Case Study /

Improving Data Quality to Decrease Provider Administration Costs

THE CHALLENGE A leading Health Plan was responsible for managing data for a network of over 34,000 physicians and healthcare professionals, 160 network hospitals, as well as a nationwide network of non-participating Providers. All Provider data was stored and maintained on a legacy platform. The existing system solution lacked scalability and involved duplication of information. …

Case Study /

Transforming PMO for Growth

THE CHALLENGE A large Medicaid health plan wanted to align their corporate initiatives to their strategic goals and operating plans across multiple business entities including five health plans, a pharmacy benefit manager, and a care management company. They wanted to implement a prioritization program that balanced the needs of each individual business unit with overall …

Case Study /

Corporate Portfolio Assessment and Planning

THE CHALLENGE A large Public Health organization was struggling with developing a reliable and repeatable approach to portfolio planning. They were challenged with articulating the cost and benefits of the initiatives necessary to meet their annual operating plan. They needed to capture and assess all current projects to determine how work should be performed moving …

Case Study /

Driving Efficiencies and Quality Through System Improvements

THE CHALLENGE A state Healthcare third party benefits administrator (TPA) concluded that its existing core healthcare insurance administration system was no longer a viable platform to support the current and future business needs of the organization. The volume and complexity of enrollment and premium billing transactions outgrew the capabilities of its current systems. Reliance on …

Case Study /

Achieving Strategic Goals through a Prioritized Project Portfolio

THE CHALLENGE A large Medicaid health plan wanted to align their corporate initiatives to their strategic goals and operating plans across multiple business entities including five health plans, a pharmacy benefit manager, and a care management company. They wanted to implement a prioritization program that balanced the needs of each individual business unit with overall …

Case Study /

Digital Marketing Organization Strategic Support

THE CHALLENGE The digital marketing group in the US Sales & Marketing organization of a leading Life Sciences company was comprised of five previously separate service lines. This new group needed to learn to collaborate, operationalize their day-to-day activities, and determine how to meet the business objectives that were outlined by the organization. OUR APPROACH …

Case Study /

Better Business Decisions via Improved Information Management

THE CHALLENGE A Pharmaceutical company needed to manage the complex issues that surfaced at the pointof transition into production of a large-scale commercial datawarehouse (CDW) implementation. The CDW implementation involved an external systems integrator and another external vendor responsible for outsourced operational support. As the project neared completion, the stakeholders were unhappy with the quality …

Case Study /

Improved Claims Payment Accuracy (through More Effective Controls)

THE CHALLENGE A regional Health Plan was challenged with medical claims “leakage” due to a number of factors including inappropriate charges, duplicate submissions, and lack of coordination of benefits. The Plan needed to identify, audit, quantify, and recover claims over-payments, and implement avoidance measures to improve claims accuracy within the organization. They needed assistance to …

Case Study /

Generating New Business Through Improved Customer Service

THE CHALLENGE A Pharmacy Benefits Manager (PBM) was struggling with providing effective customer service to their three largest accounts and responding to new business requests. The PBM desired an enhanced operating model that would better position them to provide superior customer service without sacrificing their focus on membership growth. OUR APPROACH Vynamic developed a current …

Case Study /

Driving Membership Growth Through Competitive Pricing

THE CHALLENGE Due to rising medical costs, increased demand for transparency within the marketplace, and competitor advances in pricing practices, a major Health Plan needed to modify its group rating methodology and pricing to stay competitive. OUR APPROACH Vynamic was accountable for defining, implementing, and ultimately communicating the new pricing methodology within the organization and …