Business Driver

Our Client, a Healthcare provider of in-home post-acute care products and services for pediatric and adult patients, had a start-up mentality and a “get it done” attitude that enabled them to grow. However, that approach also introduced operational challenges and unintegrated systems, which would eventually inhibit future growth. Of particular concern was the claims administration system in its ability to meet performance guarantees, handle compliance requirements, and scale capacity. Vendor customizations and manual work-arounds were already required, making software upgrades and support more difficult and introducing significant opportunities for error. But even with the customizations, the system was still missing basic capabilities. To resolve these issues and reposition the organization to double again in size, the COO asked Trexin to lead an effort to align the organization’s IT strategy with its business goals and select a new commercial claims administration system.

Approach

Trexin blended elements from two of our methodologies to tailor the approach to our Client’s needs. The overarching approach followed Trexin’s Strategy, Assessment, and Roadmap (STAR) framework, which aligned our Client’s business goal and strategy, assessed our Client’s current-state capabilities against an envisioned future state, and defined a business case and three-year capability enhancement roadmap to reach that future-state vision. Within that STAR framework, Trexin embedded its Vendor/Solution Selection methodology to identify claims administration system options. Notable steps in that process included:

• Evaluation of current capabilities and platform deficiencies
• Determination of capabilities needed to streamline processing and position for growth
• Documentation of the number and complexity of platform integration points
• Survey of commercial packaged applications that would address the future-state needs
• Identification and documentation of potential implementation problems and issues
• Alignment on future-state needs and solution recommendations

Results

Working in close collaboration with our Client’s executive team, Trexin successfully guided the group evaluation and selection of a new claims administration system vendor. Trexin also created a three-year strategic roadmap and total cost of ownership projection to improve IT capabilities focused on the implementation of the new claims administration system. The executive team presented the investment business case (linked to the business’ growth goal of doubling in size) to the Board, which approved the request and resulted in the immediate activation of the roadmap and the selection of Trexin to manage the multi-year implementation project.