Deductible Capabilities

Client Description

The client, a leading New England health insurer, is a local carrier with a national reputation for quality and care management.  The client offers a variety of commercial products in addition to Medicare and Medicaid products and covers one million members across three states.

Challenge

The client was looking to increase membership and member retention metrics to maintain the strong position they have attained in the marketplace in recent years.  Employer groups were looking for diversification and plan flexibility including deductible capabilities and embedded deductible features on multiple services.  As their members are increasingly expecting deductible capabilities and embedded deductible features, the client realized the importance of diversification tied to these features. It was also necessary for these features to be flexible at the employer level as well as for inpatient and some outpatient types of services.  The client realized they need assistance with the technical implementation.

Ninestone’s Approach

The client engaged Ninestone to manage all of the software development lifecycle including, business requirements, final implementation for the move and changes in the ability to capture deductible after copay against certain lines of business.  Ninestone was selected because of our long-standing relationship with the client, our ability to lead projects using their rigorous project management approach, as well as our experience with a breadth of the software applications that were a part of the implementation.  Ninestone laid out the work streams across multiple technology platforms to enable a deployment within a nine-month timeline with a required hard implementation date.

Technology

The work streams crossed business areas of Sales, Underwriting, Actuarial, Claims, Marketing, Member Services, Employer Services Premium Billing, Benefits, Product Strategy and Information Services.   The strategy employed by Ninestone called for a rigorous requirement documentation methodology and tracking of requirements metrics that allowed for the iterative process from designs through testing in the software development lifecycle. 

Ninestone worked with business entities to analyze and document the lines of business where the new features would be applied.   

Results

The project is on track to meet its identified deployment date of January 1, 2017 and meet the goal of instituting deductible capabilities and embedded deductible features for lines of business defined in the project scope.  There were gaps identified in the design and development phases of the project that were addressed within a formal Project Change Request and Review process that allowed all approved requests to be implemented prior to the deployment date.

Ninestone is providing project management support for the project and business strategy support throughout the project’s lifecycle.