Successful implementation of a new clinical software platform that improved efficiency with the automation of workflows, established enhanced analytics and reporting and improved member experience.

Challenge

The client is a Managed Care Organization (MCO) that needed to migrate its core system and plan for the integration of a new clinical platform. This process was dependent on the successful claims management migration. Throughout the planning and migration, the organization needed to continue business as usual with minimal disruptions to prevent member abrasion.

Solution

ProspHire partnered with the client to provide clinical expertise and support for the implementation and integration efforts of a best-in-class, Care Management Software tool that would improve staff efficiency and improve member satisfaction. ProspHire administered a thorough current-state assessment of the client’s existing Care Management and Utilization Management processes, pain points and workflows to identify opportunities for expansion and further development. The ProspHire team then collaborated and worked with key stakeholders and the clinical platform vendor to establish the necessary requirements and user stories for the clinical platform build. The team also supported process enhancements and clinical workflows. User Acceptance testing was then initiated to demonstrate the system was fit to meet business needs. ProspHire supported post Go-Live activities to ensure that the implementation effort was successful and to maximize adoption of the new platform.

Result

As a result, the client was able to successfully implement a new clinical software platform that improved efficiency with the automation of workflows, established enhanced analytics and reporting and improved member experience.

Deliverables

  • Met the go-live date on time for a successful implementation
  • Improved Member Experience by creating and utilizing a member-centric tool that focuses on all aspects of a member’s health
  • Improved Efficiency and Process Improvement by increasing automation and decreasing manual effort and duplication of documentation for member interactions

Client Overview

The client is a Managed Care Organization (MCO) that supplies various types of health services to members. Their focus is on Medicare Assured and Medical Assistance (Medicaid) plans. The client offers Medicare products to beneficiaries in certain counties and is the largest Medicare program and the largest Dual Eligible Special Needs Plan (D-SNP) in the state. They offer disease management, health and wellness and preventative care programs rooted in principles of public health.

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