Case Study: IT Strategic Plan for National Healthcare Company
Our client, a national integrated care delivery system, wanted to employ industry-leading technology to enhance its ability to provide high quality and affordable care. Their historical approach to technology investment, however, had never been very strategic. Rather, their focus was primarily on responding to the never-ending and very large volume of requests for system additions, enhancements, and replacements without much assessment of the overall strategic value of those system investments. This approach was high in cost but never seemed to allow the firm to realize their most pressing business needs.

We were brought in to help our client establish an annual strategic planning process that linked business strategy with IT investment decision-making. The goal was to have an IT investment plan that was directly linked to enabling the firm’s business strategy. This included examining the business environment, defining the future state business vision, identifying the new business capabilities required to realize that future state, and, finally, determining what technologies were best suited to enable those business capabilities. The result of our work was not only an IT multi-year strategy that provided a roadmap for the development and deployment of appropriate technologies but also the adoption of an on-going strategic planning and decision-making methodology to guide leadership as new business priorities emerged.

Services Provided

  • Business Assessment – An examination of the internal and external business environment to help define the company’s key strategic imperatives.
  • Future State Vision – A definition of the desired business outcomes 5-10 years in the future and the associated business capabilities required to achieve those outcomes.
  • IT Strategic Plan – A multi-year roadmap that identified sequenced technology development pathways that, upon completion, would support the business’ realization of its future state vision.
  • IT Investment Planning Methodology – The annual strategic evaluation process used to assess the merits of competing technical solutions within the context of the larger IT Strategic Plan.
  • Performance Monitoring Capability – The deployment of a monthly dashboard that allowed leadership to measure incremental progress in achieving the desired outcomes of the IT strategic plan.

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Case Study: On-demand Patient Telehealth Services
Patients accessing medical care have historically only been able to see a doctor at a time and place that is convenient to that doctor. If one’s child is crying due to an ear infection at 2 a.m., for instance, they typically must either wait until the next day or even later when a doctor is available or choose to sit in an ER waiting room all night. Our client, a large healthcare provider, wanted to flip this model such that they offered access to doctors when and where it was convenient for their patients. We helped make this happen by establishing an on-demand telehealth services model for a series of applicable primary care and pediatric health conditions. The result? Our client now provides hundreds of thousands of telehealth visits each year (available every day, 24 hours a day) at a time and place that is convenient to their patients. Patient satisfaction for this service exceeds 95%.

Services Provided

  • Strategy – Visioning and future state design
  • Business Case – Cost/benefit modeling and securing of necessary resources and funds
  • Operational Design – Development of standard operational model, creation of physician pools, identification of in-scope medical conditions, development of call center and web channel content and scripts
  • Technology Solutioning – Technical architecture, vendor assessment and negotiation
  • Solution Deployment and Support – Creation of a deployment “playbook” to facilitate consistent implementation and adoption of standard operational practices across all deployment sites
  • Post Deployment Advise – Strategy formulation and recommendations for service model refinement and expansion of scope of practice to include additional specialties

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Case Study: Care Management Platform for Chronic Disease Population
A specialty disease management provider was struggling to achieve its desired clinical outcomes as it couldn’t seem to lower its incidence of unanticipated hospitalizations (via the emergency department). In addition to dealing with the clinical challenges, this population also presented many psychosocial factors that were adversely affecting outcomes. Our client wanted to improve patient engagement and self-monitoring to limit such outcomes, but realized that its care providers lacked the right information at the right time to appropriately assess the population and proactively intervene with the most vulnerable segment.

We worked with our client to reshape their care model from both clinical and patient engagement perspectives. We enhanced the design of the nurse portal so that updated clinical results were available as near real-time as possible. In addition, analytics were designed that assessed current health conditions, results, and levels of patient engagement to suggest prioritized patient visits and nurse schedules. In addition, staff received more extensive coaching, i.e. motivational interviewing techniques to promote patient engagement and thereby realize better medication adherence and other benefits.

Results were immediate and most evident among the care practitioners. Significant improvement in the overall satisfaction of the nursing staff was realized by enabling greater automation with scheduling and work flow management, thereby reducing administrative burdens and promoting more patient-facing time, especially with the most at-risk groups. In addition, some progress is being made with reducing the rate of hospitalization. With better and more timely data, our client is able to assess adjust its program parameters to more cost-effectively realize its care outcomes.

Services Provided

  • Vision – Redefined the operating model for the nursing staff by creating a point-of-care portal that identified prioritized cases and customized the care session based most recent clinical data and current level of patient activation.
  • Solution Requirements – In addition to defining the point-of-care portal, detailed requirements were also developed for complementary solution elements including biometric data collection, scheduling, alerts management, and knowledge management.
  • Operational Design – Streamlined the nurses’ processes by prioritizing appointments and delivering real-time clinical results to guide the care session. Also included more extensive motivational interviewing training to enable better patient engagement.
  • Technology Solutioning – Developed point-of-care portal, modified patient scheduling, and enhanced various legacy and third party interfaces.

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Case Study: Claims Review & Cost Containment for a Regional Health Plan
Our client, a regional health plan, wanted to assess its claims payment appropriateness and efficiency relative to its competitors and implement targeted and high-impact improvements. Our client had not updated its facility and provider compliance review programs for several years and believed that it was spending operating dollars for various pre-payment and post-payment reviews with very little return in the form of cost containment.

Over the years, the plan had continued to use clinicians, mostly nurses, to assess claims based on a few simple parameters mostly driven by diagnoses and dollar amounts. Based on claims identified for review, the plan had annually increased its operating review budget, but was experiencing declining savings and recovery opportunities per reviewer. Overall returns were flat i.e. the more resources the plan devoted to their programs resulted in only negligible marginal returns.

We were brought in to help our client establish a new direction, one that would identify and target high-margin opportunities and realize greater savings with a more efficient and lower overall cost review program. By isolating new opportunities highlighted from a best practice review, Artesient’s prior performance engagement experiences, and configuration and rule enhancement sessions with its software vendor, our client was able to reshape the claims review mix with the best potential savings.

The results of our work during the initial year of deployment included a better skilled but smaller review team that delivered 25% more savings than the prior year with an operating budget trimmed by 15%.

Services Provided

  • Best Practices Review – A review of various plans’ claims review functions across several dimensions including organization and training, process management, pre- and post-payment review software, operating efficiency, and cost containment. Plan participation was secured by committing to share all survey results (de-identified) with participants.
  • Future State Vision – A definition of the desired claims review outcomes 3-5+ years in the future and the associated business capabilities required to achieve those outcomes.
  • Multi-Year Roadmap – A multi-year roadmap that identified sequenced enhancements to reviewer skills, software rules configuration and claims samples that, upon completion, would support the realization of its future state vision.
  • Organizational and Process Improvements – During the first year of implementation, more skilled code reviewers were added to the team, and work queues were modified to more quickly review and confirm savings while still meeting payment turnaround times.
  • Performance Monitoring Capability – The deployment of a monthly dashboard that allowed leadership to measure incremental progress in achieving the desired outcomes, primarily improved operational efficiency and claims cost containment.

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Case Study: Healthcare Broker Sales Channel
A major healthplan saw an opportunity to grow its membership by expanding the way its sells - through a brand new sales channel targeted to an under tapped segment of the market. By partnering with the external community of third party brokers, who traditionally sell life, accident and sometimes healthcare insurance products to small medium businesses as well as direct to consumers, the healthplan believed it could dramatically increase its market share and membership. In addition to defining the opportunity and assessing current capabilities, Artesient consultants were asked to develop new business processes to service this broker community, including implementing a whole new call center and a state of the art workflow management system. We are proud we were able to help our client understand the specific market opportunity and the way brokers like to partner with a healthplan to sell. Over the years, this channel has been a significant source of growth and has contributed to the continued fulfillment of our client’s mission of providing quality care and service.

Services Provided:
  • Market Assessment – Segmentation and sizing, value proposition development, ROI analysis
  • Capabilities Assessment – Assessed existing ability to partner with and sell through broker community
  • Call Center Operations – Infrastructure design and sourcing, budgeting, staffing and training, marketing communications
  • Workflow Management – Process development, workflow management and image recognition technology, training and implementation

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Case Study: Wireless Application Ecosystem
Wireless had emerged on the scene and had the opportunity to quickly cascade across and possibly revolutionize every business sector. Our client was a major wireless carrier which wanted to expand its portfolio of wireless application offerings for industries such as transportation, manufacturing, utilities and also healthcare. The critical question was how to take the latest innovative technology, and all the complexities involved, and make it meaningful to the end user. Artesient consultants were asked to develop a vision of where this technology and related customer needs might evolve to in healthcare, and then to create a baseline roadmap of value added products and services that would capitalize on all the benefits of wireless technology to meet those needs. This represented an intimate understanding of healthplans’ and members’ current and future needs, along with an innate understanding of how to package the technology so it would resonate with and be intuitive to practitioners and members. Our analysis included product level elements – devices, peripherals, operating systems, graphical user interfaces, development environments; as well as the business ecosystem – wireless carriers, hardware manufacturers, software companies, application developer community; and even to the business model supporting every touch point along the lifecycle – marketing, sales channels, pricing, purchasing, fulfillment, provisioning, and service. The healthcare ecosystem Artesient developed included perspectives of every constituent group including members, practitioners, business partners and employees, and supported our client’s vision of servicing their healthcare customers and associated members long into the future.

Services Provided:
  • Market and Customer Assessment - Technology assessment, customer needs and buying behavior assessment
  • Product Strategy and Development – Product/services road mapping, ecosystem/business development opportunities assessment
  • Customer Experience – Current process/capabilities/culture assessment, lifecycle process mapping and process optimization across constituent groups, implementation and change management

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Case Study: Building a Nimble, Scalable Program for Regulatory Compliance
A large healthcare organization was facing the daunting challenge of restructuring its overall provider data and network reporting regulatory compliance program to better position itself against the hundreds of new regulations coming from a variety of regulatory and accreditation entities. The DMHC, DHCS, NCQA, NAIC and other agencies had issued extensive new requirements spanning from improvements to the consumer experience to overall network adequacy; from new processes for data verification and updates to new ways of formatting outputs and update frequencies. Non-compliance would result in expensive fines and potentially negative ratings and associated public perception. Our specific role was to establish an improved and proactive compliance management platform, to position the organization to mitigate issues efficiently and effectively, and to ensure maximum compliance remediation results were achieved as quickly as possible.

Services Provided:
  • Centralized Compliance Tracking System – System design, development and implementation.
  • Organizational and Process Restructuring – Current state process definition, future state design, process and organizational change deployment.
  • Regulatory Compliance Issue Remediation – Remediation process designed and deployed, including on-going operational management.

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