Case Study 6.8.2021

Providing Transparency in Coverage

Trexin helped a large Health Plan activate an intensive effort to comply with a significant Federal regulation.

Business Driver

In the Fall of 2020, the Centers for Medicare & Medicaid Services (CMS) issued its Final Rule for Transparency in Coverage to make healthcare price information accessible to consumers and other stakeholders, allowing for easy comparison shopping. There were three major provisions with rolling implementation deadlines in the CMS regulation for Healthcare Payers, and the first needed to be completed in less than a year. Due to the complexity and immediacy of meeting the requirements, the Executive Program Owner, with COO sponsorship, asked Trexin to help activate the program.

Approach

Our Client recently adopted the Scaled Agile Framework (SAFe) as an enterprise standard, including concurrent increment planning and execution. Skilled in SAFe and familiar with our Client’s still-maturing implementation, Trexin placed a small “tiger team” with cross-functional expertise in business, technology, and data to work within SAFe in parallel to the formation of the Core Program Team that would take accountability for program execution. Engaging members of the Core team as they were assigned, Trexin’s initial focus was to:

  • clarify program needs in relation to the general regulation
  • understand the state of program foundational artifacts
  • bridge gaps that existed

Given our Client’s nascent adoption of SAFe, there was still confusion regarding needs versus desires, rules versus principles, and requirements versus guidance, so Trexin established norms for the highly dynamic program to work within, including continual communication and facilitation among workstream-level management, the Core Program Team, and executive leadership. While driving program initiation, Trexin also launched rapid-response “no regret” teams, jump-starting critical-path tasks even before the program had been fully activated.

Results

Trexin’s business and technology expertise provided clarity and guidance for our Client when facing impending regulatory deadlines and contextual ambiguity on how to comply. Working cross-functionally, Trexin was able to identify and address everything needed to activate the program, advancing our Client’s status from statute reception to a state of implementation, including the early start of “no regret” work. Trexin also ensured that an issue tracking system, Jira, was setup properly with appropriate metrics and reports that translated and enhanced communication from an enterprise-level perspective for all stakeholders. And Trexin created a Transparency of Coverage point-of-view for executive leadership to advise them on the value of combining price with quality data, reducing confusion by driving the member narrative, and addressing the reality of commoditized pricing.

Tagged in: Execution & Recovery, Healthcare & Life Sciences, Optimized Operations, Program Execution
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