Diagnostic Products Support System Implementation

Client Project

A major global pharmaceutical organization engaged PPI to assist with implementation of a major IT system supporting medical diagnostic products as part of a multiyear, multimillion-dollar initiative involving users and facilities in nine different countries.

Project Goals and Areas of Focus

Goals of the project included:

  • quot;GA") initiative to integrate data and standardize administrative transactions across all its US group insurance LOBs.

  • This initiative is largely driven by IT considerations, specifically, defining a common platform for administrative processing, common data requirements, automated workflow, controls and business rules, effective reporting tools, etc. The project also seeks to achieve process standardization and simplification.

  • PPI was engaged on a multifaceted basis, namely to:
    • Perform current state analyses of all in-scope processes and IT systems
    • Prepare additional analyses supporting future state design and migration
    • Facilitate future state planning work
    • Support additional IT-related aspects of the initiative, e.g:

      • Document business requirements.
      • Capture business rules.
      • Develop systematic approaches to account for customer and participant data across multiple systems.
      • Identify control and process opportunities.
      • Design data rules and validation enhancements.
Business Challenges
  • The initiative has a very broad scope that encompassed a multitude of different products sold in different markets with different administrative practices and requirements.

  • Because the products have historically been managed in separate silos, they have developed administrative systems and processes independently of each other.

    • Detailed analysis is therefore required to determine where real similarities exist and where superficial likenesses disguise real differences, e.g. in terminology, in data definitions, in process boundaries, etc.
    • Corporate systems that are used across the business are not necessarily used the same way

  • The current data needs of different products are significantly different. For example, full demographic information about Long Term Care participants is collected at the time they apply for coverage, but no information at all is recorded for employer-paid Disability participants until they submit a claim.

  • The existing IT environment is extremely complex:

    • Each product and market channel has its own core systems and tools, its own set of data rules and statuses, and its own process and role definitions. Legacy systems (some largely superseded, others still in use for critical functions) are often poorly documented. Obsolete systems and processes sometimes remain in use for specific customers or older products because migrating them to modern platforms would be a greater immediate cost.
    • Data is maintained redundantly and independently in non-communicating systems and subject to inconsistent rules and validation practices. The movement of data among systems is difficult to trace and control. Process and data dependencies are incompletely understood and documented.

  • Many processes require manual workarounds and user-developed tools to compensate for system limitations.

  • Because of the complexity of IT systems and data management, it was extremely difficult to obtain complete data about customers and participants, and to relate data from one source to another (e.g. to identify if an Auto and Home participant is also a Life or Dental participant).

  • Many processes and activities have been customized to the requirements of specific customers. Much process variability and data inconsistency results from long-standing policy of allowing customers maximum flexibility in determining how and when they interact with the Client and a general reluctance to require customers to comply with specified data formats and communication channels, standardized reporting, etc.

  • Simultaneously, a major sales opportunity (SO) with an aggressive timeframe required additional analysis and planning for an intermediate development phase to enable implementation in an improved version of the current-state platform prior to completion of the design and development of the full GA future state. The intention is to use SO work and designs as a springboard to the ultimate future state.
Specific Recommendations and Outcomes

PPI performed significant work in discovery and analysis to provide client leadership with information and insights necessary to:

  • Enable a sound end-to-end understanding of current processes and systems used in group insurance product administration across the organization

  • Develop a consistent operating model for all segments of the business

  • Facilitate the detailed work necessary to develop actionable designs for the SO and the eventual GA platform

  • Support the development work of the selected IT vendors
Examples of the work include:
  • High Level BRD's:
    SO specifications were reviewed and translated into business requirements. PPI walked through Level 3 Processes with business SME's and documentarians to ensure key requirements were captured and facilitated multiple meetings and more formal workshops across work streams and segments to produce comprehensive Level 1 BRD's.

  • Business Rules Collection:
    PPI conducted workshops to extract business rules from SME's' knowledge of the organization and specific transaction procedures. Organized SME discussions into logical groupings of business rules to provide consistent and standard processing to increase cycle times and quality as well as IT automation opportunities.

  • Reconciliation of Records/ Customers/Files across multiple systems:
    The objective was to accurately account for the total number of customers and participants on corporate group systems. This was to provide context of the size and scale required for IT solution vendors developing the future administrative platform. This data was distributed and duplicated in numerous systems across multiple organization departments, so PPI developed a systematic approach to build a comprehensive accounting for customers and participants.

  • Data Rules and Validation Enhancements:
    This work was done as part of the ongoing future state development path to ensure transformational change on the GA project. Opportunities exist to vastly improve the current state through data validation enhancements to ensure quality data in the future state. Currently data enters the Client's systems through multiple channels (markets/products) and mediums. Little consistency in validation rules applies. Through identification and application of common data validation rules in the future, the Client can achieve a measurable increase in data quality which will lead to less re-work and faster processing.

  • Developing Process Work-Arounds for System Limitations

  • Developing and Recommending System Sun-setting Plans

  • Identifying Low-value Process work as candidates for automation
The above work greatly facilitated a successful IT Platform selection and implementation. Efficiencies were created and built into various implementation aspects, cycle times were reduced, customer service was increased and improved decision-making highlighted some of the successes.