Payer Transformation Playbook
Overview
Architected comprehensive payer transformation playbook covering employer reporting, provider performance analytics, stop-loss analytics, consumer marketing, HEDIS/Star reporting, and predictive models for actuarial services.
Key Outcomes
2
Regional Blues transformed
Playbook
Reusable methodology created
Growth
Advisory services expanded
Platform
Commercialization achieved
The Challenge
Regional Blue plans needed to modernize their operating models to compete effectively in a changing healthcare landscape. Legacy systems and processes prevented them from leveraging data and analytics for competitive advantage.
My Approach
- Crafted strategic plan for advisory service and platform commercialization growth
- Managed client relationships for large payer accounts
- Architected transformation playbook covering multiple product lines
- Launched Digital and Analytics Products supporting Operating Model Transformation
- Delivered for two large regional Blue plans
- Established repeatable methodologies for future engagements
Technologies & Tools
Key Learnings
Payer transformation succeeds when it addresses both technology and operating model simultaneously. Reusable playbooks accelerate delivery and improve quality. Client relationships built on trust enable more ambitious transformation programs.
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