Enterprise Architecture
The Situation
The CIO of a regional Blue Cross Blue Shield Health Plan wanted to design a next-gen product to manage healthcare provider data. The goal was to create an easy and convenient way for healthcare providers to update their information, such as address, doctors, and specialties.
Administrative tasks between healthcare payers and providers were inefficient. Inaccurate data for providers compounded this problem, furthering the administrative burden on both plans and providers. This could delay patient care and often required significant manual effort to resolve.
The Challenge
Historically, health plans have addressed provider data quality through disparate solutions and a variety of manual processes and analytics.
However, each health plan in the United States needed to solve the same problem. They all needed a mechanism to ask providers to keep their data updated. Moreover, this placed unnecessary administrative burdens on providers, as each provider would be required to update the same information for multiple healthcare payers.
Therefore, it made sense to create a common solution that could be used by multiple healthcare payers. Recognizing this, the CIO assembled a collaborative of four additional regional health care plans to design a common solution. These five CIO's aimed to create a joint solution to provider data quality management.
Our Solution
First, we helped the collaborative to develop a product vision for how to build a new provider data management ecosystem. The solution needed a portal for providers to attest to their data, data feeds from third party data sources, data mastering, a data discrepancy detection engine, and an audit trail.
Next, we designed a solution architecture for the proposed solution. With a solution architecture in place, we could decide which capabilities the collaborative would develop in-house and which capabilities should be fulfilled by external vendors.
We decided that third party data sources, the provider attestation portal, and the data discrepancy detection engine were best fit for external software vendors. Moreover, after a market scan, we concluded that no one vendor addressed all three capabilities. Hence, the collaborative approached three separate vendors, one for each capability.
Lastly, we helped the collaborative develop a 6-month product roadmap to design an minimum viable product (MVP). With that in place, the collaborative decided to launch this joint initiative.
Project in Brief
Company:
Regional Blue Cross Blue Shield Health Plan
Client:
CIO
Problem Domain:
Enterprise Architecture
Results:
6-month product roadmap
Completed:
Q4 2022
