Successful System Migration of Multi-State Clinical Software Platform

Challenge

The client faced significant issues in their current care management system, centered around time-consuming, manual processes for manual creation of Care Plans (ICPs). This led to incorrect reporting and ultimately quality control issues. Additionally, there was inconsistent training among team members, lack of direct feed for authorizations into the Health Rules Payor (HRP) system. Further, prolonged system updates, combined with inaccuracies in the date and time stamps on Health Risk Assessments (HRAs), resulted in substantial periods of downtime and necessitated manual revisions of data.

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 member satisfaction. ProspHire administered a current-state assessment of the client’s existing Care Management and Utilization Management processes, challenges and workflows to identify opportunities for enhancement and expansion. The ProspHire team collaborated with key stakeholders and the clinical platform vendor to establish the necessary requirements and user stories for the clinical platform build. The team supported execution of identified process enhancements and clinical workflows, including test case development and delivery, defect logging and escalation, and prioritization of bug fixes.

Result

As a result, the client was able to successfully implement their first, multi-state clinical software platform. This platform improved efficiency with the automation of workflows, established enhanced analytics and reporting, and improved member experience.

Deliverables

  • Successful system migration of multi-state clinical software platform
  • Agile project management
  • Multi-State Clinical Software Platform for Care Management and Utilization Management
  • Regulatory compliance
  • Post-implementation support

Client Overview

The client is a Managed Care Organization (MCO) that provides Medicaid and Medicare coverage to members.

Let’s have a conversation

Jaspreet Laungia

Senior Manager
[email protected]

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