Client Results: Leading a System Integration for an MCO

We created, formalized and executed the processes that allowed our client to successfully migrate to a core healthcare administration platform.

Challenge

The client needed to implement a custom-built, large-scale, healthcare administration platform for their Medicaid lines of business. To do so, they needed to develop new organizational processes and support practices. They also had to ensure the new system met formal compliance standards.

Solution

The engagement team created and defined the program structure, business requirements, design, testing and go-live support services. They developed processes to mitigate risk with the new platform and aligned the regulatory and organizational requirements to the future state model. To effectively manage all business units’ use of the new platform, the team established a governance structure to standardize processes, structured, implemented and optimized a UAT strategy, and supported the client through go-live and post go-live implementation activities.

Result

As a result, ProspHire enabled the organization to successfully migrate to the new healthcare administration platform within the desired timeline. The migration included rolling over all business units and achieving compliance with organizational and regulatory requirements. ProspHire also provided post-implementation support and developed a post go-live strategy, including job aids, desk level procedures (DLP) and change and release management governance models.

Deliverables

Successful system migration
Regulatory compliance
Standardized processes
Desk level procedures (DLP)
Risk mitigation
Go-live strategy
Post-implementation support

Client Overview

The client is a managed care organization (MCO) that provides health services to members within Pennsylvania. They have one of the largest Medicare programs and the largest D-SNP program in the state.