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Building the Inovalon ONE Platform: Harnessing Big Data to Create a Pioneering SaaS Solution for Healthcare

Client Overview
Client Name icon

Client Name

Inovalon

Industry icon

Industry

Healthcare Technology

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Location

Nationwide (U.S.)

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Company size

1000+ employees

Initial Situation:

  • Inovalon aimed to create a comprehensive platform capable of powering multiple data-driven, cloud-based SaaS solutions to serve a wide range of healthcare organizations. The goal was to enable these organizations to improve clinical outcomes and economics through advanced analytics and real-time data access.

Specific Pain Points:

  • The need for a unified platform that could handle vast amounts of data from diverse sources.
  • Requirements for real-time data processing and actionable insights.
  • Ensuring compliance with healthcare regulations while maintaining scalability and reliability.

Client Goals:

  • Develop a robust, scalable platform to support 100+ data-driven SaaS solutions.
  • Enable real-time access to primary source data and advanced analytics.
  • Achieve national-scale connectivity for seamless data integration across various healthcare systems.

Key Performance Indicators (KPIs):

  • Successful development and deployment of the platform.
  • Integrated data sources for Payers, Providers, Pharmacies, and Life Science Organizations

Approach:

  • Kaiser Permanente sought a comprehensive overhaul of its medical transportation process to manage transportation for its 12 million members more efficiently. With annual spending exceeding a billion dollars, this cost centered required a strategic revamp to achieve substantial cost saving and operational improvements.

Technology Services Provided:

  • Facilitated Program Increment (P.I.) Planning sessions to set clear development goals and align team efforts.
  • Implemented Lean-Agile practices to enhance efficiency and productivity throughout the development process.
  • Coordinated cross-functional technology teams to ensure seamless integration and progress tracking.
  • Conducted regular ART syncs and system demos to monitor development milestones and gather feedback.

Implementation:

  • Timeline: 18-month project with monthly P.I.s and bi-weekly sprints.
  • Key Steps:
    • Initial P.I. Planning: Defined platform objectives and aligned development teams.
    • Iterative Development: Continuous delivery of incremental platform features.
    • Mid-PI Reviews: Assessed progress and adjusted development plans.
    • Final P.I. Review: Evaluated overall platform development and prepared for deployment.

Quantitative Results:

  • Platform Development: Successfully developed and deployed the Inovalon ONE Platform within the planned timeline.
  • Data Integration: Integrated 50+ primary source data connections at launch, with the capability to scale further.
  • Performance: Achieved real-time data processing capabilities with high reliability and scalability.

Summary:

  • The creation and development of the Inovalon ONE Platform under your guidance as the Release Train Engineer resulted in a powerful, scalable, and reliable platform. This platform now supports numerous healthcare organizations in improving clinical outcomes and economics through advanced analytics and real-time data access.

Strategizing Meaningful Use for LifePoint Hospitals: a Roadmap to EMR Implementation and Compliance

Client Overview
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Client Name

LifePoint Hospitals

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Industry

Healthcare

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Location

Nationwide (U.S.)

Company size white icon

Company size

80+ hospitals

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Initial Situation:

  • LifePoint Hospitals needed to achieve Meaningful Use compliance under the HI-TECH Act to enhance their electronic medical records (EMR) system, ensuring it met the necessary standards for clinical quality and patient safety.

Specific Pain Points:

  • Uncertainty about the best strategy to achieve Meaningful Use compliance.
  • The need for a clear roadmap to guide the implementation of the EMR system.
  • Ensuring the EMR system aligns with strategic goals of the organization and regulatory requirements.

Client Goals:

  • Conduct a comprehensive Meaningful Use assessment.
  • Develop a strategic roadmap to achieve Meaningful Use compliance.
  • Implement an EMR system that aligns with the developed strategy and roadmap.

Key Performance Indicators (KPIs):

  • Completion of the Meaningful Use assessment.
  • Development of a detailed, actionable roadmap.
  • Successful implementation of the EMR system.

Approach:

  • As the Release Train Engineer, we facilitated the Agile Release Train (ART) to drive the development of the Inovalon ONE Platform from concept to deployment.

Technology Services Provided:

  • Assessment: Evaluated current systems and processes to identify gaps and areas needing improvement to achieve Meaningful Use.
  • Strategy Development: Formulated a strategic plan outlining the steps LifePoint Hospitals needed to take to comply with the HI-TECH Act.
  • Roadmap Creation: Developed a detailed roadmap to guide the implementation.
    EMR Implementation: Implemented the EMR system in alignment with the strategy, ensuring it met all regulatory requirements and improved clinical outcomes.

Implementation:

  • Timeline: 18-month project with quarterly milestones and progress reviews.
  • Key Steps:
    • Initial Assessment: Conducted a comprehensive evaluation of existing systems and processes.
    • Strategy Formulation: Developed a strategic plan and roadmap.
    • Implementation Phases: Implemented the EMR system in phases, ensuring compliance with the roadmap and strategy.
    • Final Review: Assessed the overall implementation success and planned future improvements.
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Seamlessly Integrating Amerigroup Health Insurance: A Fit-Gap Assessment for a Smooth Member and Provider Transition

Client Overview
Client Name icon

Client Name

Elevance Health (formerly WellPoint)

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Industry

Health Insurance

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Location

Nationwide (U.S.)

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Company size

Fortune 500 company

Initial Situation:

  • WellPoint acquired Amerigroup Health Insurance and needed to integrate Amerigroup’s members and providers into their Facets Claims processing system. The goal was to ensure a seamless migration without disrupting member or provider services.

Specific Pain Points:

  • Potential data integrity issues during the migration process.
  • Ensuring the continuity of claims processing without errors or delays.
  • Minimizing member and provider abrasion during and after the transition.

Client Goals:

  • Conduct a comprehensive fit-gap assessment to identify integration challenges.
  • Develop a data and technology strategy to facilitate the migration.
  • Ensure a smooth transition with no impact on members or providers.

Key Performance Indicators (KPIs):

  • Successful migration of all members and providers to the Facets system.
  • Zero significant member or provider abrasion incidents.
  • Timely and accurate claims processing post-migration.

Approach:

  • As the strategic partner, we conducted a detailed fit-gap assessment and developed a robust data and technology strategy for the migration.

Technology Services Provided:

  • Fit-Gap Assessment: Analyzed current systems and processes to identify gaps and areas needing alignment with the Facets system.
  • Data Strategy: Developed a comprehensive data strategy to ensure data integrity and accuracy during the migration.
  • Technology Strategy: Created a technology roadmap to guide the integration process and ensure system compatibility.
  • Implementation Planning: Provided recommendations and a detailed plan to minimize member and provider abrasion.

Implementation:

  • Timeline: 12-month project with phased milestones and progress reviews.
  • Key Steps:
    • Initial Fit-Gap Assessment: Identified gaps between existing systems and the Facets system.
    • Data Strategy Development: Formulated data cleansing, mapping, and migration strategies.
    • Technology Strategy Development: Designed a technology integration roadmap.
    • Migration Planning: Developed a detailed plan with contingencies to ensure minimal disruption.
    • Post-Implementation Review: Assessed the migration’s success and resolved all issues.

Quantitative Results:

  • Quantitative Results: Compliance Achievement: Achieved Meaningful Use compliance across 80+ ambulatory practices within the set timeline.
  • Implementation Success: Successfully implemented the EMR system in all targeted facilities, meeting the strategic roadmap’s goals.
  • Clinical Efficiency: Improved clinical efficiency by 30% due to the streamlined EMR processes.
  • Qualitative Results: Stakeholder Satisfaction: Received positive feedback from hospital administrators and clinicians on the EMR system’s usability and impact on patient care.
  • Regulatory Compliance: Ensured all LifePoint Hospitals met or exceeded the regulatory requirements set by the HI-TECH Act.

Summary:

  • The strategic initiative to achieve Meaningful Use compliance for LifePoint Hospitals was successfully executed. The comprehensive assessment, strategic roadmap, and phased EMR implementation led to significant improvements in clinical efficiency and regulatory compliance, positioning LifePoint Hospitals as a leader in leveraging technology for enhanced patient care and operational excellence.

Digital Transformation for Kaiser Permanente's Medical Transportation: Implementing AI for Cost Savings and Efficiency

Client Overview
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Client Name

Kaiser Permanente

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Industry

Healthcare

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Location

Nationwide (U.S.)

Company size white icon

Company size

12 million members

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Opportunity

Initial Situation:

  • Kaiser Permanente needed a digital transformation of its Medical Transportation request system. to manage transportation for its 12 million members more efficiently. This cost center was valued over a billion in annual spending.

Specific Pain Points:

  • High operational costs associated with medical transportation.
  • Inefficiencies in ride allocation and management.
  • Limited use of advanced technologies for decision-making.

Client Goals:

  • Identify cost-saving opportunities within the medical transportation system.
  • Implement A.I. automation to optimize ride allocation and improve decision-making and demand management.
  • Enhance overall efficiency and reduce operational costs.
    Align member benefits to align with the new demand management strategy.

Key Performance Indicators (KPIs):

  • Cost savings achieved.
  • Reduction in operational inefficiencies.
  • Improvement in ride allocation and management accuracy.

Approach:

  • As the strategic partner, we led the digital transformation initiative, focusing on A.I. automation and data-driven decision-making.

Technology Services Provided:

  • Assessment: Conducted a thorough analysis of the existing medical transportation system to identify inefficiencies and cost-saving opportunities.
  • Strategy Development: Formulated a digital transformation strategy focusing on A.I. automation and improved decision-making.
  • Implementation: Developed and implemented A.I. algorithms to optimize ride allocation, moving Basic Life Support (BLS) rides to Gurney and Medical Van services where appropriate.
  • Optimization: Continuously monitored and refined the system to ensure maximum efficiency and cost savings.

Implementation:

  • Timeline: 12-month project with quarterly milestones and reviews.
  • Key Steps:
    • Initial Assessment: Identified key inefficiencies and opportunities for AI-driven improvements.
    • Strategy Formulation: Developed a comprehensive digital transformation strategy.
    • A.I. Implementation: Deployed A.I. algorithms for ride optimization and decision-making to improve demand management.
    • Continuous Improvement: Monitored system performance and made iterative improvements.
    • Adjust member benefits for Non-Emergement Medical Transportation services.
    • Final Review: Assessed the overall success and planned future enhancements.

Quantitative Results:

  • Cost Savings: Identified and realized $20 million in cost savings within the first year.
  • Efficiency: Reduced operational inefficiencies by 25%.
  • Ride Optimization: Improved ride allocation accuracy by 30% through A.I. automation.

Summary:

  • The digital transformation project led to significant cost savings and operational efficiencies for Kaiser Permanente’s Medical Transportation SaaS solution. Implementing A.I. automation and data-driven decision-making was vital to optimizing ride allocation, demand management, and reducing overall costs.

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GBMC img

Developing a Population Health Strategy for GMBC: Connecting Ambulatory and Acute Care EMRs for Enhanced Patient Care

Client Overview
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Client Name

GMBC (Generic Medical Center)

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Industry

Healthcare

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Location

Regional (specific location)

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Company size

Medium to large healthcare provider

Initial Situation:

  • GMBC aimed to enhance the longitudinal medical record of its patients by integrating ambulatory and acute care Electronic Medical Records (EMRs) and leveraging the Regional Health Information Exchange (HIE) provided by CRISP (Chesapeake Regional Information System for our Patients).

Specific Pain Points:

  • Fragmented patient data across different EMR systems.
  • Inefficient data sharing and communication between ambulatory and acute care settings.
  • Challenges in accessing comprehensive patient information in real-time.

Client Goals:

  • Develop a Population Health Strategy to integrate and optimize patient data across ambulatory and acute care EMRs.
  • Enhance care coordination and continuity through improved data sharing.
  • Utilize CRISP’s Regional HIE to facilitate seamless exchange of patient information.

Key Performance Indicators (KPIs):

  • Successful integration of eCW and MEDITECH EMRs.
  • Improve care coordination metrics (e.g., reduced duplicate tests, improved medication reconciliation).
  • Enhanced patient outcomes through better access to comprehensive medical records.

Approach:

  • We led the development of the Population Health Strategy, focusing on integrating EMRs and leveraging the Regional HIE.

Technology Services Provided:

  • Assessment: Evaluated existing EMR systems and data integration capabilities.
  • Strategy Development: Formulated a Population Health Strategy to optimize patient data integration and care coordination.
  • Implementation: Implemented solutions to connect eCW and MEDITECH EMRs and leverage CRISP’s Regional HIE.
  • Regulatory Compliance: Ensured compliance with healthcare regulations governing patient data privacy and exchange.

Implementation:

  • Timeline: 18-month project with phased milestones and progress reviews.
  • Key Steps:
    • Assessment Phase: Evaluated current systems and identified integration challenges.
    • Strategy Formulation: Developed a comprehensive strategy for EMR integration and HIE utilization.
    • Implementation Phase: Executed solutions to connect and optimize data sharing between eCW and EPIC.
    • Compliance and Security: Implemented measures to secure patient data and ensure regulatory compliance.
    • Ongoing Support: Provided post-implementation support and optimization to sustain improvements.

Quantitative Results:

  • EMR Integration: Successfully integrated eCW and MEDITECH EMRs, achieving seamless data exchange.
  • Care Coordination: Reduced duplicate tests by 20% and improved medication reconciliation accuracy by 30%.
  • Patient Outcomes: Enhanced patient outcomes through better access to comprehensive medical records and timely interventions.

Summary:

  • Implementing the Population Health Strategy enabled GMBC to integrate ambulatory and acute care EMRs and effectively leverage CRISP’s Regional HIE. This integration has enhanced care coordination, improved patient outcomes, and streamlined data sharing across healthcare settings.

Innovating Care for SPMI Patients: A Program to Improve Outcomes Through Risk Stratification and Coordinated Care

Client Overview
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Client Name

Confidential Healthcare Organization

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Industry

Healthcare

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Initial Situation:

  • The healthcare organization aimed to improve the management of Severely Mentally Ill patients by developing a program focused on enhancing clinical outcomes and operational efficiency through better coordination and data-driven decision-making.

Specific Pain Points:

  • High readmission rate among SPMI patients.
  • Inefficient management of therapist panel sizes.
  • Suboptimal hospital discharge processes.
  • Low medication adherence rates.

Client Goals:

  • Reduce readmissions rate.
  • Optimize panel size per therapist.
  • Improve hospital discharge rate.
  • Enhance medication adherence.

Key Performance Indicators (KPIs):

  • Readmissions rate.
  • Panel size per therapist.
  • Hospital discharge rate.
  • Medication adherence.

Approach:

  • Implement a Risk Stratification Matrix: Identify patients at risk for hospitalization and needing care to prioritize interventions effectively.
  • Strengthen Data-Driven Insights: Utilize data analytics to provide rapid response capabilities, enabling timely interventions for at-risk patients.
  • Provide Coordinated Multidisciplinary Care: Ensure seamless collaboration among healthcare providers to deliver comprehensive and coordinated care for SPMI patients.
  • Assessment: Conducted an assessment to identify key challenges and opportunities for improvement.
  • Strategy Development: Formulated a comprehensive strategy to address identified pain points.
  • Implementation: Executed the pilot project with a focus on improving clinical outcomes and operational efficiency.
  • Evaluation: Monitored and analyzed data to track progress and outcomes.

Implementation:

  • Timeline: 6-month project with two 3-month PDSA cycles.
  • Key Steps:
    • Initial Assessment: Identified key inefficiencies and opportunities for improvement.
    • Strategy Formulation: Developed a detailed strategy for the pilot project.
    • Pilot Implementation: Executed interventions and monitored outcomes.
    • Continuous Improvement: Made iterative improvements based on data analysis.
    • Final Review: Assessed the overall success and planned future enhancements.

Quantitative Results:

  • Readmissions Rate: Targeted reduction in readmissions rate.
  • Panel Size per Therapist: Optimized therapist panel sizes.
  • Hospital Discharge Rate: Improved discharge processes.
  • Medication Adherence: Enhanced medication adherence rates.

Summary:

  • The pilot project successfully implemented strategic interventions that improved the management of SPMI patients. The focused approach, involving PDSA cycles and data-driven decision-making, resulted in enhanced clinical outcomes and operational efficiencies.
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Optimizing Contracting Processes for the U.S. Army: Streamlining Efficiency and Reducing Costs

Client Overview
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Client Name

U.S. Army

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Industry

Government/Military

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Location

Bagram Airfield, Afghanistan

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Company size

1.3 million active-duty members and civilians

Initial Situation:

  • The U.S. Army faced challenges in its contracting processes, leading to inefficiencies and significant waste in government spending. The existing procedures were time-consuming and prone to delays, which hindered the Army’s operational readiness and financial efficiency.

Specific Pain Points:

  • The lengthy contracting process is causing delays in project initiation.
  • Inefficiencies leading to increased administrative costs.
  • Lack of a streamlined process for contract approval.
  • Excessive waste in government spending due to process inefficiencies.

Client Goals:

  • Streamline the contracting process to reduce time from contract offering to approval.
  • Enhance efficiency and reduce administrative costs.
  • Achieve significant savings in government spending.
  • Improve overall operational readiness through faster contract processing.

Key Performance Indicators (KPIs):

  • Reduction in time from contract offering to approval.
  • Total savings in government spending.
  • Improvement in contracting process efficiency metrics.

Approach:

  • As the consulting partner, we employed a comprehensive approach to analyze and streamline the U.S. Army’s contracting processes. Our methodology focused on Lean principles and process optimization to eliminate waste and enhance efficiency.

Services Provided:

  • Conducted an in-depth analysis of the existing contracting processes.
  • Identified key inefficiencies and areas for improvement.
  • Developed a streamlined contracting workflow.
  • Implemented Lean-Agile practices to reduce administrative overhead.
  • Provided training and support to ensure the successful adoption of new processes.

Implementation:

  • Timeline: 18-month project with quarterly milestones and monthly progress reviews.
  • Key Steps:
    • Initial Analysis: Assessed current contracting procedures and identified bottlenecks.
    • Process Redesign: Developed a new, streamlined contracting workflow.
    • Pilot Program: Tested the new processes in a controlled environment.
    • Full Rollout: Implemented the optimized processes across all
    • Army contracting divisions.
    • Training and Support: Provided ongoing training and support to ensure smooth adoption.

Quantitative Results:

  • Contracting Time: Achieved a 50% reduction in time from contract offering to approval.
  • Financial Savings: Realized over $1 billion in savings for the U.S. government.
  • Efficiency: Significant improvements in contracting process efficiency metrics.

Summary:

  • The collaboration resulted in a transformative improvement in the U.S. Army’s contracting efficiency. The project significantly enhanced the Army’s operational readiness and financial management by reducing the time from contract offering to approval by 50% and saving over $1 billion.

Unifying Data Reporting for Kaiser Permanente: Enhancing Accuracy and Accessibility with PowerBI

Client Overview
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Client Name

Kaiser Permanente

Industry white icon

Industry

Healthcare

Location white icon

Location

Nationwide (U.S.)

Company size white icon

Company size

12 million members

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Initial Situation:

  • Kaiser Permanente faced challenges with its safety and quality reporting infrastructure. The organization used various tools such as Tableau, Excel, and others to generate reports, leading to inconsistencies and inefficiencies. There was a need for a unified and streamlined reporting system to improve data accuracy and accessibility.

Specific Pain Points:

  • Fragmented reporting across multiple tools leads to inconsistencies.
  • The lack of a centralized reporting structure causes inefficiencies.
  • Difficulty in accessing and analyzing data due to disparate systems.
  • Need for improved data accuracy and real-time insights.

Client Goals:

  • Create a unified data and reporting infrastructure for safety and quality initiatives.
  • Migrate all existing reports to a single platform to enhance efficiency.
  • Leverage PowerBI to streamline report generation and improve data accessibility.
  • Establish a model reporting structure that could be adopted organization-wide.

Key Performance Indicators (KPIs):

  • Several reports successfully migrated to PowerBI.
  • Improvement in report generation time and efficiency.
  • User satisfaction with the new reporting system.
  • Reduction in data inconsistencies and errors.

Approach:

  • Tasked with designing and implementing a new data and reporting infrastructure for Kaiser Permanente’s safety and quality initiatives. Our approach focused on leveraging PowerBI to create a centralized, efficient, and user-friendly reporting system.

Services Provided:

  • Conducted an assessment of the existing reporting tools and processes.
  • Developed a migration plan to transition all reports to PowerBI.
  • Designed a streamlined reporting structure to ensure consistency and accuracy.
  • Provided training and support to Kaiser Permanente staff to facilitate adoption.

Implementation:

  • Timeline: 12-month project with phased migration and monthly progress reviews.
  • Key Steps:
    • Initial Assessment: Evaluated the existing reporting tools and identified key reports for migration.
    • Migration Plan: Developed a detailed plan for transitioning reports to PowerBI.
    • Pilot Migration: Conducted a pilot migration to test the new reporting structure.
    • Full Migration: Completed the migration of all reports to PowerBI.
    • Training and Support: Provided training sessions and ongoing support to ensure successful adoption.

Quantitative Results:

  • Reports Migration: Over 200 reports were successfully migrated to PowerBI.
  • Efficiency: Reduced report generation time by 40%.
  • Data Accuracy: Achieved a 30% reduction in data inconsistencies.

Summary:

  • The collaboration led to the successful creation and implementation of a new data and reporting infrastructure for Kaiser Permanente. By migrating all reports to PowerBI, we established a streamlined and efficient reporting system that became the model for the entire organization.
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Ensuring Operational Continuity During IT Disruptions for Kaiser Permanente: Developing Robust Outage Protocols

Client Overview
Client Name icon

Client Name

Kaiser Permanente

Industry icon

Industry

Healthcare

Location icon

Location

Nationwide (U.S.)

Company size icon

Company size

12 million members

Initial Situation:

  • Kaiser Permanente recognized the need to develop comprehensive protocols and procedures to ensure seamless clinical and administrative operations during a complete I.T. outage. The goal was to maintain care delivery standards without reliance on I.T. systems.

Specific Pain Points:

  • Vulnerability to I.T. outages affecting clinical and administrative functions.
  • Lack of standardized protocols for operations without I.T. support.
  • Risk of disruptions in member care during I.T. outages.
  • There is a need for alignment across all departments on contingency procedures.

Client Goals:

  • Develop and implement standardized protocols for clinical and administrative operations during I.T. outages.
  • Ensure all departments are prepared to maintain care delivery without I.T. systems.
  • Align operations to function seamlessly during an I.T. outage.
  • Minimize any potential impact on member care during I.T. disruptions.

Key Performance Indicators (KPIs):

  • Successful development and implementation of I.T. outage protocols.
  • Training completion rates across departments.
  • Measured readiness and performance during simulated I.T. outage scenarios.
  • Zero impact on member care during actual I.T. outages.

Approach:

  • We collaborated with Kaiser Permanente to design and implement robust I.T. outage protocols and procedures. Our strategy focused on comprehensive planning, cross-departmental alignment, and rigorous training.

Services Provided:

  • Conducted a risk assessment to identify critical areas affected by I.T. outages.
  • Developed detailed protocols for clinical and administrative operations without I.T. systems.
  • Facilitated cross-departmental workshops to ensure alignment and consistency.
  • Conducted training sessions and simulation exercises to prepare staff for I.T. outage scenarios.

Implementation:

  • Timeline: 9-month project with phased implementation and quarterly readiness reviews.
  • Key Steps:
    • Initial Risk Assessment: Identified critical functions and vulnerabilities during I.T. outages.
    • Protocol Development: Created detailed procedures for maintaining operations without I.T.
    • Cross-Departmental Alignment: Ensured consistency and preparedness across all departments.
    • Training and Simulations: Conducted training sessions and simulated I.T. outage scenarios to test readiness.

Quantitative Results:

  • Protocol Implementation: Successfully developed and implemented I.T. outage protocols for all departments.
  • Training Completion: Achieved a 95% training completion rate across clinical and administrative staff.
  • Simulation Success: Conducted 10+ successful I.T. outage simulation exercises with high-performance metrics.

Summary:

  • The collaboration resulted in the successful development and implementation of comprehensive I.T. outage protocols for Kaiser Permanente. These protocols ensured seamless operations and high standards of care delivery during the Crowdstrike IT outage, with no impact on member care.
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