Project For a National Senior Market Health Insurer
The executives of a national Medicare Advantage health plan wanted to adopt a common information systems platform for all of its products in the Medicare-eligible population. The health plan had selected the TriZetto-hosted Facets product as the core claims processing system. The Facets application was already supporting the plan’s Preferred Provider Organization (PPO) and Private Fee-for-Service (PFFS) products; the health plan needed to migrate their HMO product to Facets from the EZ-CAP system to create a single, enterprise-wide information solution.
In order to implement Facets within the HMO product line, the operations leadership of the health plan required functional and technical expertise to work with their end-users and the health plan’s Information Technology (IT) Department.
Advanta staffed the effort with a project manager, who had more than 10 years of Facets implementation experience with a wide range of plan types, along with a project team, throughout the lifecycle. The project manager and the team:
- Elicited and documented business requirements
- Conducted a gap analysis between identified business requirements and system capabilities
- Developed and documented new business processes and workflows to define the “new” operational model
- Developed policies and procedures to support new operational model
- Created desktop and job aides to support future processes and workflows
- Facilitated decision-making around system configuration
- Provided testing support, including user-acceptance testing (UAT)
- Developed and provided staff training on the new operational model and system functionalities
Staffed go-live and post-deployment activities
The migration of the HMO business from EZ-CAP to TriZetto Facets was successful and became the foundation for achieving planned operational improvements and cost reductions.