in the deployment of not only core claims systems but other enterprise-scale payer platforms, we’ve identified what we believe are the essential factors that can help ensure a successful system replacement.
By: Maureen Simmonds, MBA Consulting Senior Manager, Change Healthcare Consulting Services
Mauricio Jimenez, Consulting Senior Manager, Change Healthcare Consulting Services
As the transformation of healthcare continues to accelerate, the limitations of many legacy core systems are increasingly apparent when it comes to meeting the demands of today’s value-based environment.
Faced with the need to support higher levels of provider-payer collaboration, stronger member engagement, and the design and execution of complex reimbursement models, a growing number of payers are seeking systems that are more flexible, scalable, and data-driven.
These modern systems leverage newer technologies to achieve these demands. Technologies like microservices, FHIR APIs, and artificial intelligence are tools that can be leveraged to adapt to rapidly changing operational demands and regulatory requirements.
Identifying the optimal replacement platform, however, represents only half the battle when it comes to transitioning mission-critical business operations. Without a similar commitment to ensuring the implementation process is effectively planned and executed, the best of intentions can quickly unravel. In the worst case, this can mean ongoing disruptions to vital business functions, deteriorating provider and member relations, out-of-control timelines, and extensive cost overruns.
At Change Healthcare Consulting Services, we understand the complexities surrounding core system replacement and the many steps required to successfully advance a project from inception to fruition. Having worked with dozens of clients to assist in the deployment of not only core claims systems but other enterprise-scale payer platforms, we’ve identified what we believe are the essential factors that can help ensure a successful system replacement.
We’ve organized these elements into a series of planning and execution steps that collectively fall into four categories—what we call the Four Pillars of Success.
The pillars include:
- Implementation Readiness
- Governance
- Business Transformation
- Execution Framework
Before initiating the steps encompassed by the Four Pillars, it’s important to revisit the central rationale for the project by reexamining anticipated benefits as well as perceived risks. By communicating to all affected employees clear and concise objectives, along with anticipated hazards that could derail the project, implementation leaders help sustain buy-in and vigilance across the organization.
Implementation readiness
Developing detailed answers to five critical questions is a good starting point for defining the project scope and creating a viable road map for moving forward with implementation. The Q&A process looks like this:
- Why? Create a concise statement that defines the aims of the project, including the high-level strategic objectives, tactical business goals, and specific and measurable outcomes.
- How? Identify and resolve key decisions that need to be made before moving forward. These can include issues surrounding data migration, data warehousing, system reporting, and process redesign. Decision outcomes (as well as the process followed to reach them; e.g., pros, cons, justifications, etc.) should be documented in detail, since these will serve as guard- rails to guide the scope of the project.
- What? Scope the specific body of work that will be contained within the project, including business functions, integrations, interfaces, and the number of business lines and reports impacted. Define what’s in and what’s out. Create success metrics at the beginning of the project rather than at the end.
- Who? Clearly define the roles and respective responsibilities of each team member. Eliminating role ambiguity improves collaboration, reduces misunderstanding, and expedites execution.
- When? A mutually agreed-upon project schedule should encompass all milestones, project activities, and assignments and include planned start and end dates, as well as an effective tracking mechanism.
Governance
A governance framework will serve to more precisely define elements developed during the Implementation Readiness phase and more effectively manage the project. Key governance processes must be agreed upon by all parties and include roles and responsibilities; ownership; change management procedures; the delineation of risk, action, issue, and decision processes (RAID); as well as strategic considerations.
When further refining roles and responsibilities, it’s useful to identify single points of accountability and expertise in specific areas, as well as the processes team members should follow to access these resources when issues arise.
In our implementation-consulting engagements, we typically seek to tailor the governance structure to accommodate the cultures and capabilities of the client organization. For example, if the client has a project management office (PMO), Change Healthcare will incorporate the PMO into the governance structure. Alternatively, we can provide the necessary project-management expertise if those capabilities are not available internally.
Either way, it’s essential that project ownership reside within the organization. Deferring all aspects of the implementation to a vendor or consultant can result in diffuse objectives and responsibilities and, ultimately, a lack of accountability.
One of the most critical components of the governance pillar is the establishment of a clear and workable communications strategy. In our experience, we’ve found that communications breakdowns are among the most common reasons for unsuccessful implementations.
Status reporting must be formalized and widely available to build confidence and shared commitment as the project moves forward. In addition, both internal and external communication responsibilities must be defined. On the external side, for example, ownership should be established for apprising vendors, providers, and government entities about implementation progress and to alert them about testing or other considerations.
Business transformation
Transformation inevitably brings disruption, so it is therefore important to carefully think through the impact the new platform’s functional changes will have on business processes. This step involves identifying value chains for core business functions, codifying new workflows and procedures, defining new or changed roles and responsibilities, and creating critical performance indicators that can measure the new processes.
Equally important is the development of training initiatives that will help ensure the system’s capabilities are adopted and the benefits fully realized. Focused, role-based training is the most effective way to maximize returns on your training investment. In other words, training must be tailored to each role within the organization. An individual from Member Services clearly should not receive the same training as someone from Provider Relations.
Unless training content directly relates to the individual’s tasks and responsibilities, a trainee will feel their time has been wasted and ignore the message. Similarly, neglecting employees affected by the transformation will guarantee resistance to change.
Effective training ultimately depends on employee buy-in, which, in turn, requires a steady, clear, and transparent communication stream from the project owners. You must not only send the right message to the right people, but you also must let them know how often and by what means relevant information will be conveyed.
Execution framework
Competent execution is the most critical of the Four Pillars, since without it, the best-laid implementation readiness, governance, and business-transformation efforts will be wasted. One of the keys to optimal implementation is strict adherence to the plan in place, particularly when conflicts or problems arise. This may seem self-evident, but it is common for distractions to divert attention, energy, and effort once the process begins, leaving team members scrambling to complete necessary tasks.
Leaders should emphasize the importance of remaining focused and should stand ready to assist team members in quickly and consistently prioritizing as issues begin to pile up. And while sticking to the plan remains the baseline of solid execution, flexibility also is important to quickly work around unforeseen problems or complexities.
Here are some other key factors to keep in mind during the execution phase:
- Requirements gathering: Focus on business requirements. We often see requirements that mimic the processes of the legacy system, as opposed to focusing on business or system-agnostic requirements born from actual business needs. It is therefore important to segregate business and technical requirements. Remember, the technical requirements provide the blueprint for the technical solution’s architecture, while the business requirements represent the functionality you wish to achieve.
- Stay Focused: All relevant information must be spelled out in detail when it comes to requirement Gathering. Incorrect or misunderstood requirements result from miscommunications, erroneous assumptions, undocumented processes, and misaligned definitions.
- System Integration: An integration strategy is required to define standards around how systems will talk to each other. Define an enterprise-system architecture, coding guidelines, tools, languages, system schedulers, and endpoints. Develop an end-to-end connectivity approach.
A custom, comprehensive approach
The Four Pillars of Success reflect the knowledge and wisdom we’ve accumulated over the course of dozens of implementation projects going back more than a decade. That said, we recognize that every project is unique and must be assessed from the ground up as a stand-alone, custom installation. In other words, we won’t adopt a cookie-cutter approach when it comes to implementation assistance.
Similarly, we will calibrate our support to a level that best meets your needs and desires. Our spectrum of consulting services ranges from playing a limited advisory and project-review role to filling key positions and running the implementation. We’ve found the most effective approach is a blended arrangement that incorporates personnel from both your organization and ours, with Change Healthcare filling in gaps as necessary from a skill and capacity perspective. This partnership model helps ensure that you, the client, retains ownership, and also creates an avenue for knowledge transfer between our personnel and yours.
Ultimately, the Four Pillars provide a blueprint that will help you anticipate and overcome common pitfalls that often derail core system implementations. With detailed planning, a comprehensive governance structure, proactive change management, and a systematic implementation framework, your organization can smoothly transition from today’s increasingly obsolete system capabilities to a platform capable of accommodating the growing complexities of today’s value-based environment.
