Optimity Architectural Planning Helps Healthcare Payer Make Smart Investment Decision for Enrollment Modernization

OUR SOLUTION

Goldilocks meets enrollment modernization – finding a solution that’s just right

Over the course of 14 weeks, we created a multi-year roadmap and program plan to implement an end-to-end solution architecture for our client. First, we created a holistic Build vs. Buy recommendation, including an iterative vendor feature rating, mapping and recommendation. The client chose to defer the Build vs Buy decision until its vendor RFI process was completed and to develop roadmaps for both scenarios. 

Our Build vs. Buy Analysis & Recommendation consisted of the following:  

• Establishing Guiding Principles: Established the organization’s ability to make a categorical build-or-buy decision, with weighted direction and severity for each criterion. 

• Conducting a Build vs. Buy Survey: Identified core business and architectural requirements, examined in-house solutions, commercial off-the-shelf solutions and innovative technological solutions. 

• Customization & Specialization Analysis: Conducted a customization and specialization analysis of both the web portals and enterprise publish data view. 

• Build vs. Buy Recommendation: Synthesized our research in a visually descriptive format and catalyzed the client to pursue recommended option. 

• Vendor Research: Evaluated options based on functionality with a quantitative scoring system across criteria that included member and enrollment processing, compliance, partner management operations, and enterprise architecture management.  

• Vendor Scoring: Optimity used four distinct sources of data & input to reach a recommended vendor shortlist: business needs, industry rankings & rankings, internal Optimity knowledge, and client preference. Other input considered included the ability of vendors to meet capability, source of vendor information, importance score, third-party Gartner research firm validation, Optimity vendor rankings, and final FEPOC input on specific vendor limitations.  

• Vendor List Recommendation: Focus on “Best of Breed” model combining in-house and vendor solutions across various options. We provided a short-list of eight top vendor choices by evaluating the core functionality of each, such as data storage, file transfer intake, EBA Processor UI, environment management, data security, HIPAA privacy, internal API integration, document processing, and much more. This initial short list was developed based on a raw score of the number of services the vendor offers. Optimity also provided the client with a more comprehensive list of 33 vendors with whom Optimity interacted and researched. Categories include Core Administrative (end-to-end capabilities), Specialty (enrollment processing specific), and HIE Stack (data exchange platforms).    

Next, we developed roadmaps for both Build and Buy scenarios, creating multi-year roadmaps with key initiatives, projects, timelines, and dependencies aligned to the enrollment solution architecture. The roadmaps also included high-level cost estimates and work breakdown structures for each option. 

Finally, we created detailed project plans for both Build and Buy scenarios, with project-level milestones, activities, and timelines, and we captured functional and non-functional tasks and key dependencies captured to support implementation efforts. 

As a complementary initiative, Optimity also conducted Lean Process Simulation and Optimization to ensure a smooth integration of the program. We combined workflow simulation with rapid UX prototyping to model optimal user interfaces (UI) with corresponding process and systems, and then generated a user-driven predictive model of improved processes. In order to divide responsibilities appropriately, we devised a checks-and-balances system across a core team, an approval team, and a steering committee who oversaw the end-to-end project process.

TOOLKIT

Build vs. Buy Analysis 

Company-Wide Guiding Principles Survey  

Multi-Year Project Roadmap 

Detailed Project Plans 

Business & Architectural Requirement Glossary